Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 320.00 - Rates for Clinical Laboratory Services
Section 320.05 - Allowable Fees
|
Code |
Rate |
Description |
|
Organ and Disease Oriented Panels |
||
|
80047 |
$12.11 |
Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520) |
|
80048 |
$7.46 |
Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) |
|
80050 |
$17.18 |
General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) or Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443) |
|
80051 |
$6.18 |
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295) |
|
80053 |
$9.31 |
Comprehensive metabolic panel. This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN) (84520) |
|
80055 |
$42.17 |
Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) or Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis test, non-treponemal antibody; qualitative (eg., VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901) |
|
80061 |
$11.81 |
Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) |
|
80069 |
$7.66 |
Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) |
|
80074 |
$42.01 |
Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) |
|
80076 |
$7.21 |
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) |
|
80081 |
$66.03 |
Obstetric panel (includes HIV testing) |
|
Drug Testing and Therapeutic Assays |
||
|
80143 |
$16.44 |
Acetaminophen |
|
80145 |
$34.02 |
Adalimumab |
|
80150 |
$13.30 |
Amikacin |
|
80151 |
$16.44 |
Amiodarone |
|
80155 |
$34.02 |
Caffeine |
|
80156 |
$12.85 |
Carbamazepine; total |
|
80157 |
$11.69 |
Carbamazepine; free |
|
80158 |
$15.92 |
Cyclosporine |
|
80159 |
$17.77 |
Clozapine |
|
80161 |
$16.44 |
Carbamazepine; -10,11-epoxide |
|
80162 |
$11.71 |
Digoxin; total |
|
80163 |
$11.71 |
Digoxin; free |
|
80164 |
$11.94 |
Valproic acid (dipropylacetic acid); total |
|
80165 |
$11.94 |
Valproic acid (dipropylacetic acid); free |
|
80167 |
$16.44 |
Felbamate |
|
80168 |
$14.41 |
Ethosuximide |
|
80169 |
$12.11 |
Everolimus |
|
80170 |
$14.45 |
Gentamicin |
|
80171 |
$19.11 |
Gabapentin, whole blood, serum, or plasma |
|
80173 |
$13.92 |
Haloperidol |
|
80175 |
$11.69 |
Lamotrigine |
|
80176 |
$12.96 |
Lidocaine |
|
80177 |
$11.69 |
Levetiracetam |
|
80178 |
$5.83 |
Lithium |
|
80179 |
$16.44 |
Salicylate |
|
80180 |
$15.92 |
Mycophenolate (mycophenolic acid) |
|
80181 |
$16.44 |
Flecainide |
|
80183 |
$11.69 |
Oxcarbazepine |
|
80184 |
$13.49 |
Phenobarbital |
|
80185 |
$11.69 |
Phenytoin; total |
|
80186 |
$12.14 |
Phenytoin; free |
|
80187 |
$23.91 |
Posaconazole |
|
80188 |
$14.63 |
Primidone |
|
80189 |
$23.91 |
Itraconazole |
|
80190 |
$52.92 |
Procainamide; |
|
80192 |
$14.77 |
Procainamide; with metabolites (e.g., n-acetyl procainamide) |
|
80193 |
$34.02 |
Leflunomide |
|
80194 |
$12.88 |
Quinidine |
|
80195 |
$12.11 |
Sirolimus |
|
80197 |
$12.11 |
Tacrolimus |
|
80198 |
$12.47 |
Theophylline |
|
80199 |
$23.91 |
Tiagabine |
|
80200 |
$14.23 |
Tobramycin |
|
80201 |
$10.51 |
Topiramate |
|
80202 |
$11.94 |
Vancomycin |
|
80203 |
$11.69 |
Zonisamide |
|
80204 |
$34.02 |
Methotrexate |
|
80210 |
$23.91 |
Rufinamide |
|
80220 |
$16.44 |
Hydroxychloroquine |
|
80230 |
$34.02 |
Infliximab |
|
80235 |
$23.91 |
Lacosamide |
|
80280 |
$34.02 |
Vedolizumab |
|
80285 |
$23.91 |
Voriconazole |
|
Evocative Suppression Testing |
||
|
80299 |
$16.44 |
Quantitation of therapeutic drug, not elsewhere specified |
|
80305 |
$8.92 |
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (e.g., utilizing immunoassay [e.g., dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service |
|
80306 |
$11.89 |
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; read by instrument assisted direct optical observation (e.g, utilizing immunoassay [e.g., dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service |
|
80307 |
$47.55 |
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (e.g., utilizing immunoassay [e.g., EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (e.g, GC, HPLC), and mass spectrometry either with or without chromatography, (e.g, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service |
|
80400 |
$28.77 |
ACTH stimulation panel; for adrenal insufficiency This panel must include the following: Cortisol (82533 x 2) |
|
80402 |
$76.70 |
ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2) |
|
80406 |
$69.03 |
ACTH stimulation panel; for 3 beta-hydroxydehydrogenase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2) |
|
80408 |
$110.69 |
Aldosterone suppression evaluation panel (e.g., saline infusion) This panel must include the following: Aldosterone (82088 x 2) Renin (84244 x 2) |
|
80410 |
$70.89 |
Calcitonin stimulation panel (e.g., calcium, pentagastrin) This panel must include the following: Calcitonin (82308 x 3) |
|
80412 |
$707.03 |
Corticotropic releasing hormone (CRH) stimulation panel This panel must include the following: Cortisol (82533 x 6) Adrenocorticotropic hormone (ACTH) (82024 x 6) |
|
80414 |
$45.55 |
Chorionic gonadotropin stimulation panel; testosterone response This panel must include the following: Testosterone (84403 x 2 on 3 pooled blood samples) |
|
80415 |
$49.29 |
Chorionic gonadotropin stimulation panel; estradiol response This panel must include the following: Estradiol, total (82670 x 2 on 3 pooled blood samples) |
|
80416 |
$184.62 |
Renal vein renin stimulation panel (e.g., captopril) This panel must include the following: Renin (84244 x 6) |
|
80417 |
$38.80 |
Peripheral vein renin stimulation panel (e.g., captopril) This panel must include the following: Renin (84244 x 2) |
|
80418 |
$511.10 |
Combined rapid anterior pituitary evaluation panel This panel must include the following: Adrenocorticotropic hormone (ACTH) (82024 x 4) Luteinizing hormone (LH) (83002 x 4) Follicle stimulating hormone (FSH) (83001 x 4) Prolactin (84146 x 4) Human growth hormone (HGH) (83003 x 4) Cortisol (82533 x 4) Thyroid stimulating hormone (TSH) (84443 x 4) |
|
80420 |
$142.78 |
Dexamethasone suppression panel, 48 hour This panel must include the following: Free cortisol, urine (82530 x 2) Cortisol (82533 x 2) Volume measurement for timed collection (81050 x 2) |
|
80422 |
$40.63 |
Glucagon tolerance panel; for insulinoma This panel must include the following: Glucose (82947 x 3) Insulin (83525 x 3) |
|
80424 |
$44.54 |
Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2) |
|
80426 |
$130.90 |
Gonadotropin releasing hormone stimulation panel This panel must include the following: Follicle stimulating hormone (FSH) (83001 x 4) Luteinizing hormone (LH) (83002 x 4) |
|
80428 |
$58.83 |
Growth hormone stimulation panel (e.g., arginine infusion, l-dopa administration) This panel must include the following: Human growth hormone (HGH) (83003 x 4) |
|
80430 |
$114.07 |
Growth hormone suppression panel (glucose administration) This panel must include the following: Glucose (82947 x 3) Human growth hormone (HGH) (83003 x 4) |
|
80432 |
$146.07 |
