How To Use CPT Code 80230

CPT 80230 describes the quantification of infliximab, a therapeutic antibody against tumor necrosis factor-alpha (TNF-a), in a patient specimen. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 80230?

CPT 80230 can be used to measure the level of infliximab, a medication that targets TNF-a, in a patient specimen. This code is used when the lab analyst performs the technical steps to quantify the amount of infliximab present in the specimen, typically serum. The test utilizes liquid chromatography-tandem mass spectrometry (LC-MS/MS) to provide a quantitative result for infliximab.

2. Official Description

The official description of CPT code 80230 is: ‘Therapeutic drug assay(s), quantitative; not otherwise specified.’

3. Procedure

1. The lab analyst performs all technical steps to measure the level of infliximab in the patient specimen.
2. The most common specimen for this test is serum, which is obtained by the collecting provider as a separate procedure.
3. The test utilizes liquid chromatography-tandem mass spectrometry (LC-MS/MS) to separate and ionize the components of the specimen, providing a quantitative result for infliximab.

4. Qualifying circumstances

CPT 80230 is typically ordered by clinicians to monitor the clinical response to therapy with infliximab. This medication is used to mitigate the inflammatory response associated with autoimmune diseases such as inflammatory bowel disease, arthritis, and psoriasis. The test may also be reflexed to a separate test for antibodies to infliximab (ATI) if antibody formation against infliximab is suspected.

5. When to use CPT code 80230

CPT code 80230 should be used when there is a need to quantitatively measure the level of infliximab in a patient specimen. It is commonly ordered to monitor the clinical response to infliximab therapy. This code should not be used for other therapeutic drug assays or for testing for antibodies to infliximab.

6. Documentation requirements

To support a claim for CPT 80230, the documentation should include:

• Indication for the test, such as monitoring clinical response to infliximab therapy
• Type of specimen collected, typically serum
• Test method used, such as liquid chromatography-tandem mass spectrometry (LC-MS/MS)
• Quantitative result for infliximab

7. Billing guidelines

When billing for CPT 80230, ensure that the test is performed to quantify the level of infliximab in the patient specimen. It should not be reported with other therapeutic drug assays or tests for antibodies to infliximab. Additionally, some payers may separately reimburse for the collection of the specimen using a code such as 36415.

8. Historical information

CPT 80230 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing a quantitative test to measure the level of infliximab in a patient’s serum specimen.
2. A clinician ordering CPT 80230 to monitor the therapeutic response of a patient receiving infliximab therapy for rheumatoid arthritis.
3. A patient with inflammatory bowel disease undergoing regular testing to ensure appropriate levels of infliximab in their system.
4. A lab utilizing liquid chromatography-tandem mass spectrometry (LC-MS/MS) to provide a quantitative result for infliximab in a patient specimen.
5. A reflex test for antibodies to infliximab (ATI) being performed after an initial quantitative test using CPT 80230.