CPT code 80197: Drug level, tacrolimus concentration2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures tacrolimus concentration for monitoring immunosuppressive therapy, commonly after solid-organ transplantation and during dose management.
Medicare pays $13.73 for 80197 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 80197 covers
This assay measures tacrolimus concentration, most often in whole blood. Transplant teams use results to monitor immunosuppressive therapy and guide dose management after solid-organ transplants. The ordering clinician considers the result alongside the prescribed regimen and the patient’s clinical status; collection timing may be coordinated with the dosing schedule.
Report 80197 for an assay that measures tacrolimus. The code identifies the drug tested, not a medication dose or a multi-drug panel. Medicare pays this test only through the CLFS. The 2026 national CLFS amount is $13.73 and has remained unchanged since 2020. One amount applies nationwide, with no locality adjustment or office-versus-facility 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 80197
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 80197. 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 80197 with status X (excluded by statute), so the test itself is paid only from the CLFS.
80197 on the lab fee schedule since 2020
80197 · 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.
80197 compared with similar tests
- 80180Mycophenolate levelQuantitative assay$18.05
- 80180 measures mycophenolate; 80197 measures tacrolimus. Choose according to the drug assayed, even when both are monitored.
- 80195Sirolimus levelWhole-blood drug level$13.73
- 80195 measures sirolimus rather than tacrolimus. Use 80197 only for the tacrolimus assay.
80197 billing questions
When should 80197 be selected instead of another drug assay?
Use 80197 when the assay measures tacrolimus. Select a different drug assay code when the laboratory measures another medication, such as sirolimus or mycophenolate.
Does 80197 represent a tacrolimus dose or a panel?
No. It identifies an assay of tacrolimus concentration, not a medication dose or a multi-drug panel.
What specimen is commonly used?
Tacrolimus monitoring commonly uses whole blood. Collection timing may be coordinated with the dosing schedule.
How does Medicare pay for 80197?
Medicare pays it through the CLFS at one national amount, with no locality-based or 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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