Insulin-induced C-peptide suppression panel This panel must include the following: Insulin (83525) C-peptide (84681 x 5) Glucose (82947 x 5) |
|
80434 |
$251.40 |
Insulin tolerance panel; for ACTH insufficiency This panel must include the following: Cortisol (82533 x 5) Glucose (82947 x 5) |
|
80435 |
$90.85 |
Insulin tolerance panel; for growth hormone deficiency This panel must include the following: Glucose (82947 x 5) Human growth hormone (HGH) (83003 x 5) |
|
80436 |
$80.40 |
Metyrapone panel This panel must include the following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2) |
|
80438 |
$44.46 |
Thyrotropin releasing hormone (TRH) stimulation panel; 1 hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 3) |
|
80439 |
$59.28 |
Thyrotropin releasing hormone (TRH) stimulation panel; 2 hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 4) |
|
Urinalysis |
||
|
81000 |
$3.55 |
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy |
|
81001 |
$2.80 |
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy |
|
81002 |
$3.07 |
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy |
|
81003 |
$1.98 |
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy |
|
81005 |
$1.91 |
Urinalysis; qualitative or semiquantitative, except immunoassays |
|
81007 |
$26.44 |
Urinalysis; bacteriuria screen, except by culture or dipstick |
|
81015 |
$2.69 |
Urinalysis; microscopic only |
|
81020 |
$4.15 |
Urinalysis; 2 or 3 glass test |
|
81025 |
$7.59 |
Urine pregnancy test, by visual color comparison methods |
|
81050 |
$3.21 |
Volume measurement for timed collection, each |
|
81099 |
I.C. |
Unlisted urinalysis procedure |
|
Chemistry |
||
|
82009 |
$3.99 |
Ketone body(s) (e.g., acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative |
|
82010 |
$7.21 |
Ketone body(s) (e.g., acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative |
|
82013 |
$10.84 |
Acetylcholinesterase |
|
82016 |
$14.54 |
Acylcarnitines; qualitative, each specimen |
|
82017 |
$14.88 |
Acylcarnitines; quantitative, each specimen |
|
82024 |
$34.06 |
Adrenocorticotropic hormone (ACTH) |
|
82030 |
$22.76 |
Adenosine, 5-monophosphate, cyclic (cyclic AMP) |
|
82040 |
$4.37 |
Albumin; serum, plasma or whole blood |
|
82042 |
$6.86 |
Albumin; other source, quantitative, each specimen |
|
82043 |
$5.10 |
Albumin; urine (e.g., microalbumin), quantitative |
|
82044 |
$5.49 |
Albumin; urine (e.g., microalbumin), semiquantitative (e.g., reagent strip assay) |
|
82045 |
$29.94 |
Albumin; ischemia modified |
|
82075 |
$26.46 |
Alcohol (ethanol); breath |
|
82077 |
$15.23 |
Alcohol (ethanol); any specimen except urine and breath, immunoassay (e.g., IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase) |
|
82085 |
$8.56 |
Aldolase |
|
82088 |
$35.94 |
Aldosterone |
|
82103 |
$11.85 |
Alpha-1-antitrypsin; total |
|
82104 |
$12.75 |
Alpha-1-antitrypsin; phenotype |
|
82105 |
$14.79 |
Alpha-fetoprotein (AFP); serum |
|
82106 |
$14.99 |
Alpha-fetoprotein (AFP); amniotic fluid |
|
82107 |
$56.81 |
Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and total AFP (including ratio) |
|
82108 |
$22.47 |
Aluminum |
|
82120 |
$5.28 |
Amines, vaginal fluid, qualitative |
|
82127 |
$12.51 |
Amino acids; single, qualitative, each specimen |
|
82128 |
$12.23 |
Amino acids; multiple, qualitative, each specimen |
|
82131 |
$20.27 |
Amino acids; single, quantitative, each specimen |
|
82135 |
$14.51 |
Aminolevulinic acid, delta (ALA) |
|
82136 |
$17.30 |
Amino acids, 2 to 5 amino acids, quantitative, each specimen |
|
82139 |
$14.88 |
Amino acids, 6 or more amino acids, quantitative, each specimen |
|
82140 |
$12.85 |
Ammonia |
|
82143 |
$8.25 |
Amniotic fluid scan (spectrophotometric) |
|
82150 |
$5.72 |
Amylase |
|
82154 |
$25.43 |
Androstanediol glucuronide |
|
82157 |
$25.82 |
Androstenedione |
|
82160 |
$22.54 |
Androsterone |
|
82163 |
$18.10 |
Angiotensin II |
|
82164 |
$12.88 |
Angiotensin I - converting enzyme (ACE) |
|
82172 |
$18.60 |
Apolipoprotein, each |
|
82175 |
$16.73 |
Arsenic |
|
82180 |
$8.72 |
Ascorbic acid (Vitamin C), blood |
|
82190 |
$14.02 |
Atomic absorption spectroscopy, each analyte |
|
82232 |
$14.27 |
Beta-2 microglobulin |
|
82239 |
$15.10 |
Bile acids; total |
|
82240 |
$23.44 |
Bile acids; cholylglycine |
|
82247 |
$4.43 |
Bilirubin; total |
|
82248 |
$4.43 |
Bilirubin; direct |
|
82252 |
$4.02 |
Bilirubin; feces, qualitative |
|
82261 |
$14.88 |
Biotinidase, each specimen |
|
82270 |
$3.86 |
Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e, patient was provided three cards or single triple card for consecutive collection) |
|
82271 |
$4.69 |
Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; other sources |
|
82272 |
$3.73 |
Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening |
|
82274 |
$14.04 |
Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations |
|
82286 |
$4.55 |
Bradykinin |
|
82300 |
$20.85 |
Cadmium |
|
82306 |
$26.11 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
|
82308 |
$23.63 |
Calcitonin |
|
82310 |
$4.55 |
Calcium; total |
|
82330 |
$12.07 |
Calcium; ionized |
|
82331 |
$11.77 |
Calcium; after calcium infusion test |
|
82340 |
$5.32 |
Calcium; urine quantitative, timed specimen |
|
82355 |
$10.21 |
Calculus; qualitative analysis |
|
82360 |
$11.35 |
Calculus; quantitative analysis, chemical |
|
82365 |
$11.38 |
Calculus; infrared spectroscopy |
|
82370 |
$11.04 |
Calculus; X-ray diffraction |
|
82373 |
$15.93 |
Carbohydrate deficient transferrin |
|
82374 |
$4.30 |
Carbon dioxide (bicarbonate) |
|
82375 |
$10.87 |
Carboxyhemoglobin; quantitative |
|
82376 |
$12.41 |
Carboxyhemoglobin; qualitative |
|
82378 |
$16.72 |
Carcinoembryonic antigen (CEA) |
|
82379 |
$14.88 |
Carnitine (total and free), quantitative, each specimen |
|
82380 |
$8.13 |
Carotene |
|
82382 |
$24.08 |
Catecholamines; total urine |
|
82383 |
$25.65 |
Catecholamines; blood |
|
82384 |
$22.27 |
Catecholamines; fractionated |
|
82387 |
$15.93 |
Cathepsin-D |
|
82390 |
$9.47 |
Ceruloplasmin |
|
82397 |
$12.45 |
Chemiluminescent assay |
|
82415 |
$11.17 |
Chloramphenicol |
|
82435 |
$4.06 |
Chloride; blood |
|
82436 |
$5.07 |
Chloride; urine |
|
82438 |
$4.41 |
Chloride; other source |
|
82441 |
$5.30 |
Chlorinated hydrocarbons, screen |
|
82465 |
$3.84 |
Cholesterol, serum or whole blood, total |
|
82480 |
$6.94 |
Cholinesterase; serum |
|
82482 |
$8.65 |
Cholinesterase; RBC |
|
82485 |
$18.21 |
Chondroitin B sulfate, quantitative |
|
82495 |
$17.89 |
Chromium |
|
82507 |
$24.52 |
Citrate |
|
82523 |
$16.48 |
Collagen cross links, any method |
|
82525 |
$10.95 |
Copper |
|
82528 |
$19.86 |
Corticosterone |
|
82530 |
$14.74 |
Cortisol; free |
|
82533 |
$14.38 |
Cortisol; total |
|
82540 |
$4.09 |
Creatine |
|
82542 |
$21.25 |
Column chromatography, includes mass spectrometry, if performed (e.g., HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen |
|
82550 |
$5.74 |
Creatine kinase (CK), (CPK); total |
|
82552 |
$11.81 |
