How much does Medicare pay for CPT 80197?

Medicare allowed an average of $13.41 per service and paid $13.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $196.03, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80197?

Tacrolimus level. It was billed 343,872 times to 73,338 Medicare beneficiaries by 213 providers in 2024.

Which specialty bills 80197 most?

Clinical Laboratory, with 326,868 services from 161 clinicians. Next are Pathology, Nephrology, Family Practice.

CPT 80197

Tacrolimus level

$13.41Medicare-allowed amount per service, averaged across 343,872 services

Providers submitted

$196.03

Asking price, not received

Medicare allowed

$13.41

The fee schedule figure

Medicare paid

$13.41

Balance is patient coinsurance

Providers submitted an average of $196.03 for this code and Medicare allowed $13.41 — 14.6× 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 $13.41 (100%); the rest is the patient’s coinsurance and deductible.

Services: 343,872
Beneficiaries: 73,338
Providers billing it: 213
Total allowed: $4,611,324

What Medicare pays for CPT 80197

Across 343,872 services billed by 213 providers to 73,338 beneficiaries, Medicare allowed an average of $13.41 per service. That is 4.7 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 80197

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	326,868	69,429	$13.41	161
Pathology	10,218	1,806	$13.41	7
Nephrology	3,487	1,315	$13.33	12
Family Practice	1,252	267	$13.22	10
Nurse Practitioner	720	192	$13.40	8
Internal Medicine	475	115	$13.12	5
Pediatric Medicine	253	48	$13.07	3
Physician Assistant	232	81	$13.25	4
Medical Oncology	170	27	$13.46	1
Hematology-Oncology	130	44	$13.46	1
Emergency Medicine	67	14	$13.46	1

80197 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	53,463	$13.45	$13.46	28
North Carolina	37,283	$13.43	$13.46	22
New Jersey	35,232	$13.46	$13.46	9
Florida	33,065	$13.43	$13.46	7
Texas	27,300	$13.43	$13.46	15
Arizona	22,923	$13.40	$13.46	5
Massachusetts	12,492	$13.46	$13.46	5
Kansas	11,688	$13.45	$13.46	4
Minnesota	10,645	$13.38	$13.46	25
Alabama	9,137	$13.44	$13.46	3
Illinois	8,597	$13.46	$13.46	4
Ohio	8,591	$13.39	$13.46	7
Oklahoma	8,422	$13.43	$13.46	3
Pennsylvania	7,263	$13.42	$13.46	5
Wisconsin	7,260	$12.53	$13.46	4
New York	6,458	$13.44	$13.46	6
Maryland	6,453	$13.38	$13.46	6
Washington	6,373	$13.43	$13.46	5
Georgia	5,891	$13.46	$13.46	1
Virginia	4,647	$13.35	$13.46	5
Tennessee	3,822	$13.40	$13.46	4
Hawaii	2,558	$13.31	$13.46	2
Oregon	2,227	$13.35	$13.46	5
Nevada	1,894	$13.44	$13.46	3
Colorado	1,370	$13.16	$13.46	3
New Mexico	1,344	$13.16	$13.46	1
Mississippi	1,336	$13.27	$13.46	4
South Dakota	1,067	$13.44	$13.46	2
Iowa	1,040	$13.26	$13.46	3
Michigan	721	$13.43	$13.46	2
Maine	698	$13.15	$13.46	1
Utah	653	$13.39	$13.46	1
Idaho	561	$13.32	$13.46	1
Louisiana	310	$13.44	$13.46	3
Puerto Rico	296	$13.46	$13.46	3
North Dakota	257	$13.20	$13.46	2
Kentucky	227	$11.91	$13.46	1
Indiana	226	$13.36	$13.46	1
Rhode Island	60	$13.46	$13.46	1
Nebraska	22	$13.46	$13.46	1

Related codes

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
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.