Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot© Copyright 2026 American Medical Association. All rights reserved.
The CPT® Code 80230 refers to a laboratory test specifically designed to monitor therapeutic drug levels of infliximab. Infliximab is a chimeric monoclonal antibody that combines human and murine elements, targeting a critical immune system protein known as tumor necrosis factor alpha (TNFa). This medication is primarily utilized in the treatment of inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, and it may also be indicated for inflammatory arthritis. The mechanism of action of infliximab involves its anti-inflammatory properties, which can lead to a significant immune response characterized by the formation of antibodies against TNFa. This immune response can result in a reduction of serum drug levels, potentially diminishing the therapeutic efficacy of infliximab. It is important to note that a subset of patients may experience inadequate therapeutic response due to low serum trough concentrations of infliximab. This phenomenon is categorized into two groups: primary non-responders, who do not respond adequately during the initial induction phase of treatment, and secondary non-responders, who initially show improvement but later lose their response over time. The rates of these non-responses can be significant, with 10-30% of patients classified as primary non-responders and an additional 50% as secondary non-responders. To address these challenges, the rapid point-of-care test for semi-quantitative levels of infliximab is employed, allowing clinicians to monitor serum drug trough concentrations just before the next scheduled dose. This timely monitoring enables healthcare providers to make necessary adjustments to the treatment regimen without delaying the dosing schedule. The testing process involves obtaining a blood sample through a separately reported procedure, followed by diluting the serum with a buffering agent, mixing it, and loading it into a test cartridge. The cartridge is then placed into a preprogrammed reading device provided by the manufacturer, where it undergoes a 15-minute incubation period. The results of the test are subsequently displayed on a digital screen, providing immediate feedback on the patient's infliximab levels.
© Copyright 2026 Coding Ahead. All rights reserved.
The laboratory test associated with CPT® Code 80230 is indicated for monitoring therapeutic drug levels of infliximab in patients undergoing treatment for specific conditions. The following indications are explicitly recognized for this procedure:
The procedure for conducting the laboratory test associated with CPT® Code 80230 involves several detailed steps to ensure accurate measurement of infliximab levels. The following procedural steps are outlined:
Post-procedure care following the infliximab level monitoring test primarily involves the interpretation of the test results. Clinicians will review the displayed serum drug levels to determine if the patient is within the therapeutic range. If the results indicate low serum trough concentrations, adjustments to the infliximab dosing schedule may be necessary to enhance therapeutic efficacy. Additionally, ongoing monitoring may be recommended to ensure that the patient maintains adequate drug levels throughout their treatment. It is essential for healthcare providers to communicate the results to the patient and discuss any changes in their treatment plan based on the findings.
| Short Descr | DRUG ASSAY INFLIXIMAB | Medium Descr | DRUG ASSAY INFLIXIMAB | Long Descr | Infliximab | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | Q4 | Service for ordering/referring physician qualifies as a service exemption |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2020-01-01 | Added | Code added. |
Get instant expert-level medical coding assistance.