Creatine kinase (CK), (CPK); isoenzymes |
|
82553 |
$10.19 |
Creatine kinase (CK), (CPK); MB fraction only |
|
82554 |
$10.47 |
Creatine kinase (CK), (CPK); isoforms |
|
82565 |
$4.52 |
Creatinine; blood |
|
82570 |
$4.57 |
Creatinine; other source |
|
82575 |
$8.34 |
Creatinine; clearance |
|
82585 |
$12.47 |
Cryofibrinogen |
|
82595 |
$5.71 |
Cryoglobulin, qualitative or semi-quantitative (e.g., cryocrit) |
|
82600 |
$17.11 |
Cyanide |
|
82607 |
$13.30 |
Cyanocobalamin (Vitamin B-12); |
|
82608 |
$12.63 |
Cyanocobalamin (Vitamin B-12); unsaturated binding capacity |
|
82610 |
$16.33 |
Cystatin C |
|
82615 |
$8.42 |
Cystine and homocystine, urine, qualitative |
|
82626 |
$22.29 |
Dehydroepiandrosterone (DHEA) |
|
82627 |
$19.61 |
Dehydroepiandrosterone-sulfate (DHEA-S) |
|
82633 |
$27.32 |
Desoxycorticosterone, 11- |
|
82634 |
$25.82 |
Deoxycortisol, 11- |
|
82638 |
$10.80 |
Dibucaine number |
|
82642 |
$25.82 |
Dihydrotestosterone (DHT) |
|
82652 |
$33.96 |
Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed |
|
82653 |
$20.26 |
Elastase, pancreatic (EL-1), fecal; quantitative |
|
82656 |
$10.17 |
Elastase, pancreatic (EL-1), fecal, qualitative or semi-quantitative |
|
82657 |
$19.55 |
Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen |
|
82658 |
$38.83 |
Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; radioactive substrate, each specimen |
|
82664 |
$54.24 |
Electrophoretic technique, not elsewhere specified |
|
82668 |
$16.57 |
Erythropoietin |
|
82670 |
$24.64 |
Estradiol; total |
|
82671 |
$28.49 |
Estrogens; fractionated |
|
82672 |
$19.14 |
Estrogens; total |
|
82677 |
$21.33 |
Estriol |
|
82679 |
$22.01 |
Estrone |
|
82681 |
$24.64 |
Estradiol; free, direct measurement (e.g., equilibrium dialysis) |
|
82693 |
$13.14 |
Ethylene glycol |
|
82696 |
$23.14 |
Etiocholanolone |
|
82705 |
$4.50 |
Fat or lipids, feces; qualitative |
|
82710 |
$14.82 |
Fat or lipids, feces; quantitative |
|
82715 |
$20.26 |
Fat differential, feces, quantitative |
|
82725 |
$16.56 |
Fatty acids, nonesterified |
|
82726 |
$17.42 |
Very long chain fatty acids |
|
82728 |
$12.02 |
Ferritin |
|
82731 |
$56.81 |
Fetal fibronectin, cervicovaginal secretions, semi-quantitative |
|
82735 |
$16.35 |
Fluoride |
|
82746 |
$12.97 |
Folic acid; serum |
|
82747 |
$15.57 |
Folic acid; RBC |
|
82757 |
$15.29 |
Fructose, semen |
|
82759 |
$18.95 |
Galactokinase, RBC |
|
82760 |
$9.88 |
Galactose |
|
82775 |
$18.58 |
Galactose-1-phosphate uridyl transferase; quantitative |
|
82776 |
$10.35 |
Galactose-1-phosphate uridyl transferase; screen |
|
82777 |
$39.03 |
Galectin-3 |
|
82784 |
$8.20 |
Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each |
|
82785 |
$14.52 |
Gammaglobulin (immunoglobulin); IgE |
|
82787 |
$7.07 |
Gammaglobulin (immunoglobulin); immunoglobulin subclasses (e.g., IgG1, 2, 3, or 4), each |
|
82800 |
$9.70 |
Gases, blood, pH only |
|
82803 |
$22.99 |
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); |
|
82805 |
$69.48 |
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry |
|
82810 |
$8.62 |
Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry |
|
82820 |
$11.77 |
Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen) |
|
82930 |
$5.92 |
Gastric acid analysis, includes pH if performed, each specimen |
|
82938 |
$15.60 |
Gastrin after secretin stimulation |
|
82941 |
$15.55 |
Gastrin |
|
82943 |
$12.60 |
Glucagon |
|
82945 |
$3.47 |
Glucose, body fluid, other than blood |
|
82946 |
$15.67 |
Glucagon tolerance test |
|
82947 |
$3.47 |
Glucose; quantitative, blood (except reagent strip) |
|
82948 |
$4.45 |
Glucose; blood, reagent strip |
|
82950 |
$4.19 |
Glucose; post glucose dose (includes glucose) |
|
82951 |
$11.35 |
Glucose; tolerance test (GTT), three specimens (includes glucose) |
|
82952 |
$3.46 |
Glucose; tolerance test, each additional beyond three specimens (List separately in addition to code for primary procedure) |
|
82955 |
$8.56 |
Glucose-6-phosphate dehydrogenase (G6PD); quantitative |
|
82960 |
$5.34 |
Glucose-6-phosphate dehydrogenase (G6PD); screen |
|
82962 |
$2.89 |
Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use |
|
82963 |
$18.95 |
Glucosidase, beta |
|
82965 |
$11.60 |
Glutamate dehydrogenase |
|
82977 |
$6.35 |
Glutamyltransferase, gamma (GGT) |
|
82978 |
$13.63 |
Glutathione |
|
82979 |
$8.33 |
Glutathione reductase, RBC |
|
82985 |
$14.78 |
Glycated protein |
|
83001 |
$16.39 |
Gonadotropin; follicle stimulating hormone (FSH) |
|
83002 |
$16.33 |
Gonadotropin; luteinizing hormone (LH) |
|
83003 |
$14.70 |
Growth hormone, human (HGH) (somatotropin) |
|
83006 |
$66.68 |
Growth stimulation expressed gene 2 (ST2, Interleukin 1 receptor like-1) |
|
83009 |
$59.41 |
Helicobacter pylori, blood test analysis for urease activity, nonradioactive isotope (e.g, C-13) |
|
83010 |
$11.10 |
Haptoglobin; quantitative |
|
83012 |
$23.72 |
Haptoglobin; phenotypes |
|
83013 |
$59.41 |
Helicobacter pylori; breath test analysis for urease activity, nonradioactive isotope (e.g., C-13) |
|
83014 |
$6.93 |
Helicobacter pylori; drug administration |
|
83015 |
$18.47 |
Heavy metal (e.g., arsenic, barium, beryllium, bismuth, antimony, mercury); qualitative, any number of analytes |
|
83018 |
$19.37 |
Heavy metal (e.g., arsenic, barium, beryllium, bismuth, antimony, mercury); quantitative, each, not elsewhere specified |
|
83020 |
$11.35 |
Hemoglobin fractionation and quantitation; electrophoresis (e.g., A2, S, C, and/or F) |
|
83021 |
$15.93 |
Hemoglobin fractionation and quantitation; chromatography (e.g., A2, S, C, and/or F) |
|
83026 |
$3.54 |
Hemoglobin; by copper sulfate method, nonautomated |
|
83030 |
$9.47 |
Hemoglobin; F (fetal), chemical |
|
83033 |
$7.06 |
Hemoglobin; F (fetal), qualitative |
|
83036 |
$8.56 |
Hemoglobin; glycosylated (A1C) |
|
83037 |
$8.56 |
Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use |
|
83045 |
$5.72 |
Hemoglobin; methemoglobin, qualitative |
|
83050 |
$7.23 |
Hemoglobin; methemoglobin, quantitative |
|
83051 |
$6.45 |
Hemoglobin; plasma |
|
83060 |
$7.76 |
Hemoglobin; sulfhemoglobin, quantitative |
|
83065 |
$7.94 |
Hemoglobin; thermolabile |
|
83068 |
$8.35 |
Hemoglobin; unstable, screen |
|
83069 |
$3.48 |
Hemoglobin; urine |
|
83070 |
$4.19 |
Hemosiderin, qualitative |
|
83080 |
$14.88 |
b-Hexosaminidase, each assay |
|
83088 |
$26.05 |
Histamine |
|
83090 |
$15.81 |
Homocysteine |
|
83150 |
$19.77 |
Homovanillic acid (HVA) |
|
83491 |
$15.79 |
Hydroxycorticosteroids, 17- (17-OHCS) |
|
83497 |
$11.38 |
Hydroxyindolacetic acid, 5-(HIAA) |
|
83498 |
$23.96 |
Hydroxyprogesterone, 17-d |
|
83500 |
$19.98 |
Hydroxyproline; free |
|
83505 |
$21.43 |
Hydroxyproline; total |
|
83516 |
$10.17 |
Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method |
|
83518 |
$8.50 |
Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, single step method (e.g., reagent strip) |
|
83519 |
$16.23 |
Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (e.g., RIA) |
|
