CPT 80159

Across 28,365 services billed by 93 providers to 8,218 beneficiaries, Medicare allowed an average of $19.74 per service. That is 3.5 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.

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.

• 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
• 80156Carbamazepine level$14.27
• 80175Lamotrigine level$12.97
• 80158Cyclosporine level$17.64
• 80195Sirolimus level$13.42
• 80184Phenobarbital level$14.94
• 80165Valproic acid level$13.26

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.

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