2025 CPT code 80364
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Laboratory - Drug Assay Procedures Pathology and Laboratory Procedures Feed
Definitive testing for five or more opioids and opiate analogs.
Modifiers may be applicable depending on the circumstances, such as modifier 59 (distinct procedural service) if multiple specimens are tested.Consult your payer's specific guidelines for allowed modifiers.
Medical necessity for this test is determined by the ordering physician based on clinical findings, suspicion of opioid abuse or overdose, monitoring of therapeutic drug levels in patients on opioid therapy, or forensic investigations.Justification must be documented in the patient's chart.
The clinical responsibility lies with the laboratory personnel performing the analysis. The ordering physician is responsible for medical necessity and appropriate interpretation of results.
In simple words: This lab test checks for five or more specific types of opioid pain medications or similar substances in a sample (like blood or urine). It precisely measures the amount of each substance found or simply determines if they are present.
This CPT code reports definitive testing to identify five or more opioids and/or their analogs in a patient specimen.The testing may be qualitative (positive/negative), quantitative (measuring the exact amount), or a combination of both.Definitive methods include techniques such as gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS).The specimen type can vary (e.g., urine, blood).
Example 1: A patient presents to the emergency room after a suspected opioid overdose.A urine toxicology screen is ordered, and this code would be used if five or more opioids or analogs are identified using definitive testing methods., A patient is undergoing drug monitoring as part of a pain management program. Regular urine samples are analyzed, and this code would apply if five or more opioids/opiate analogs are detected in the definitive analysis., A forensic laboratory performs toxicology analysis on a blood sample from a crime scene.If five or more opioids/opiate analogs are positively identified using definitive analytical techniques, this code would be appropriate.
* Complete patient demographics.* Order details specifying the requested analytes.* Specimen collection and handling documentation.* Detailed laboratory report indicating the methods used, analytes tested, and results (qualitative and/or quantitative).
** Always verify the number of analytes tested to ensure accurate code selection.Consult with your laboratory for clarification on reporting specific metabolites not explicitly listed in the CPT codebook.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Refer to CMS guidelines and local payer policies for RVU values and reimbursement rates.RVUs will vary based on geographic location, facility type (non-facility vs. facility), and other factors.
- Global Days: Not applicable. This is a laboratory test, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is a laboratory test, not a procedure with a technical component.
- Fee Schedule: Fee schedules vary by payer and geographic location.Refer to your payer's fee schedule for historical information. Information prior to 2015 is not available.
- Specialties:* Clinical Chemistry* Toxicology* Forensic Medicine* Pain Management
- Place of Service:Office, Hospital (Inpatient/Outpatient), Clinical Laboratory, Urgent Care, Emergency Room