83520 |
$15.23 |
Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified |
|
83521 |
$15.23 |
Immunoglobulin light chains (i.e., kappa, lambda), free, each |
|
83525 |
$10.08 |
Insulin; total |
|
83527 |
$11.42 |
Insulin; free |
|
83528 |
$17.48 |
Intrinsic factor |
|
83529 |
$15.23 |
Interleukin-6 (IL-6) |
|
83540 |
$5.71 |
Iron |
|
83550 |
$7.71 |
Iron binding capacity |
|
83570 |
$7.81 |
Isocitric dehydrogenase (IDH) |
|
83582 |
$13.64 |
Ketogenic steroids, fractionation |
|
83586 |
$11.29 |
Ketosteroids, 17- (17-KS); total |
|
83593 |
$25.14 |
Ketosteroids, 17- (17-KS); fractionation |
|
83605 |
$10.20 |
Lactate (lactic acid) |
|
83615 |
$5.33 |
Lactate dehydrogenase (LD), (LDH); |
|
83625 |
$11.28 |
Lactate dehydrogenase (LD), (LDH); isoenzymes, separation and quantitation |
|
83630 |
$17.38 |
Lactoferrin, fecal; qualitative |
|
83631 |
$17.31 |
Lactoferrin, fecal; quantitative |
|
83632 |
$17.83 |
Lactogen, human placental (HPL) human chorionic somatomammotropin |
|
83633 |
$9.92 |
Lactose, urine, qualitative |
|
83655 |
$10.68 |
Lead |
|
83661 |
$19.40 |
Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio |
|
83662 |
$16.68 |
Fetal lung maturity assessment; foam stability test |
|
83663 |
$16.68 |
Fetal lung maturity assessment; fluorescence polarization |
|
83664 |
$17.04 |
Fetal lung maturity assessment; lamellar body density |
|
83670 |
$8.65 |
Leucine aminopeptidase (LAP) |
|
83690 |
$6.08 |
Lipase |
|
83695 |
$12.63 |
Lipoprotein (a) |
|
83698 |
$40.85 |
Lipoprotein-associated phospholipase A2 (Lp-PLA2) |
|
83700 |
$9.93 |
Lipoprotein, blood; electrophoretic separation and quantitation |
|
83701 |
$29.86 |
Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins, including lipoprotein subclasses when performed (e.g., electrophoresis, ultracentrifugation) |
|
83704 |
$30.16 |
Lipoprotein, blood; quantitation of lipoprotein particle number(s) (e.g., by nuclear magnetic resonance spectroscopy), includes lipoprotein particle subclass(es), when performed |
|
83718 |
$7.22 |
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) |
|
83719 |
$11.25 |
Lipoprotein, direct measurement; VLDL cholesterol |
|
83721 |
$9.26 |
Lipoprotein, direct measurement; LDL cholesterol |
|
83722 |
$30.16 |
Lipoprotein, direct measurement; small dense LDL cholesterol |
|
83727 |
$15.16 |
Luteinizing releasing factor (LRH) |
|
83735 |
$5.91 |
Magnesium |
|
83775 |
$6.50 |
Malate dehydrogenase |
|
83785 |
$23.51 |
Manganese |
|
83789 |
$21.27 |
Mass spectrometry and tandem mass spectrometry (e.g., MS, MS/MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen |
|
83825 |
$14.34 |
Mercury, quantitative |
|
83835 |
$14.94 |
Metanephrines |
|
83857 |
$9.47 |
Methemalbumin |
|
83861 |
$19.83 |
Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity |
|
83864 |
$25.14 |
Mucopolysaccharides, acid, quantitative |
|
83872 |
$5.17 |
Mucin, synovial fluid (Ropes test) |
|
83873 |
$15.17 |
Myelin basic protein, cerebrospinal fluid |
|
83874 |
$11.40 |
Myoglobin |
|
83876 |
$44.86 |
Myeloperoxidase (MPO) |
|
83880 |
$34.63 |
Natriuretic peptide |
|
83883 |
$12.00 |
Nephelometry, each analyte not elsewhere specified |
|
83885 |
$21.62 |
Nickel |
|
83915 |
$9.83 |
Nucleotidase 5'- |
|
83916 |
$24.16 |
Oligoclonal immune (oligoclonal bands) |
|
83918 |
$20.82 |
Organic acids; total, quantitative, each specimen |
|
83919 |
$14.51 |
Organic acids; qualitative, each specimen |
|
83921 |
$18.71 |
Organic acid, single, quantitative |
|
83930 |
$5.83 |
Osmolality; blood |
|
83935 |
$6.02 |
Osmolality; urine |
|
83937 |
$26.33 |
Osteocalcin (bone g1a protein) |
|
83945 |
$12.74 |
Oxalate |
|
83950 |
$56.81 |
Oncoprotein; HER-2/neu |
|
83951 |
$56.81 |
Oncoprotein; des-gamma-carboxy-prothrombin (DCP) |
|
83970 |
$36.41 |
Parathormone (parathyroid hormone) |
|
83986 |
$3.16 |
pH; body fluid, not otherwise specified |
|
83987 |
$3.16 |
pH; exhaled breath condensate |
|
83992 |
$15.37 |
Phencyclidine (PCP) |
|
83993 |
$17.31 |
Calprotectin, fecal |
|
84030 |
$4.85 |
Phenylalanine (PKU), blood |
|
84035 |
$3.51 |
Phenylketones, qualitative |
|
84060 |
$6.74 |
Phosphatase, acid; total |
|
84066 |
$8.52 |
Phosphatase, acid; prostatic |
|
84075 |
$4.57 |
Phosphatase, alkaline; |
|
84078 |
$7.29 |
Phosphatase, alkaline; heat stable (total not included) |
|
84080 |
$13.04 |
Phosphatase, alkaline; isoenzymes |
|
84081 |
$14.57 |
Phosphatidylglycerol |
|
84085 |
$8.33 |
Phosphogluconate, 6-, dehydrogenase, RBC |
|
84087 |
$9.46 |
Phosphohexose isomerase |
|
84100 |
$4.18 |
Phosphorus inorganic (phosphate); |
|
84105 |
$5.10 |
Phosphorus inorganic (phosphate); urine |
|
84106 |
$5.13 |
Porphobilinogen, urine; qualitative |
|
84110 |
$7.44 |
Porphobilinogen, urine; quantitative |
|
84112 |
$86.53 |
Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (e.g., placental alpha microglobulin-1 [PAMG-1], placental protein 12 [PP12], alpha-fetoprotein), qualitative, each specimen |
|
84119 |
$11.78 |
Porphyrins, urine; qualitative |
|
84120 |
$12.97 |
Porphyrins, urine; quantitation and fractionation |
|
84126 |
$34.50 |
Porphyrins, feces, quantitative |
|
84132 |
$4.20 |
Potassium; serum, plasma or whole blood |
|
84133 |
$4.17 |
Potassium; urine |
|
84134 |
$12.87 |
Prealbumin |
|
84135 |
$18.76 |
Pregnanediol |
|
84138 |
$18.57 |
Pregnanetriol |
|
84140 |
$18.23 |
Pregnenolone |
|
84143 |
$20.12 |
17-hydroxypregnenolone |
|
84144 |
$18.40 |
Progesterone |
|
84145 |
$24.01 |
Procalcitonin (PCT) |
|
84146 |
$17.09 |
Prolactin |
|
84150 |
$36.84 |
Prostaglandin, each |
|
84152 |
$16.22 |
Prostate specific antigen (PSA); complexed (direct measurement) |
|
84153 |
$16.22 |
Prostate specific antigen (PSA); total |
|
84154 |
$16.22 |
Prostate specific antigen (PSA); free |
|
84155 |
$3.24 |
Protein, total, except by refractometry; serum, plasma or whole blood |
|
84156 |
$3.24 |
Protein, total, except by refractometry; urine |
|
84157 |
$3.53 |
Protein, total, except by refractometry; other source (e.g., synovial fluid, cerebrospinal fluid) |
|
84160 |
$4.95 |
Protein, total, by refractometry, any source |
|
84163 |
$13.27 |
Pregnancy-associated plasma protein-A (PAPP-A) |
|
84165 |
$9.47 |
Protein; electrophoretic fractionation and quantitation, serum |
|
84166 |
$15.73 |
Protein; electrophoretic fractionation and quantitation, other fluids with concentration (e.g., urine, CSF) |
|
84181 |
$15.02 |
Protein; Western Blot, with interpretation and report, blood or other body fluid |
|
84182 |
$25.76 |
Protein; Western Blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each |
|
84202 |
$12.66 |
Protoporphyrin, RBC; quantitative |
|
84203 |
$8.59 |
Protoporphyrin, RBC; screen |
|
84206 |
$23.54 |
Proinsulin |
|
84207 |
$24.78 |
Pyridoxal phosphate (Vitamin B-6) |
|
84210 |
$12.77 |
Pyruvate |
|
84220 |
$8.33 |
Pyruvate kinase |
|
84228 |
$10.26 |
Quinine |
|
84233 |
$77.51 |
Receptor assay; estrogen |
|
84234 |
$57.22 |
Receptor assay; progesterone |
|
84235 |
$62.82 |
