Assay of theophylline
Blood test for theophylline drug levels lacks standardized Medicare pricing, making hospital charges unpredictable and requiring careful review of your itemized bill to avoid unexpected costs.
About the analyst
Michael Glenn reviews CMS datasets and drug pricing at BillRazor Research. He focuses on NADAC acquisition costs and procedure coding accuracy. Expertise: drug pricing, NADAC data, CPT coding.
This procedure measures theophylline levels in blood to monitor patients taking this asthma or COPD medication. Patients on theophylline therapy typically need regular monitoring to ensure safe, effective dosing. Code 80198 is a quantitative laboratory test that charges approximately 8.5x the Medicare reimbursement rate at many facilities.
Common billing errors
Common billing errors in Pathology & Laboratory procedures frequently involve unbundling of comprehensive panel tests, where individual components are billed separately instead of using the appropriate panel code, resulting in charges above the benchmark. Duplicate billing occurs when both automated and manual differential blood counts are charged for the same specimen, or when basic metabolic panels and comprehensive metabolic panels appear on the same claim. Code confusion often happens between similar urinalysis procedures, such as CPT 81001 (automated) versus 81003 (microscopic examination), where the more expensive microscopic code may be used inappropriately. Another frequent error involves billing for both screening and diagnostic versions of the same test, such as occult blood tests, when only one was actually performed. Given the wide Medicare rate range of $3 to $545 across 101 procedures, patients should verify that complex pathology interpretations justify higher-tier billing codes and confirm that routine lab work reflects standard automated processing rates rather than specialized manual analysis charges.
What to check on your bill
When reviewing your Pathology & Laboratory bill, first verify that each CPT code matches the specific tests your physician ordered - common codes include 80053 for comprehensive metabolic panels or 85025 for complete blood counts. Check that you're not billed separately for specimen collection (CPT 36415 for venipuncture) if it was performed during the same visit as other procedures, as this may represent charges above the benchmark. Confirm the facility where tests were processed matches where you had blood drawn, since send-out testing to reference labs often carries higher fees. Finally, review any pathology interpretation codes (88300 series) to ensure you're not charged multiple times for reading the same specimen - each tissue sample should typically have one interpretation code unless multiple specialized reviews were medically necessary and documented.
Non-facility rate
$14
Office setting benchmark
Data sources
3
22 data points
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Non-facility (office) | $14 | Lowest |
| Clinical lab limit | $14 | Lowest |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Related procedures
FAQ — Pathology & Laboratory billing
What is the typical Medicare reimbursement range for Pathology & Laboratory procedures?
How should I handle billing when charges exceed Medicare benchmark rates for lab procedures?
Are all 101 Pathology & Laboratory procedures reimbursed at the same Medicare rate?
What billing considerations apply to the lower-cost pathology procedures under $10?
Related pricing data
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use