CPT 84228: Quinine Level in Serum or Plasma

CPT code 84228 represents a laboratory assay that measures the concentration of quinine in patient specimens such as serum or plasma. This test is clinically relevant for therapeutic drug monitoring and for evaluating potential quinine toxicity, with implications for patient safety and medication management across ambulatory and inpatient settings. Nationally, quinine level testing is a specialized laboratory service that supports clinicians managing antimalarial therapy or assessing adverse drug effects.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and payer coverage considerations. The publication outlines common billing modifiers associated with laboratory services and highlights what is known about coding, utilization patterns, and areas where payers often apply medical necessity review.

This resource provides benchmarks and practical policy context for hospital and clinical laboratory administrators, billing professionals, and clinicians who order or process quinine level testing. Data not available in the input are noted where applicable. The goal is to present clear, actionable information about CPT code 84228 so readers can align billing, documentation, and clinical workflows with payer expectations and coding standards.

Billing Code Overview

CPT code 84228 describes a laboratory test performed by a lab analyst to measure the level of quinine in a patient specimen, such as serum or plasma. This service is a clinical pharmacology/toxicology assay used to assess quinine concentration for therapeutic monitoring or toxicity evaluation.

Service type: Laboratory drug assay (quinine level)
Typical site of service: Clinical laboratory or hospital laboratory performing blood-based specimen testing

Clinical Context

A 48-year-old patient on chronic quinine therapy for nocturnal leg cramps or a patient presenting to the emergency department with suspected quinine toxicity after accidental overdose has a serum or plasma specimen submitted for quantitative quinine level measurement. The clinical workflow begins when the treating clinician orders 84228 to assess therapeutic concentration or toxicity risk. A phlebotomy technician collects a blood specimen (serum or plasma) following standard venipuncture procedures and labels and sends the specimen to the clinical laboratory. The laboratory accessioner logs the specimen, and a clinical laboratory scientist or toxicology analyst performs the quantitative assay using immunoassay, high-performance liquid chromatography (HPLC), or mass spectrometry methods. Results are verified by a qualified laboratory professional and reported to the ordering clinician, who interprets the value in context of symptoms, dosing history, and potential drug interactions. Typical sites of service include hospital inpatient labs, hospital outpatient laboratories, emergency departments, and independent clinical reference laboratories. Clinicians ordering this test commonly include emergency medicine physicians, internists, toxicologists, and clinical pharmacologists.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation or professional component of the test separate from technical work.

Taxonomy Code	Specialty	Notes
208100000X	Anatomic and Clinical Pathology	Pathologists and clinical laboratory directors overseeing toxicology testing.
207K00000X	Emergency Medicine	Emergency physicians ordering quinine levels for acute toxicity assessment.
207R00000X	Internal Medicine	Hospitalists and internists monitoring therapeutic drug levels.
2080P0004X	Clinical Pharmacology	Specialists interpreting drug levels and interactions.
2086S0102X	Medical Toxicology	Toxicologists managing poisoning and overdose cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T45.1X5A`	Adverse effect of antimalarials, initial encounter	Quinine is an antimalarial; used when adverse effects or toxicity from therapeutic use are suspected and a level is required.
`T42.6X5A`	Poisoning by other antiepileptic and sedative-hypnotic drugs, initial encounter	Included for polypharmacy or overdose presentations where quinine may be involved; used when documenting toxicity evaluation.
`R78.89`	Other abnormal findings of blood chemistry	Used when an abnormal laboratory result prompts specific drug level testing such as quinine.
`G62.9`	Polyneuropathy, unspecified	Quinine can cause peripheral neuropathy; levels may be checked when neurotoxicity is suspected.
`R50.9`	Fever, unspecified	Quinine is sometimes used for malaria; fever evaluation may include quinine level in complex cases.
`Z51.81`	Encounter for therapeutic drug monitoring	Used when quinine levels are obtained for routine therapeutic monitoring to guide dosing.
`T36-T50` (group)	Poisoning by drugs, medicaments and biological substances (use specific code as applicable)	Broad category for toxic exposures where quinine level may be clinically relevant.
`I95.9`	Hypotension, unspecified	Severe quinine toxicity can cause cardiovascular effects; levels may be ordered in symptomatic patients.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80053`	Comprehensive metabolic panel; 14 tests	Often ordered concurrently to assess electrolyte, renal and hepatic function which affect quinine metabolism and toxicity.
`82550`	Drug assay, other than immunoassay, qualitative or semi-quantitative; multiple drug classes	May be ordered in toxicology workups alongside a specific quinine assay to evaluate polypharmacy or co-ingestants.
`80307`	Drug confirmation, testing by high performance liquid chromatography/mass spectrometry (HPLC/MS) for drugs of abuse	A confirmation method used when quantitative confirmation of quinine (or other drugs) is required by definitive testing.
`36415`	Collection of venous blood by venipuncture	The specimen collection CPT usually performed prior to laboratory analysis billed by collection facility or included in lab technical component.
`80100`	Therapeutic drug assay, qualitative or quantitative, other than those listed (e.g., specific drug level)	Related category for therapeutic drug monitoring; `84228` is the specific code for quinine levels and `80100` may be used for other nonlisted assays when appropriate.

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Summary & Overview