Receptor assay; endocrine, other than estrogen or progesterone (specify hormone) |
|
84238 |
$32.25 |
Receptor assay; non-endocrine (specify receptor) |
|
84244 |
$19.40 |
Renin |
|
84252 |
$17.85 |
Riboflavin (Vitamin B-2) |
|
84255 |
$22.52 |
Selenium |
|
84260 |
$27.32 |
Serotonin |
|
84270 |
$19.17 |
Sex hormone binding globulin (SHBG) |
|
84275 |
$11.85 |
Sialic acid |
|
84285 |
$22.24 |
Silica |
|
84295 |
$4.24 |
Sodium; serum, plasma or whole blood |
|
84300 |
$4.46 |
Sodium; urine |
|
84302 |
$4.29 |
Sodium; other source |
|
84305 |
$18.75 |
Somatomedin |
|
84307 |
$16.12 |
Somatostatin |
|
84311 |
$7.14 |
Spectrophotometry, analyte not elsewhere specified |
|
84315 |
$2.89 |
Specific gravity (except urine) |
|
84375 |
$34.40 |
Sugars, chromatographic, TLC or paper chromatography |
|
84376 |
$4.85 |
Sugars (mono-, di-, and oligosaccharides); single qualitative, each specimen |
|
84377 |
$4.85 |
Sugars (mono-, di-, and oligosaccharides); multiple qualitative, each specimen |
|
84378 |
$10.17 |
Sugars (mono-, di-, and oligosaccharides); single quantitative, each specimen |
|
84379 |
$10.17 |
Sugars (mono-, di-, and oligosaccharides); multiple quantitative, each specimen |
|
84392 |
$4.84 |
Sulfate, urine |
|
84402 |
$22.46 |
Testosterone; free |
|
84403 |
$22.76 |
Testosterone; total |
|
84410 |
$45.23 |
Testosterone; bioavailable, direct measurement (e.g., differential precipitation) |
|
84425 |
$18.72 |
Thiamine (Vitamin B-1) |
|
84430 |
$10.26 |
Thiocyanate |
|
84431 |
$30.97 |
Thromboxane metabolite(s), including thromboxane if performed, urine |
|
84432 |
$14.16 |
Thyroglobulin |
|
84436 |
$6.06 |
Thyroxine; total |
|
84437 |
$5.71 |
Thyroxine; requiring elution (e.g., neonatal) |
|
84439 |
$7.96 |
Thyroxine; free |
|
84442 |
$13.04 |
Thyroxine binding globulin (TBG) |
|
84443 |
$14.82 |
Thyroid stimulating hormone (TSH) |
|
84445 |
$44.86 |
Thyroid stimulating immune globulins (TSI) |
|
84446 |
$12.51 |
Tocopherol alpha (Vitamin E) |
|
84449 |
$15.88 |
Transcortin (cortisol binding globulin) |
|
84450 |
$4.57 |
Transferase; aspartate amino (AST) (SGOT) |
|
84460 |
$4.67 |
Transferase; alanine amino (ALT) (SGPT) |
|
84466 |
$11.25 |
Transferrin |
|
84478 |
$5.06 |
Triglycerides |
|
84479 |
$5.71 |
Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) |
|
84480 |
$12.51 |
Triiodothyronine T3; total (TT-3) |
|
84481 |
$14.94 |
Triiodothyronine T3; free |
|
84482 |
$13.90 |
Triiodothyronine T3; reverse |
|
84484 |
$11.00 |
Troponin, quantitative |
|
84485 |
$6.35 |
Trypsin; duodenal fluid |
|
84488 |
$6.44 |
Trypsin; feces, qualitative |
|
84490 |
$8.76 |
Trypsin; feces, quantitative, 24-hour collection |
|
84510 |
$9.38 |
Tyrosine |
|
84512 |
$8.90 |
Troponin, qualitative |
|
84520 |
$3.48 |
Urea nitrogen; quantitative |
|
84525 |
$4.52 |
Urea nitrogen; semiquantitative (e.g., reagent strip test) |
|
84540 |
$4.90 |
Urea nitrogen, urine |
|
84545 |
$6.35 |
Urea nitrogen, clearance |
|
84550 |
$3.99 |
Uric acid; blood |
|
84560 |
$4.48 |
Uric acid; other source |
|
84577 |
$14.82 |
Urobilinogen, feces, quantitative |
|
84578 |
$3.94 |
Urobilinogen, urine; qualitative |
|
84580 |
$8.42 |
Urobilinogen, urine; quantitative, timed specimen |
|
84583 |
$5.34 |
Urobilinogen, urine; semiquantitative |
|
84585 |
$13.67 |
Vanillylmandelic acid (VMA), urine |
|
84586 |
$31.16 |
Vasoactive intestinal peptide (VIP) |
|
84588 |
$29.94 |
Vasopressin (antidiuretic hormone, ADH) |
|
84590 |
$10.24 |
Vitamin A |
|
84591 |
$15.05 |
Vitamin, not otherwise specified |
|
84597 |
$12.10 |
Vitamin K |
|
84600 |
$15.09 |
Volatiles (e.g., acetic anhydride, diethylether) |
|
84620 |
$11.39 |
Xylose absorption test, blood and/or urine |
|
84630 |
$10.05 |
Zinc |
|
84681 |
$18.35 |
C-peptide |
|
84702 |
$13.27 |
Gonadotropin, chorionic (hCG); quantitative |
|
84703 |
$6.63 |
Gonadotropin, chorionic (hCG); qualitative |
|
84704 |
$13.49 |
Gonadotropin, chorionic (hCG); free beta chain |
|
84830 |
$11.20 |
Ovulation tests, by visual color comparison methods for human luteinizing hormone |
|
84999 |
$4.34 |
Unlisted chemistry procedure |
|
Hematology and Coagulation |
||
|
85002 |
$4.25 |
Bleeding time |
|
85004 |
$5.71 |
Blood count; automated differential WBC count |
|
85007 |
$3.35 |
Blood count; blood smear, microscopic examination with manual differential WBC count |
|
85008 |
$3.03 |
Blood count; blood smear, microscopic examination without manual differential WBC count |
|
85009 |
$4.47 |
Blood count; manual differential WBC count, buffy coat |
|
85013 |
$6.17 |
Blood count; spun microhematocrit |
|
85014 |
$2.09 |
Blood count; hematocrit (Hct) |
|
85018 |
$2.09 |
Blood count; hemoglobin (Hgb) |
|
85025 |
$6.85 |
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count |
|
85027 |
$5.71 |
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) |
|
85032 |
$3.80 |
Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each |
|
85041 |
$2.66 |
Blood count; red blood cell (RBC), automated |
|
85044 |
$3.80 |
Blood count; reticulocyte, manual |
|
85045 |
$3.52 |
Blood count; reticulocyte, automated |
|
85046 |
$4.91 |
Blood count; reticulocytes, automated, including one or more cellular parameters (e.g., reticulocyte hemoglobin content [CHr], immature reticulocyte fraction [IRF], reticulocyte volume [MRV], RNA content), direct measurement |
|
85048 |
$2.24 |
Blood count; leukocyte (WBC), automated |
|
85049 |
$3.95 |
Blood count; platelet, automated |
|
85055 |
$31.52 |
Reticulated platelet assay |
|
85130 |
$10.49 |
Chromogenic substrate assay |
|
85170 |
$14.38 |
Clot retraction |
|
85175 |
$17.97 |
Clot lysis time, whole blood dilution |
|
85210 |
$11.45 |
Clotting; factor II, prothrombin, specific |
|
85220 |
$15.57 |
Clotting; factor V (AcG or proaccelerin), labile factor |
|
85230 |
$15.79 |
Clotting; factor VII (proconvertin, stable factor) |
|
85240 |
$15.79 |
Clotting; factor VIII (AHG), 1-stage |
|
85244 |
$18.01 |
Clotting; factor VIII related antigen |
|
85245 |
$20.23 |
Clotting; factor VIII, VW factor, ristocetin cofactor |
|
85246 |
$20.23 |
Clotting; factor VIII, VW factor antigen |
|
85247 |
$20.23 |
Clotting; factor VIII, von Willebrand factor, multimetric analysis |
|
85250 |
$16.79 |
Clotting; factor IX (PTC or Christmas) |
|
85260 |
$15.79 |
Clotting; factor X (Stuart-Prower) |
|
85270 |
$15.79 |
Clotting; factor XI (PTA) |
|
85280 |
$17.07 |
Clotting; factor XII (Hageman) |
|
85290 |
$14.41 |
Clotting; factor XIII (fibrin stabilizing) |
|
85291 |
$8.04 |
Clotting; factor XIII (fibrin stabilizing), screen solubility |
|
85292 |
$16.70 |
Clotting; prekallikrein assay (Fletcher factor assay) |
|
85293 |
$16.70 |
Clotting; high molecular weight kininogen assay (Fitzgerald factor assay) |
|
85300 |
$10.45 |
Clotting inhibitors or anticoagulants; antithrombin III, activity |
|
85301 |
$9.53 |
Clotting inhibitors or anticoagulants; antithrombin III, antigen assay |
|
85302 |
$10.59 |
Clotting inhibitors or anticoagulants; protein C, antigen |
|
85303 |
$12.21 |
Clotting inhibitors or anticoagulants; protein C, activity |
|
85305 |
$10.24 |
Clotting inhibitors or anticoagulants; protein S, total |
|
85306 |
$13.51 |
Clotting inhibitors or anticoagulants; protein S, free |
|
85307 |
$13.51 |
Activated Protein C (APC) resistance assay |
|
85335 |
$11.35 |
Factor inhibitor test |
|
85337 |
$15.23 |
Thrombomodulin |
|
85345 |
$4.14 |
Coagulation time; Lee and White |
|
85347 |
$3.77 |
Coagulation time; activated |
|
85348 |
$3.96 |
Coagulation time; other methods |
|
85360 |
$7.42 |
Euglobulin lysis |
|
85362 |
$6.08 |
Fibrin(ogen) degradation (split) products (FDP) (FSP); agglutination slide, semiquantitative |
|
85366 |
$70.97 |
Fibrin(ogen) degradation (split) products (FDP) (FSP); paracoagulation |
|
85370 |
$10.96 |
Fibrin(ogen) degradation (split) products (FDP) (FSP); quantitative |
|
85378 |
$8.57 |
Fibrin degradation products, D-dimer; qualitative or semiquantitative |
|
85379 |
$8.98 |
Fibrin degradation products, D-dimer; quantitative |
|
85380 |
$8.98 |
Fibrin degradation products, D-dimer; ultrasensitive (e.g., for evaluation for venous thromboembolism), qualitative or semiquantitative |
|
85384 |
$8.57 |
Fibrinogen; activity |
|
85385 |
$12.75 |
Fibrinogen; antigen |
|
85390 |
$13.65 |
Fibrinolysins or coagulopathy screen, interpretation and report |
|
85397 |
$27.22 |
Coagulation and fibrinolysis, functional activity, not otherwise specified (e.g., ADAMTS-13), each analyte |
|
85400 |
$6.80 |
Fibrinolytic factors and inhibitors; plasmin |
|
85410 |
$6.80 |
Fibrinolytic factors and inhibitors; alpha-2 antiplasmin |
|
85415 |
$15.16 |
Fibrinolytic factors and inhibitors; plasminogen activator |
|
85420 |
$5.76 |
Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay |
|
85421 |
$8.98 |
Fibrinolytic factors and inhibitors; plasminogen, antigenic assay |
|
85441 |
$3.70 |
Heinz bodies; direct |
|
85445 |
$6.02 |
Heinz bodies; induced, acetyl phenylhydrazine |
|
85460 |
$6.82 |
Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis (Kleihauer-Betke) |
|
85461 |
$8.26 |
Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; rosette |
|
85475 |
$7.82 |
Hemolysin, acid |
|
85520 |
$11.55 |
Heparin assay |
|
85525 |
$10.44 |
Heparin neutralization |
|
85530 |
$11.55 |
Heparin-protamine tolerance test |
|
85536 |
$6.07 |
Iron stain, peripheral blood |
|
85540 |
$7.59 |
Leukocyte alkaline phosphatase with count |
|
85547 |
$7.59 |
Mechanical fragility, RBC |
|
85549 |
$16.54 |
Muramidase |
|
85555 |
$6.59 |
Osmotic fragility, RBC; unincubated |
|
85557 |
$11.78 |
Osmotic fragility, RBC; incubated |
|
85576 |
$21.97 |
Platelet, aggregation (in vitro), each agent |
|
85597 |
$15.86 |
Phospholipid neutralization; platelet |
|
85598 |
$15.86 |
Phospholipid neutralization; hexagonal phospholipid |
|
85610 |
$3.78 |
Prothrombin time; |
|
85611 |
$3.48 |
Prothrombin time; substitution, plasma fractions, each |
|
85612 |
$15.43 |
Russell viper venom time (includes venom); undiluted |
|
85613 |
$8.45 |
Russell viper venom time (includes venom); diluted |
|
85635 |
$8.69 |
Reptilase test |
|
85651 |
$3.77 |
Sedimentation rate, erythrocyte; nonautomated |
|
85652 |
$2.38 |
Sedimentation rate, erythrocyte; automated |
|
85660 |
$4.86 |
Sickling of RBC, reduction |
|
85670 |
$5.09 |
Thrombin time; plasma |
|
85675 |
$6.04 |
Thrombin time; titer |
|
85705 |
$8.49 |
Thromboplastin inhibition, tissue |
|
85730 |
$5.30 |
Thromboplastin time, partial (PTT); plasma or whole blood |
|
85732 |
$5.71 |
Thromboplastin time, partial (PTT); substitution, plasma fractions, each |
|
85810 |
$10.29 |
Viscosity |
|
85999 |
I.C. |
Unlisted hematology and coagulation procedure |
|
Immunology |
||
|
86000 |
$6.16 |
Agglutinins, febrile (e.g., Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus), each antigen |
|
86001 |
$6.90 |
Allergen specific IgG quantitative or semiquantitative, each allergen |
|
86003 |
$4.60 |
Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each |
|
86005 |
$7.03 |
Allergen specific IgE; qualitative, multiallergen screen (e.g., disk, sponge, card) |
|
86008 |
$15.81 |
Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each |
|
86015 |
$10.17 |
Actin (smooth muscle) antibody (ASMA), each |
|
86021 |
$13.27 |
Antibody identification; leukocyte antibodies |
|
86022 |
$16.20 |
Antibody identification; platelet antibodies |
|
86023 |
$10.99 |
Antibody identification; platelet associated immunoglobulin assay |
|
86036 |
$10.63 |
Antineutrophil cytoplasmic antibody (ANCA); screen, each antibody |
|
86037 |
$10.63 |
Antineutrophil cytoplasmic antibody (ANCA); titer, each antibody |
|
86038 |
$10.66 |
Antinuclear antibodies (ANA); |
|
86039 |
$9.84 |
Antinuclear antibodies (ANA); titer |
|
86051 |
$10.17 |
Aquaporin-4 (neuromyelitis optica [NMO]) antibody; enzyme-linked immunosorbent immunoassay (ELISA) |
|
86052 |
$10.63 |
Aquaporin-4 (neuromyelitis optica [NMO]) antibody; cell-based immunofluorescence assay (CBA), each |
|
86053 |
$10.63 |
Aquaporin-4 (neuromyelitis optica [NMO]) antibody; flow cytometry (i.e., fluorescence-activated cell sorting [FACS]), each |
|
86060 |
$6.44 |
Antistreptolysin 0; titer |
|
86063 |
$5.09 |
Antistreptolysin 0; screen |
|
86140 |
$4.57 |
C-reactive protein; |
|
86141 |
$11.42 |
C-reactive protein; high sensitivity (hsCRP) |
|
86146 |
$22.45 |
Beta 2 Glycoprotein I antibody, each |
|
86147 |
$22.45 |
Cardiolipin (phospholipid) antibody, each Ig class |
|
86148 |
$14.17 |
Anti-phosphatidylserine (phospholipid) antibody |
|
86152 |
$221.19 |
Cell enumeration using immunologic selection and identification in fluid specimen (e.g., circulating tumor cells in blood); |
|
86155 |
$14.10 |
Chemotaxis assay, specify method |
|
86156 |
$7.12 |
Cold agglutinin; screen |
|
86157 |
$7.11 |
Cold agglutinin; titer |
|
86160 |
$10.58 |
Complement; antigen, each component |
|
86161 |
$10.58 |
Complement; functional activity, each component |
|
86162 |
$17.92 |
Complement; total hemolytic (CH50) |
|
86171 |
$8.83 |
Complement fixation tests, each antigen |
|
86200 |
$11.42 |
Cyclic citrullinated peptide (CCP), antibody |
|
86215 |
$11.69 |
Deoxyribonuclease, antibody |
|
86225 |
$12.12 |
Deoxyribonucleic acid (DNA) antibody; native or double stranded |
|
86226 |
$10.68 |
Deoxyribonucleic acid (DNA) antibody; single stranded |
|
86231 |
$10.66 |
Endomysial antibody (EMA), each immunoglobulin (Ig) class |
|
86235 |
$15.81 |
Extractable nuclear antigen, antibody to, any method (e.g., nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody |
|
86255 |
$10.63 |
Fluorescent noninfectious agent antibody; screen, each antibody |
|
86256 |
$10.63 |
Fluorescent noninfectious agent antibody; titer, each antibody |
|
86258 |
$10.17 |
Gliadin (deamidated) (DGP) antibody, each immunoglobulin (Ig) class |
|
86277 |
$13.88 |
Growth hormone, human (HGH), antibody |
|
86280 |
$7.22 |
Hemagglutination inhibition test (HAI) |
|
86294 |
