How much does Medicare pay for CPT 80202?

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 $103.72, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80202?

Vancomycin (antibiotic) level. It was billed 50,851 times to 15,380 Medicare beneficiaries by 153 providers in 2024.

Does 80202 pay differently in an office than a hospital?

Yes. The allowed amount averaged $13.26 in an office setting and $13.27 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 80202 most?

Clinical Laboratory, with 50,680 services from 150 clinicians. Next are Pathology.

CPT 80202

Vancomycin (antibiotic) level

$13.26Medicare-allowed amount per service, averaged across 50,851 services

Providers submitted

$103.72

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 $103.72 for this code and Medicare allowed $13.26 — 7.8× 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.

Office pays differently to hospital

Office / non-facility: $13.26
Hospital / facility: $13.27

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 50,751 services were billed in an office setting and 100 in a facility.

Services: 50,851
Beneficiaries: 15,380
Providers billing it: 153
Total allowed: $674,284

What Medicare pays for CPT 80202

Across 50,851 services billed by 153 providers to 15,380 beneficiaries, Medicare allowed an average of $13.26 per service. That is 3.3 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 80202

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	50,680	15,305	$13.26	150
Pathology	171	75	$13.27	3

80202 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	9,078	$13.27	$13.27	9
Florida	7,174	$13.24	$13.27	17
Mississippi	5,913	$13.27	$13.27	2
California	5,551	$13.27	$13.27	21
Texas	3,540	$13.27	$13.27	12
Illinois	2,339	$13.27	$13.27	11
North Carolina	2,186	$13.27	$13.27	4
New York	2,137	$13.27	$13.27	3
Arizona	1,901	$13.27	$13.27	3
Ohio	1,511	$13.25	$13.27	6
Virginia	1,085	$13.27	$13.27	5
Nevada	1,074	$13.10	$13.27	3
Massachusetts	943	$13.27	$13.27	5
Tennessee	919	$13.27	$13.27	5
Maryland	848	$13.26	$13.27	4
Alabama	622	$13.15	$13.27	3
Oklahoma	587	$13.27	$13.27	5
Kansas	553	$13.27	$13.27	3
Colorado	392	$13.27	$13.27	4
Pennsylvania	343	$13.27	$13.27	5
Missouri	316	$13.27	$13.27	2
Georgia	290	$13.27	$13.27	3
Wisconsin	252	$12.65	$13.27	2
Louisiana	221	$13.27	$13.27	2
Utah	185	$13.27	$13.27	1
Kentucky	156	$13.27	$13.27	3
Michigan	151	$13.27	$13.27	1
Washington	148	$13.27	$13.27	2
Hawaii	148	$13.27	$13.27	2
Rhode Island	135	$13.27	$13.27	1
Connecticut	56	$13.27	$13.27	1
Iowa	36	$13.27	$13.27	1
Arkansas	34	$13.27	$13.27	1
North Dakota	27	$13.27	$13.27	1

Related codes

80299Quantitation of therapeutic drug$18.24
80235Measurement of lacosamide$26.53
80220Measurement of hydroxychloroquine$18.32
80201Topiramate level$11.67
80230Measurement of infliximab$37.79
80203Zonisamide level$12.97
80280Measurement of vedolizumab$37.80
80204Measurement of methotrexate$37.80

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.