CPT code 80169: Everolimus level, immunosuppressant monitoring2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures everolimus concentration for therapeutic drug monitoring, including management of immunosuppressive therapy in transplant recipients.
Medicare pays $13.73 for 80169 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$13.73
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What 80169 covers
This laboratory assay measures everolimus concentration in blood, typically whole blood. Clinicians may order it for patients receiving everolimus as immunosuppressive therapy, particularly after organ transplantation, to assess drug exposure during treatment or when reviewing a possible change in clinical status, dose, or interacting therapy. A clinical laboratory performs and reports the test; the result informs the treating clinician’s medication management.
Report 80169 for an everolimus assay, not for a different immunosuppressant measured in the same patient. Medicare pays the test through the CLFS, not the physician fee schedule. The 2026 national CLFS amount is $13.73, unchanged from 2020 through 2026. The amount is the same across localities, with no office or facility payment difference.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 80169
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 80169. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 80169 with status X (excluded by statute), so the test itself is paid only from the CLFS.
80169 on the lab fee schedule since 2020
80169 · CLFS 2026 Q4 (current)
$13.73
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
80169 compared with similar tests
- 80158Cyclosporine assayTherapeutic drug monitoring$18.05
- 80158 is for cyclosporine measurement. Choose the code for the drug actually assayed, even when both drugs are monitored in the same patient.
- 80180Mycophenolate levelQuantitative assay$18.05
- 80180 measures mycophenolate, not everolimus. Separate assays for both drugs are reported with their respective codes.
- 80197Drug levelTacrolimus concentration$13.73
- 80197 is the tacrolimus assay. It is not interchangeable with 80169; select based on the analyte tested.
80169 billing questions
When should 80169 be chosen instead of the cyclosporine assay?
Use 80169 when the laboratory measures everolimus. Use 80158 when it measures cyclosporine; the drug assayed determines the code.
Can 80169 be reported with another immunosuppressant assay?
Separate assays may be reported for separate drugs when performed. For example, everolimus and cyclosporine are measured with their respective analyte-specific codes.
What specimen does the assay measure?
The assay measures everolimus concentration in blood, typically whole blood.
What should the laboratory documentation identify?
Identify everolimus as the analyte measured.
Does Medicare payment vary by locality or setting?
No. Medicare pays this code at one national CLFS amount, without a locality adjustment or an office-versus-facility difference.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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