CPT code 80195: Sirolimus level, whole-blood drug level2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures sirolimus in blood to monitor immunosuppressive therapy, commonly for transplant recipients whose treatment may need dose adjustment.
Medicare pays $13.73 for 80195 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 7 sections
What 80195 covers
This assay measures sirolimus concentration in a whole-blood specimen. Transplant teams commonly order it to monitor immunosuppressive therapy after organ transplantation and guide treatment decisions, including dose adjustment. A clinical laboratory performs the assay and reports the measured level to the ordering clinician. Collection timing may be coordinated with the dosing schedule so the result can be interpreted in the context of the patient’s regimen.
Report 80195 for each sirolimus assay performed; it identifies the drug being measured, not a drug dose or a panel of immunosuppressants. Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $13.73, unchanged since 2020; the same amount applies across localities, without geographic or office-versus-facility adjustment. The physician fee schedule excludes this test by statute.
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 80195
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 80195. 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 80195 with status X (excluded by statute), so the test itself is paid only from the CLFS.
80195 on the lab fee schedule since 2020
80195 · 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.
80195 compared with similar tests
- 80197Drug levelTacrolimus concentration$13.73
- Choose 80195 for a sirolimus level and 80197 for a tacrolimus level. The codes are distinguished by the drug measured.
- 80180Mycophenolate levelQuantitative assay$18.05
- 80180 measures mycophenolate; 80195 measures sirolimus. Use the code matching the assay performed, not the general purpose of monitoring immunosuppressive therapy.
80195 billing questions
When should 80195 be selected instead of 80197?
Use 80195 when the laboratory measures sirolimus. Code 80197 identifies a tacrolimus assay; select according to the drug tested.
Is 80195 reported per specimen or per drug dose?
Report the assay performed on the specimen. The code represents a sirolimus measurement, not the amount of medication administered.
Does Medicare pay a separate physician interpretation for 80195?
Medicare pays this test through the CLFS only. The physician fee schedule excludes it by statute.
Does the CLFS amount vary by location or setting?
No. Medicare uses one national amount for the code across localities, with no geographic or office-versus-facility adjustment.
Can 80195 identify a panel of transplant drug levels?
No. It identifies the sirolimus assay. Other drug measurements are reported with the code for the specific analyte tested.
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
Fee sheets · Coming soon
Put 80195 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist