How much does Medicare pay for CPT 80305?

Medicare allowed an average of $12.17 per service and paid $12.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $64.29, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80305?

Testing for presence of drug, read by direct observation. It was billed 381,878 times to 198,633 Medicare beneficiaries by 4,587 providers in 2024.

Does 80305 pay differently in an office than a hospital?

Yes. The allowed amount averaged $12.17 in an office setting and $12.35 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 80305 most?

Nurse Practitioner, with 86,945 services from 1,169 clinicians. Next are Family Practice, Pain Management, Anesthesiology.

CPT 80305

Testing for presence of drug, read by direct observation

$12.17Medicare-allowed amount per service, averaged across 381,878 services

Providers submitted

$64.29

Asking price, not received

Medicare allowed

$12.17

The fee schedule figure

Medicare paid

$12.17

Balance is patient coinsurance

Providers submitted an average of $64.29 for this code and Medicare allowed $12.17 — 5.3× 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 $12.17 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $12.17
Hospital / facility: $12.35

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 381,798 services were billed in an office setting and 80 in a facility.

Services: 381,878
Beneficiaries: 198,633
Providers billing it: 4,587
Total allowed: $4,647,455

What Medicare pays for CPT 80305

Across 381,878 services billed by 4,587 providers to 198,633 beneficiaries, Medicare allowed an average of $12.17 per service. That is 1.9 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 80305

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	86,945	44,146	$12.17	1,169
Family Practice	65,655	32,733	$12.17	1,219
Pain Management	43,099	22,789	$12.17	288
Anesthesiology	37,282	21,223	$12.18	231
Internal Medicine	35,434	16,308	$12.20	527
Interventional Pain Management	32,370	17,394	$12.12	208
Physician Assistant	27,712	16,349	$12.14	380
Physical Medicine and Rehabilitation	25,782	14,841	$12.16	233
General Practice	5,502	2,001	$12.25	47
Psychiatry	3,923	2,148	$12.28	71
Orthopedic Surgery	3,187	1,112	$12.15	20
Neurology	2,937	1,704	$12.22	32
Addiction Medicine	2,151	713	$12.28	27
Clinical Laboratory	2,018	1,270	$12.30	29
Rheumatology	1,575	907	$12.07	24

80305 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
Mississippi	41,187	$12.16	$12.35	416
Florida	32,939	$12.26	$12.35	308
Texas	29,013	$12.18	$12.35	379
California	27,032	$12.24	$12.35	254
Georgia	21,390	$12.11	$12.35	265
Tennessee	21,128	$12.08	$12.35	268
Oklahoma	16,078	$12.10	$12.35	130
North Carolina	14,545	$12.18	$12.35	195
Kentucky	12,383	$12.13	$12.35	241
Alabama	12,057	$12.05	$12.35	159
New York	11,437	$12.15	$12.35	113
Arkansas	9,683	$12.06	$12.35	74
Michigan	8,647	$12.07	$12.35	122
New Jersey	7,970	$12.29	$12.35	67
Pennsylvania	7,762	$12.23	$12.35	176
Ohio	7,542	$12.20	$12.35	108
Louisiana	7,410	$12.15	$12.35	56
Virginia	7,085	$12.20	$12.35	122
Wyoming	6,725	$12.20	$12.35	21
Maryland	6,344	$12.21	$12.35	52
Illinois	5,831	$12.23	$12.35	75
Washington	5,431	$12.09	$12.35	74
Arizona	5,001	$12.20	$12.35	65
Indiana	4,978	$12.26	$12.35	83
South Carolina	4,950	$12.21	$12.35	72
Nevada	4,563	$12.07	$12.35	43
Utah	4,240	$12.00	$12.35	56
New Mexico	3,952	$12.24	$12.35	54
Kansas	3,592	$12.12	$12.35	25
Massachusetts	3,562	$12.21	$12.35	72
Colorado	3,499	$12.26	$12.35	58
Minnesota	3,399	$12.20	$12.35	27
Missouri	2,717	$12.08	$12.35	32
New Hampshire	2,669	$12.16	$12.35	21
Connecticut	2,215	$12.27	$12.35	31
Alaska	1,976	$12.27	$12.35	24
Idaho	1,953	$12.18	$12.35	35
Oregon	1,792	$12.21	$12.35	51
Nebraska	1,382	$11.97	$12.35	21
West Virginia	998	$12.30	$12.35	21
Wisconsin	965	$12.13	$12.35	18
Vermont	694	$12.30	$12.35	30
Maine	636	$12.33	$12.35	12
Delaware	559	$12.23	$12.35	10
Iowa	506	$12.28	$12.35	9
North Dakota	360	$12.28	$12.35	4
Rhode Island	341	$12.10	$12.35	5
Montana	279	$12.14	$12.35	15
South Dakota	172	$12.17	$12.35	8
Hawaii	167	$12.19	$12.35	7
District of Columbia	124	$12.35	$12.35	2
Puerto Rico	18	$12.35	$12.35	1

Related codes

80307Testing for presence of drug$60.31
80306Testing for presence of drug$16.59

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.