$22.55 |
Immunoassay for tumor antigen, qualitative or semiquantitative (e.g., bladder tumor antigen) |
|
86300 |
$18.35 |
Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29) |
|
86301 |
$18.35 |
Immunoassay for tumor antigen, quantitative; CA 19-9 |
|
86304 |
$18.35 |
Immunoassay for tumor antigen, quantitative; CA 125 |
|
86305 |
$18.35 |
Human epididymis protein 4 (HE4) |
|
86308 |
$4.57 |
Heterophile antibodies; screening |
|
86309 |
$5.71 |
Heterophile antibodies; titer |
|
86310 |
$6.50 |
Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney |
|
86316 |
$18.35 |
Immunoassay for tumor antigen, other antigen, quantitative (e.g., CA 50, 72-4, 549), each |
|
86317 |
$13.22 |
Immunoassay for infectious agent antibody, quantitative, not otherwise specified |
|
86318 |
$15.96 |
Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (e.g., reagent strip); |
|
86320 |
$26.39 |
Immunoelectrophoresis; serum |
|
86325 |
$20.40 |
Immunoelectrophoresis; other fluids (e.g., urine, cerebrospinal fluid) with concentration |
|
86327 |
$26.39 |
Immunoelectrophoresis; crossed (2-dimensional assay) |
|
86328 |
$45.23 |
Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
|
86329 |
$12.39 |
Immunodiffusion; not elsewhere specified |
|
86331 |
$10.57 |
Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody |
|
86332 |
$21.49 |
Immune complex assay |
|
86334 |
$19.70 |
Immunofixation electrophoresis; serum |
|
86335 |
$25.89 |
Immunofixation electrophoresis; other fluids with concentration (e.g., urine, CSF) |
|
86336 |
$13.75 |
Inhibin A |
|
86337 |
$18.88 |
Insulin antibodies |
|
86340 |
$13.30 |
Intrinsic factor antibodies |
|
86341 |
$20.79 |
Islet cell antibody |
|
86343 |
$10.99 |
Leukocyte histamine release test (LHR) |
|
86344 |
$9.16 |
Leukocyte phagocytosis |
|
86352 |
$119.83 |
Cellular function assay involving stimulation (e.g., mitogen or antigen) and detection of biomarker (e.g., ATP) |
|
86353 |
$43.24 |
Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis |
|
86355 |
$33.28 |
B cells, total count |
|
86356 |
$23.62 |
Mononuclear cell antigen, quantitative (e.g., flow cytometry), not otherwise specified, each antigen |
|
86357 |
$33.28 |
Natural killer (NK) cells, total count |
|
86359 |
$33.28 |
T cells; total count |
|
86360 |
$41.44 |
T cells; absolute CD4 and CD8 count, including ratio |
|
86361 |
$23.62 |
T cells; absolute CD4 count |
|
86362 |
$10.63 |
Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; cell-based immunofluorescence assay (CBA), each |
|
86363 |
$10.63 |
Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; flow cytometry (i.e., fluorescence-activated cell sorting [FACS]), each |
|
86364 |
$10.17 |
Tissue transglutaminase, each immunoglobulin (Ig) class |
|
86367 |
$68.60 |
Stem cells (i.e., CD34), total count |
|
86376 |
$12.83 |
Microsomal antibodies (e.g., thyroid or liver-kidney), each |
|
86381 |
$22.45 |
Mitochondrial antibody (e.g., M2), each |
|
86382 |
$14.91 |
Neutralization test, viral |
|
86384 |
$12.00 |
Nitroblue tetrazolium dye test (NTD) |
|
86386 |
$19.21 |
Nuclear Matrix Protein 22 (NMP22), qualitative |
|
86403 |
$10.18 |
Particle agglutination; screen, each antibody |
|
86406 |
$9.38 |
Particle agglutination; titer, each antibody |
|
86408 |
$42.13 |
Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen |
|
86409 |
$105.33 |
Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer |
|
86413 |
$51.43 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative |
|
86430 |
$5.42 |
Rheumatoid factor; qualitative |
|
86431 |
$5.00 |
Rheumatoid factor; quantitative |
|
86480 |
$54.67 |
Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon |
|
86481 |
$88.20 |
Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension |
|
86485 |
$24.48 |
Skin test; candida |
|
86590 |
$11.17 |
Streptokinase, antibody |
|
86592 |
$3.77 |
Syphilis test, non-treponemal antibody; qualitative (e.g., VDRL, RPR, ART) |
|
86593 |
$3.88 |
Syphilis test, non-treponemal antibody; quantitative |
|
86596 |
$16.23 |
Voltage-gated calcium channel antibody, each |
|
86602 |
$8.98 |
Antibody; actinomyces |
|
86603 |
$11.35 |
Antibody; adenovirus |
|
86606 |
$13.27 |
Antibody; Aspergillus |
|
86609 |
$11.36 |
Antibody; bacterium, not elsewhere specified |
|
86611 |
$8.98 |
Antibody; Bartonella |
|
86612 |
$11.38 |
Antibody; Blastomyces |
|
86615 |
$11.63 |
Antibody; Bordetella |
|
86617 |
$13.66 |
Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (e.g., Western Blot or immunoblot) |
|
86618 |
$15.02 |
Antibody; Borrelia burgdorferi (Lyme disease) |
|
86619 |
$11.80 |
Antibody; Borrelia (relapsing fever) |
|
86622 |
$7.88 |
Antibody; Brucella |
|
86625 |
$11.57 |
Antibody; Campylobacter |
|
86628 |
$10.59 |
Antibody; Candida |
|
86631 |
$10.43 |
Antibody; Chlamydia |
|
86632 |
$11.18 |
Antibody; Chlamydia, IgM |
|
86635 |
$10.12 |
Antibody; Coccidioides |
|
86638 |
$10.69 |
Antibody; Coxiella burnetii (Q fever) |
|
86641 |
$12.71 |
Antibody; Cryptococcus |
|
86644 |
$12.69 |
Antibody; cytomegalovirus (CMV) |
|
86645 |
$14.86 |
Antibody; cytomegalovirus (CMV), IgM |
|
86648 |
$13.42 |
Antibody; Diphtheria |
|
86651 |
$11.63 |
Antibody; encephalitis, California (La Crosse) |
|
86652 |
$11.63 |
Antibody; encephalitis, Eastern equine |
|
86653 |
$11.63 |
Antibody; encephalitis, St. Louis |
|
86654 |
$11.63 |
Antibody; encephalitis, Western equine |
|
86658 |
$11.49 |
Antibody; enterovirus (e.g., coxsackie, echo, polio) |
|
86663 |
$11.57 |
Antibody; Epstein-Barr (EB) virus, early antigen (EA) |
|
86664 |
$13.49 |
Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA) |
|
86665 |
$16.00 |
Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) |
|
86666 |
$8.98 |
Antibody; Ehrlichia |
|
86668 |
$12.49 |
Antibody; Francisella tularensis |
|
86671 |
$10.80 |
Antibody; fungus, not elsewhere specified |
|
86674 |
$12.98 |
Antibody; Giardia lamblia |
|
86677 |
$14.86 |
Antibody; Helicobacter pylori |
|
86682 |
$11.47 |
Antibody; helminth, not elsewhere specified |
|
86684 |
$13.97 |
Antibody; Haemophilus influenza |
|
86687 |
$8.02 |
Antibody; HTLV-I |
|
86688 |
$12.35 |
Antibody; HTLV-II |
|
86689 |
$17.07 |
Antibody; HTLV or HIV antibody, confirmatory test (e.g., Western Blot) |
|
86692 |
$15.14 |
Antibody; hepatitis, delta agent |
|
86694 |
$12.69 |
Antibody; herpes simplex, nonspecific type test |
|
86695 |
$11.63 |
Antibody; herpes simplex, type 1 |
|
86696 |
$17.07 |
Antibody; herpes simplex, type 2 |
|
86698 |
$12.16 |
Antibody; histoplasma |
|
86701 |
$7.84 |
Antibody; HIV-1 |
|
86702 |
$11.92 |
Antibody; HIV-2 |
|
86703 |
$12.09 |
Antibody; HIV-1 and HIV-2, single result |
|
86704 |
$10.63 |
Hepatitis B core antibody (HBcAb); total |
|
86705 |
$10.38 |
Hepatitis B core antibody (HBcAb); IgM antibody |
|
86706 |
$9.47 |
Hepatitis B surface antibody (HBsAb) |
|
86707 |
$10.20 |
Hepatitis Be antibody (HBeAb) |
|
86708 |
$10.93 |
Hepatitis A antibody (HAAb) |
|
86709 |
$9.93 |
Hepatitis A antibody (HAAb), IgM antibody |
