How much does Medicare pay for CPT 80165?

Medicare allowed an average of $13.26 per service and paid $13.26 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $108.76, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80165?

Valproic acid level, free. It was billed 13,680 times to 9,553 Medicare beneficiaries by 76 providers in 2024.

Which specialty bills 80165 most?

Clinical Laboratory, with 13,633 services from 74 clinicians. Next are Family Practice, Pathology.

CPT 80165

Valproic acid level, free

$13.26Medicare-allowed amount per service, averaged across 13,680 services

Providers submitted

$108.76

Asking price, not received

Medicare allowed

$13.26

The fee schedule figure

Medicare paid

$13.26

Balance is patient coinsurance

Providers submitted an average of $108.76 for this code and Medicare allowed $13.26 — 8.2× 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 $13.26 (100%); the rest is the patient’s coinsurance and deductible.

Services: 13,680
Beneficiaries: 9,553
Providers billing it: 76
Total allowed: $181,397

What Medicare pays for CPT 80165

Across 13,680 services billed by 76 providers to 9,553 beneficiaries, Medicare allowed an average of $13.26 per service. That is 1.4 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 80165

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	13,633	9,523	$13.26	74
Family Practice	25	14	$13.27	1
Pathology	22	16	$13.27	1

80165 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 York	3,869	$13.27	$13.27	3
New Jersey	1,496	$13.26	$13.27	4
North Carolina	1,429	$13.27	$13.27	3
California	1,340	$13.27	$13.27	7
Florida	928	$13.25	$13.27	5
Ohio	599	$13.26	$13.27	5
Massachusetts	545	$13.27	$13.27	2
Texas	522	$13.25	$13.27	5
Illinois	317	$13.27	$13.27	1
Minnesota	305	$13.18	$13.27	4
Alabama	289	$13.21	$13.27	2
Pennsylvania	259	$13.27	$13.27	5
Washington	198	$13.27	$13.27	2
Nevada	192	$13.19	$13.27	2
Kansas	178	$13.27	$13.27	3
Virginia	178	$13.27	$13.27	2
Wisconsin	168	$13.13	$13.27	4
Georgia	168	$13.27	$13.27	1
Arizona	120	$13.27	$13.27	2
Colorado	118	$13.27	$13.27	2
Tennessee	111	$13.16	$13.27	2
Maryland	102	$13.27	$13.27	2
Oklahoma	80	$13.27	$13.27	2
Utah	68	$13.27	$13.27	1
New Mexico	47	$13.27	$13.27	1
Rhode Island	15	$13.27	$13.27	1
Oregon	13	$13.27	$13.27	1
Michigan	13	$13.27	$13.27	1
Indiana	13	$12.33	$13.27	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
80156Carbamazepine level$14.27
80159Clozapine level$19.74
80175Lamotrigine level$12.97
80158Cyclosporine level$17.64
80195Sirolimus level$13.42
80184Phenobarbital level$14.94

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.