How much does Medicare pay for CPT 80195?

Medicare allowed an average of $13.42 per service and paid $13.42 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $185.90, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80195?

Sirolimus level. It was billed 21,211 times to 6,059 Medicare beneficiaries by 70 providers in 2024.

Which specialty bills 80195 most?

Clinical Laboratory, with 20,407 services from 67 clinicians. Next are Pathology, Medical Oncology, Nurse Practitioner.

CPT 80195

Sirolimus level

$13.42Medicare-allowed amount per service, averaged across 21,211 services

Providers submitted

$185.90

Asking price, not received

Medicare allowed

$13.42

The fee schedule figure

Medicare paid

$13.42

Balance is patient coinsurance

Providers submitted an average of $185.90 for this code and Medicare allowed $13.42 — 13.9× 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 $13.42 (100%); the rest is the patient’s coinsurance and deductible.

Services: 21,211
Beneficiaries: 6,059
Providers billing it: 70
Total allowed: $284,652

What Medicare pays for CPT 80195

Across 21,211 services billed by 70 providers to 6,059 beneficiaries, Medicare allowed an average of $13.42 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.

Who bills 80195

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	20,407	5,919	$13.42	67
Pathology	494	105	$13.46	1
Medical Oncology	156	20	$13.46	1
Nurse Practitioner	154	15	$13.46	1

80195 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
California	2,914	$13.46	$13.46	9
Florida	2,465	$13.46	$13.46	4
New Jersey	2,340	$13.46	$13.46	3
Texas	2,234	$13.45	$13.46	7
North Carolina	2,153	$13.42	$13.46	1
Arizona	1,465	$13.37	$13.46	3
Oklahoma	778	$13.42	$13.46	3
Massachusetts	742	$13.46	$13.46	2
Minnesota	694	$13.44	$13.46	2
Illinois	640	$13.46	$13.46	1
Kansas	618	$13.42	$13.46	3
Maryland	532	$13.41	$13.46	2
Washington	399	$13.46	$13.46	3
Georgia	396	$13.46	$13.46	1
Pennsylvania	379	$13.46	$13.46	3
New York	320	$13.46	$13.46	2
Oregon	294	$13.42	$13.46	4
Ohio	292	$13.46	$13.46	2
Alabama	265	$13.46	$13.46	1
Wisconsin	256	$11.96	$13.46	2
Virginia	193	$13.40	$13.46	2
New Mexico	177	$13.40	$13.46	1
Tennessee	167	$13.46	$13.46	2
Colorado	151	$13.46	$13.46	2
Nevada	105	$13.46	$13.46	1
Utah	85	$13.29	$13.46	1
Hawaii	77	$13.02	$13.46	1
Iowa	55	$13.35	$13.46	1
Michigan	25	$13.46	$13.46	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
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.