CY 2025 Clinical Lab Fee Schedule - Effective 04/01/25-03/31/26

Sep 4, 2026

Upload by Rowan

Clinical lab fee schedule covering HCPCS and CPT-modified lab services for the period 04/01/2025 through 03/31/2026. Provides itemized rates for venipuncture and common laboratory panels, including metabolic, electrolyte, lipid, renal, hepatic, obstetric, and acute hepatitis testing. Includes quantitative drug assays and therapeutic drug monitoring for multiple medications, plus pathology consultation codes and urinalysis services with automated and microscopy options. Also lists endocrine stimulation panels, pregnancy testing, and selected genetic/genotyping procedures with specified state rates.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages25

Reading Time1 h 3 min

AccessFree to download

Covered fee period

HCPCS/CPT-modified rates

Notes and pricing basis

Clinical Lab Fee Schedule Effective 04/01/25-03/31/26 HCPCS / WV Rate CPT Mod SHORTDESC 4/1/2025-3/31/2026 Notes 36415 Coll venous bld venipuncture $ 9.09 Exception to 90% of Medicare, pay 100% 80047 QW Metabolic panel ionized ca $ 12.36 80047 Metabolic panel ionized ca $ 12.36 80048 QW Metabolic panel total ca $ 7.61 80048 Metabolic panel total ca $ 7.61 80050 General health panel $ 45.12 Priced per BMS, Not priced by CMS or RBRVS 80051 QW Electrolyte panel $ 6.31 80051 Electrolyte panel $ 6.31 80053 QW Comprehen metabolic panel $ 9.50 80053 Comprehen metabolic panel $ 9.50 80055 Obstetric panel $ 43.03 80061 QW Lipid panel $ 12.05 80061 Lipid panel $ 12.05 80069 QW Renal function panel $ 7.81 80069 Renal function panel $ 7.81 80074 Acute hepatitis panel $ 42.87 80076 Hepatic function panel $ 7.35 80081 Obstetric panel inc hiv tstg $ 67.37 80143 Drug assay acetaminophen $ 16.78 80145 Drug assay adalimumab $ 34.71 80150 Assay of amikacin $ 13.57 80151 Drug assay amiodarone $ 16.78 80155 Drug assay caffeine $ 34.71 80156 Assay carbamazepine total $ 13.11 80157 Assay carbamazepine free $ 11.93 80158 Drug assay cyclosporine $ 16.25 80159 Drug assay clozapine $ 18.14 80161 Asy carbamazepin 10,11-epxid $ 16.78 80162 Assay of digoxin total $ 11.95 80163 Assay of digoxin free $ 11.95 80164 Assay dipropylacetic acd tot $ 12.19 80165 Dipropylacetic acid free $ 12.19 80167 Drug assay felbamate $ 16.78 80168 Assay of ethosuximide $ 14.71 80169 Drug assay everolimus $ 12.36 80170 Assay of gentamicin $ 14.74 80171 Drug screen quant gabapentin $ 19.50 80173 Assay of haloperidol $ 14.20 80175 Drug screen quan lamotrigine $ 11.93 80176 Assay of lidocaine $ 13.22 80177 Drug scrn quan levetiracetam $ 11.93 80178 QW Assay of lithium $ 5.95 80178 Assay of lithium $ 5.95 80179 Drug assay salicylate $ 16.78 80180 Drug scrn quan mycophenolate $ 16.25 80181 Drug assay flecainide $ 16.78 80183 Drug scrn quant oxcarbazepin $ 11.93 80184 Assay of phenobarbital $ 13.77 80185 Assay of phenytoin total $ 11.93 80186 Assay of phenytoin free $ 12.38 80187 Drug assay posaconazole $ 24.40 80188 Assay of primidone $ 14.93 80189 Drug assay itraconazole $ 24.40 80190 Assay of procainamide $ 54.00 80192 Assay of procainamide $ 15.08 80193 Drug assay leflunomide $ 34.71 80194 Assay of quinidine $ 13.14 80195 Assay of sirolimus $ 12.36 80197 Assay oftacrolimus $ 12.36 80198 Assay of theophylline $ 12.73 80199 Drug screen quant tiagabine $ 24.40 80200 Assay of tobramycin $ 14.52 80201 Assay of topiramate $ 10.73 80202 Assay of vancomycin $ 12.19 80203 Drug screen quant zonisamide $ 11.93 80204 Drug assay methotrexate $ 34.71 80210 Drug assay rufinamide $ 24.40 80220 Drug asy hydroxychloroquine $ 16.78 80230 Drug assay infliximab $ 34.71 Clinical Lab Fee Schedule Effective 04/01/25-03/31/26 HCPCS / WV Rate CPT Mod SHORTDESC 4/1/2025-3/31/2026 Notes 80235 Drug assay lacosamide $ 24.40 80280 Drug assay vedolizumab $ 34.71 80285 Drug assay voriconazole $ 24.40 80299 Quantitative assay drug $ 16.78 80305 Drug test prsmv dir opt obs $ 11.34 80306 Drug test prsmv instrmnt $ 15.43 80307 Drug test prsmv chem anlyzr $ 55.93 80400 Acth stimulation panel $ 29.36 80402 Acth stimulation panel $ 78.26 80406 Acth stimulation panel $ 70.43 80408 Aldosterone suppression eval $ 112.95 80410 Calcitonin stimul panel $ 72.33 80412 Crh stimulation panel $ 721.46 80414 Testosterone response panel $ 46.48 80415 Tot estradiol response panel $ 50.30 80416 Renin stimulation panel $ 188.39 80417 Renin stimulation panel $ 39.59 80418 Pituitary evaluation panel $ 521.53 80420 Dexamethasone panel $ 145.69 80422 Glucagon tolerance panel $ 41.46 80424 Glucagon tolerance panel $ 45.45 80426 Gonadotropin hormone panel $ 133.57 80428 Growth hormone panel $ 60.03 80430 Growth hormone panel $ 116.40 80432 In

FAQs

What is the effective date range for the clinical lab fee schedule?

The schedule is effective from 04/01/2025 through 03/31/2026.

Which types of laboratory services are included in the fee schedule?

It includes venipuncture, laboratory panels (metabolic, electrolyte, lipid, renal, hepatic, obstetric), urinalysis variants, pathology consultation, endocrine stimulation panels, and genetic/genotyping tests.

Does the schedule include drug testing and therapeutic drug monitoring?

Yes. It provides rates for quantitative drug assays and drug screening/assays for multiple medications, each listed with a corresponding HCPCS/CPT code and amount.

Sep 4, 2026

Upload by Rowan