How much does Medicare pay for CPT 80162?

Medicare allowed an average of $13.00 per service and paid $13.00 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $81.15, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80162?

Digoxin level, total. It was billed 57,763 times to 38,387 Medicare beneficiaries by 268 providers in 2024.

Does 80162 pay differently in an office than a hospital?

Yes. The allowed amount averaged $13.00 in an office setting and $13.01 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 80162 most?

Clinical Laboratory, with 56,940 services from 251 clinicians. Next are Pathology, Cardiology, Hematology-Oncology.

CPT 80162

Digoxin level, total

$13.00Medicare-allowed amount per service, averaged across 57,763 services

Providers submitted

$81.15

Asking price, not received

Medicare allowed

$13.00

The fee schedule figure

Medicare paid

$13.00

Balance is patient coinsurance

Providers submitted an average of $81.15 for this code and Medicare allowed $13.00 — 6.2× 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 $13.00 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $13.00
Hospital / facility: $13.01

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 57,732 services were billed in an office setting and 31 in a facility.

Services: 57,763
Beneficiaries: 38,387
Providers billing it: 268
Total allowed: $750,919

What Medicare pays for CPT 80162

Across 57,763 services billed by 268 providers to 38,387 beneficiaries, Medicare allowed an average of $13.00 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 80162

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	56,940	37,799	$13.00	251
Pathology	388	309	$12.98	8
Cardiology	205	106	$13.01	5
Hematology-Oncology	102	87	$13.01	1
Internal Medicine	97	68	$13.01	2
Family Practice	31	18	$13.01	1

80162 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	8,500	$13.01	$13.01	15
Florida	5,805	$12.99	$13.01	21
California	5,736	$13.00	$13.01	33
Texas	4,817	$13.01	$13.01	22
North Carolina	4,118	$13.00	$13.01	6
Ohio	3,261	$13.00	$13.01	11
New York	2,761	$13.01	$13.01	8
Massachusetts	2,018	$13.01	$13.01	7
Alabama	1,819	$13.00	$13.01	6
Kansas	1,767	$13.01	$13.01	5
Illinois	1,475	$13.01	$13.01	13
Arizona	1,343	$13.01	$13.01	3
Pennsylvania	1,300	$13.00	$13.01	9
Washington	1,232	$12.99	$13.01	6
Tennessee	1,165	$12.99	$13.01	8
Oklahoma	1,114	$13.01	$13.01	5
Louisiana	1,079	$13.01	$13.01	7
Georgia	1,028	$13.01	$13.01	4
Maryland	968	$13.00	$13.01	6
Virginia	861	$13.00	$13.01	7
Wisconsin	808	$12.90	$13.01	5
Nevada	658	$13.01	$13.01	3
Kentucky	417	$13.01	$13.01	4
Colorado	412	$13.01	$13.01	4
Oregon	394	$12.90	$13.01	3
Hawaii	391	$12.93	$13.01	2
Mississippi	329	$13.01	$13.01	4
Michigan	257	$13.01	$13.01	6
Indiana	249	$12.96	$13.01	4
Arkansas	241	$13.01	$13.01	3
Minnesota	214	$13.01	$13.01	4
South Dakota	177	$12.96	$13.01	2
Iowa	172	$12.95	$13.01	4
Rhode Island	135	$13.01	$13.01	1
North Dakota	112	$13.01	$13.01	3
Connecticut	102	$13.00	$13.01	3
Maine	100	$13.01	$13.01	1
South Carolina	90	$13.01	$13.01	2
Nebraska	81	$13.01	$13.01	2
New Mexico	64	$13.01	$13.01	1
New Hampshire	46	$13.01	$13.01	1
Utah	46	$13.01	$13.01	1
Idaho	42	$13.01	$13.01	1
Missouri	37	$13.01	$13.01	1
Delaware	22	$13.01	$13.01	1

Related codes

80197Tacrolimus level$13.41
80164Valproic acid level$13.26
80177Levetiracetam level$12.97
80178Lithium level$6.47
80185Phenytoin level$12.97
80156Carbamazepine level$14.27
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.