Laboratory test measuring the blood level of lithium, used to monitor patients taking lithium for therapeutic range and toxicity.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Current lithium dose and prescriber
- Reason for the level, such as a new NSAID or peri-operative fluid changes
- Timing of the sample relative to the last dose
- Long-term drug therapy diagnosis
- Plan for communicating results to the prescriber
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 2 cited references ↓
80178 measures serum lithium. Orthopedics does not manage lithium, but ortho patients take it, and the interaction matters. NSAIDs, which ortho prescribes constantly for arthritis, tendinopathy, and post-op pain, raise lithium levels and can push a stable patient into toxicity. So can dehydration around surgery.
The usual ortho role is to flag the risk and coordinate with the prescriber, who orders the level. If an ortho provider does order it, for example when a lithium patient starts a scheduled NSAID after surgery, the note should say so. The diagnosis should be long-term drug therapy plus the clinical reason, not just the psychiatric diagnosis.
It is a lab test paid under the Clinical Laboratory Fee Schedule. The lab bills it. Repeat levels on the same day need modifier 91. Frequency edits are less common here than for screening labs, but routine levels with no change in dose or medications may be questioned.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
Common denial reasons
The recurring reasons claims for CPT 80178 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- No diagnosis supporting drug monitoring
- Same-day repeat billed without modifier 91
- Routine level with no documented clinical change
- Ordering provider not identified
- Billed by a practice without the right CLIA certificate
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01Why would an orthopedic patient need a lithium level?
02Who usually orders 80178?
03Is 80178 paid under the physician fee schedule?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs
Mira Scribe
Mira Scribe captures the full medication list at the visit, so a lithium and NSAID interaction is documented when pain medication is prescribed.
See how Mira captures CPT 80178 documentation