How much does Medicare pay for CPT 80186?

Medicare allowed an average of $13.47 per service and paid $13.47 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $111.72, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80186?

Phenytoin level, free. It was billed 3,450 times to 2,547 Medicare beneficiaries by 56 providers in 2024.

Which specialty bills 80186 most?

Clinical Laboratory, with 3,450 services from 56 clinicians.

CPT 80186

Phenytoin level, free

$13.47Medicare-allowed amount per service, averaged across 3,450 services

Providers submitted

$111.72

Asking price, not received

Medicare allowed

$13.47

The fee schedule figure

Medicare paid

$13.47

Balance is patient coinsurance

Providers submitted an average of $111.72 for this code and Medicare allowed $13.47 — 8.3× 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 $13.47 (100%); the rest is the patient’s coinsurance and deductible.

Services: 3,450
Beneficiaries: 2,547
Providers billing it: 56
Total allowed: $46,472

What Medicare pays for CPT 80186

Across 3,450 services billed by 56 providers to 2,547 beneficiaries, Medicare allowed an average of $13.47 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 80186

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	3,450	2,547	$13.47	56

80186 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
North Carolina	798	$13.45	$13.48	2
New Jersey	345	$13.48	$13.48	5
Florida	229	$13.48	$13.48	3
California	204	$13.48	$13.48	5
Massachusetts	173	$13.40	$13.48	2
Ohio	164	$13.48	$13.48	4
Minnesota	156	$13.48	$13.48	4
Texas	145	$13.48	$13.48	5
Pennsylvania	118	$13.48	$13.48	3
Kansas	116	$13.48	$13.48	2
Arizona	114	$13.48	$13.48	2
Illinois	109	$13.48	$13.48	1
Georgia	109	$13.48	$13.48	1
Washington	102	$13.48	$13.48	2
Wisconsin	81	$13.34	$13.48	2
Nevada	72	$13.48	$13.48	1
New York	69	$13.48	$13.48	1
Maryland	60	$13.48	$13.48	1
Virginia	50	$13.48	$13.48	1
Oklahoma	45	$13.48	$13.48	2
Colorado	44	$13.48	$13.48	2
Oregon	44	$13.48	$13.48	2
Utah	37	$13.48	$13.48	1
Alabama	35	$13.48	$13.48	1
Tennessee	31	$13.48	$13.48	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.