How much does Medicare pay for CPT 80156?

Medicare allowed an average of $14.27 per service and paid $14.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $94.78, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80156?

Carbamazepine level, total. It was billed 30,268 times to 20,454 Medicare beneficiaries by 179 providers in 2024.

Does 80156 pay differently in an office than a hospital?

Yes. The allowed amount averaged $14.27 in an office setting and $14.28 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 80156 most?

Clinical Laboratory, with 30,255 services from 178 clinicians. Next are Nurse Practitioner.

CPT 80156

Carbamazepine level, total

$14.27Medicare-allowed amount per service, averaged across 30,268 services

Providers submitted

$94.78

Asking price, not received

Medicare allowed

$14.27

The fee schedule figure

Medicare paid

$14.27

Balance is patient coinsurance

Providers submitted an average of $94.78 for this code and Medicare allowed $14.27 — 6.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $14.27 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $14.27
Hospital / facility: $14.28

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 30,249 services were billed in an office setting and 19 in a facility.

Services: 30,268
Beneficiaries: 20,454
Providers billing it: 179
Total allowed: $431,924

What Medicare pays for CPT 80156

Across 30,268 services billed by 179 providers to 20,454 beneficiaries, Medicare allowed an average of $14.27 per service. That is 1.5 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 80156

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	30,255	20,441	$14.27	178
Nurse Practitioner	13	13	$14.28	1

80156 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New Jersey	4,161	$14.27	$14.28	9
North Carolina	2,719	$14.28	$14.28	4
Texas	2,696	$14.27	$14.28	15
California	2,516	$14.28	$14.28	17
Florida	2,493	$14.26	$14.28	13
Ohio	2,075	$14.27	$14.28	7
Illinois	1,596	$14.28	$14.28	7
Massachusetts	1,419	$14.28	$14.28	7
Kansas	1,016	$14.28	$14.28	6
Georgia	873	$14.28	$14.28	3
Pennsylvania	701	$14.24	$14.28	7
Alabama	699	$14.28	$14.28	2
New York	650	$14.27	$14.28	5
Oklahoma	616	$14.28	$14.28	6
Louisiana	549	$14.28	$14.28	4
Arizona	528	$14.26	$14.28	3
Virginia	488	$14.25	$14.28	6
Tennessee	484	$14.28	$14.28	3
Washington	483	$14.28	$14.28	4
Nevada	446	$14.27	$14.28	3
Wisconsin	396	$14.14	$14.28	3
Colorado	332	$14.28	$14.28	4
Michigan	307	$14.28	$14.28	4
Maryland	290	$14.24	$14.28	4
Kentucky	202	$14.28	$14.28	2
Oregon	202	$14.28	$14.28	3
Minnesota	190	$14.28	$14.28	5
South Dakota	123	$14.28	$14.28	1
South Carolina	121	$14.28	$14.28	2
New Mexico	103	$13.91	$14.28	2
Utah	102	$14.05	$14.28	2
Connecticut	94	$14.02	$14.28	1
Missouri	80	$14.28	$14.28	1
Rhode Island	75	$14.28	$14.28	1
Iowa	71	$14.28	$14.28	2
Mississippi	70	$14.28	$14.28	2
Indiana	64	$13.88	$14.28	1
Arkansas	61	$14.28	$14.28	2
Hawaii	57	$14.28	$14.28	2
Maine	46	$14.28	$14.28	1
North Dakota	44	$14.28	$14.28	2
Delaware	30	$14.28	$14.28	1

Related codes

80197Tacrolimus level$13.41
80164Valproic acid level$13.26
80177Levetiracetam level$12.97
80178Lithium level$6.47
80162Digoxin level$13.00
80185Phenytoin level$12.97
80159Clozapine level$19.74
80175Lamotrigine level$12.97
80158Cyclosporine level$17.64
80195Sirolimus level$13.42
80184Phenobarbital level$14.94
80165Valproic acid level$13.26

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.