2025 CPT code 80363
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Definitive Drug Class Procedures Pathology and Laboratory Procedures > Drug Assay Procedures Feed
This CPT code reports definitive testing for three or four opioids and opiate analogs in a patient specimen (e.g., urine, blood).
Modifiers may apply depending on the circumstances.For example, modifier 59 may be used to indicate that multiple specimens were tested on the same day (e.g., both blood and urine).
Medical necessity is established by the ordering physician's clinical judgment based on the patient's symptoms, presentation, history, and the need to diagnose or monitor specific opioids and/or their analogs.The test may be medically necessary in cases of suspected overdose, compliance monitoring, postmortem toxicology, and other situations as determined by the physician.
The clinical responsibility lies with the laboratory analyst who performs the test, analyzes the results, and reports them to the ordering physician. The physician is responsible for interpreting the results within the context of the patient's clinical presentation and medical history to make appropriate clinical decisions.
- Pathology and Laboratory Procedures > Drug Assay Procedures
- Pathology and Laboratory Procedures > Drug Assay Procedures > Definitive Drug Class Procedures
In simple words: The lab test checks for three or four specific types of opioid pain medicines in a sample of your blood or urine.It uses advanced techniques to accurately identify these drugs and measures the amount present, if needed.
This code encompasses definitive qualitative or quantitative testing to identify three or four opioids and opiate analogs.The test identifies specific drugs and associated metabolites (if performed), distinguishing between structural isomers. Definitive methods include gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS), excluding immunoassays and enzymatic methods.Each category of a drug class, including metabolites (except stereoisomers), is reported once per date of service.Metabolites not listed in the CPT codebook may be reported using the parent drug's code. The specimen type can vary (e.g., urine, blood) unless specified otherwise in the code descriptor. Testing can be qualitative (positive/negative), semi-quantitative, or quantitative.
Example 1: A patient presents to the emergency department following a suspected opioid overdose.A blood sample is sent to the lab for definitive identification and quantification of three to four specific opioids and/or their analogs to guide treatment., A patient is participating in a drug monitoring program to ensure compliance with their prescribed opioid medication.Urine samples are collected regularly, and this code would reflect the definitive testing for the presence and amount of three or four specific opioids and their analogs., A forensic toxicology laboratory performs definitive testing on a postmortem blood sample to determine the presence and concentration of three to four specific opioids and/or their analogs in a suspected overdose death.This data contributes to the cause-of-death determination.
* Patient demographics and relevant identifying information.* Date and time of specimen collection.* Specimen type (e.g., blood, urine).* Detailed laboratory report specifying the analytes tested, methodology used (GC-MS, LC-MS), and quantitative or qualitative results.* Physician's order for the test indicating the medical necessity.
** Always refer to the most current CPT codebook and coding guidelines for the most accurate and up-to-date information.Pay close attention to the specific analytes tested and ensure that the code accurately reflects the testing performed.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Information not available in provided text.Consult the official CPT codebook or a reliable medical billing resource for RVU data.
- Global Days: Not applicable to this laboratory code.
- Payment Status: Active
- Modifier TC rule: Not applicable to this code. This is a comprehensive laboratory test, not a procedure with separate professional and technical components.
- Fee Schedule: Information not available in provided text. Consult a reliable medical billing resource for historical fee schedule data.
- Specialties:Clinical Chemistry, Toxicology, Forensic Pathology, Emergency Medicine, Addiction Medicine
- Place of Service:Office, Hospital (Inpatient and Outpatient), Urgent Care Facility, Clinical Laboratory, Forensic Laboratory