|
86710 |
$11.95 |
Antibody; influenza virus |
|
86711 |
$14.90 |
Antibody; JC (John Cunningham) virus |
|
86713 |
$13.49 |
Antibody; Legionella |
|
86717 |
$10.80 |
Antibody; Leishmania |
|
86720 |
$14.29 |
Antibody; Leptospira |
|
86723 |
$11.63 |
Antibody; Listeria monocytogenes |
|
86727 |
$11.35 |
Antibody; lymphocytic choriomeningitis |
|
86732 |
$13.23 |
Antibody; mucormycosis |
|
86735 |
$11.51 |
Antibody; mumps |
|
86738 |
$11.68 |
Antibody; mycoplasma |
|
86741 |
$11.63 |
Antibody; Neisseria meningitidis |
|
86744 |
$14.10 |
Antibody; Nocardia |
|
86747 |
$13.26 |
Antibody; parvovirus |
|
86750 |
$11.63 |
Antibody; Plasmodium (malaria) |
|
86753 |
$10.93 |
Antibody; protozoa, not elsewhere specified |
|
86756 |
$14.01 |
Antibody; respiratory syncytial virus |
|
86757 |
$17.07 |
Antibody; Rickettsia |
|
86759 |
$16.08 |
Antibody; rotavirus |
|
86762 |
$12.69 |
Antibody; rubella |
|
86765 |
$11.36 |
Antibody; rubeola |
|
86768 |
$11.63 |
Antibody; Salmonella |
|
86769 |
$42.13 |
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
|
86771 |
$21.59 |
Antibody; Shigella |
|
86774 |
$13.05 |
Antibody; tetanus |
|
86777 |
$12.69 |
Antibody; Toxoplasma |
|
86778 |
$12.71 |
Antibody; Toxoplasma, IgM |
|
86780 |
$11.68 |
Antibody; Treponema pallidum |
|
86784 |
$11.08 |
Antibody; Trichinella |
|
86787 |
$11.36 |
Antibody; varicella-zoster |
|
86788 |
$14.86 |
Antibody; West Nile virus, IgM |
|
86789 |
$12.69 |
Antibody; West Nile virus |
|
86790 |
$11.36 |
Antibody; virus, not elsewhere specified |
|
86793 |
$11.63 |
Antibody; Yersinia |
|
86794 |
$14.86 |
Antibody; Zika virus, IgM |
|
86800 |
$14.03 |
Thyroglobulin antibody |
|
86803 |
$12.59 |
Hepatitis C antibody; |
|
86804 |
$13.66 |
Hepatitis C antibody; confirmatory test (e.g., immunoblot) |
|
86805 |
$167.15 |
Lymphocytotoxicity assay, visual crossmatch; with titration |
|
86806 |
$41.97 |
Lymphocytotoxicity assay, visual crossmatch; without titration |
|
86807 |
$69.37 |
Serum screening for cytotoxic percent reactive antibody (PRA); standard method |
|
86808 |
$26.18 |
Serum screening for cytotoxic percent reactive antibody (PRA); quick method |
|
86812 |
$22.76 |
HLA typing; A, B, or C (e.g., A10, B7, B27), single antigen |
|
86813 |
$51.16 |
HLA typing; A, B, or C, multiple antigens |
|
86816 |
$26.61 |
HLA typing; DR/DQ, single antigen |
|
86817 |
$93.62 |
HLA typing; DR/DQ, multiple antigens |
|
86821 |
$32.25 |
HLA typing; lymphocyte culture, mixed (MLC) |
|
86825 |
$96.57 |
Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (e.g., using flow cytometry); first serum sample or dilution |
|
86826 |
$32.22 |
Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (e.g., using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure) |
|
86828 |
$56.62 |
Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA Class I and Class II HLA antigens |
|
86829 |
$56.62 |
Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, Flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA Class I or Class II HLA antigens |
|
86830 |
$84.25 |
Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class I |
|
86831 |
$72.22 |
Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class II |
|
86832 |
$285.55 |
Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, Flow cytometry); high definition qualitative panel for identification of antibody specificities (e.g., individual antigen per bead methodology), HLA Class I |
|
86833 |
$287.36 |
Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, Flow cytometry); high definition qualitative panel for identification of antibody specificities (e.g., individual antigen per bead methodology), HLA Class II |
|
86834 |
$315.37 |
Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (e.g., titer), HLA Class I |
|
86835 |
$284.85 |
Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (e.g., titer), HLA Class II |
|
86849 |
I.C. |
Unlisted immunology procedure |
|
Transformation |
||
|
86850 |
$8.62 |
Antibody screen, RBC, each serum technique |
|
86860 |
I.C. |
Antibody elution (RBC), each elution |
|
86870 |
I.C. |
Antibody identification, RBC antibodies, each panel for each serum technique |
|
86880 |
$4.75 |
Antihuman globulin test (Coombs test); direct, each antiserum |
|
86885 |
$5.05 |
Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell |
|
86886 |
$4.57 |
Antihuman globulin test (Coombs test); indirect, each antibody titer |
|
86890 |
I.C. |
Autologous blood or component, collection processing and storage; predeposited |
|
86891 |
I.C. |
Autologous blood or component, collection processing and storage; intra- or post-operative salvage |
|
86900 |
$2.64 |
Blood typing, serologic; ABO |
|
86901 |
$2.64 |
Blood typing, serologic; Rh (D) |
|
86902 |
$5.60 |
Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test |
|
86904 |
$14.41 |
Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened |
|
86905 |
$3.38 |
Blood typing, serologic; RBC antigens, other than ABO or Rh (D), each |
|
86906 |
$6.84 |
Blood typing, serologic; Rh phenotyping, complete |
|
86920 |
I.C. |
Compatibility test each unit; immediate spin technique |
|
86921 |
I.C. |
Compatibility test each unit; incubation technique |
|
86922 |
I.C. |
Compatibility test each unit; antiglobulin technique |
|
86923 |
I.C. |
Compatibility test each unit; electronic |
|
86927 |
I.C. |
Fresh frozen plasma, thawing, each unit |
|
86930 |
I.C. |
Frozen blood, each unit; freezing (includes preparation) |
|
86931 |
I.C. |
Frozen blood, each unit; thawing |
|
86932 |
I.C. |
Frozen blood, each unit; freezing (includes preparation) and thawing |
|
86940 |
$7.74 |
Hemolysins and agglutinins; auto, screen, each |
|
86941 |
$10.68 |
Hemolysins and agglutinins; incubated |
|
86945 |
$23.48 |
Irradiation of blood product, each unit |
|
86960 |
I.C. |
Volume reduction of blood or blood product (e.g., red blood cells or platelets), each unit |
|
86965 |
$23.48 |
Pooling of platelets or other blood products |
|
86970 |
$18.76 |
Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with chemical agents or drugs, each |
|
86971 |
$18.76 |
Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with enzymes, each |
|
86976 |
$18.76 |
Pretreatment of serum for use in RBC antibody identification; by dilution |
|
86977 |
$18.76 |
Pretreatment of serum for use in RBC antibody identification; incubation with inhibitors, each |
|
86978 |
$18.76 |
Pretreatment of serum for use in RBC antibody identification; by differential red cell absorption using patient RBCs or RBCs of known phenotype, each absorption |
|
86985 |
I.C. |
Splitting of blood or blood products, each unit |
|
86999 |
I.C. |
Unlisted transfusion medicine procedure |
|
Microbiology |
||
|
87003 |
$14.85 |
Animal inoculation, small animal, with observation and dissection |
|
87015 |
$5.89 |
Concentration (any type), for infectious agents |
|
87040 |
$9.10 |
Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) |
|
87045 |
$8.33 |
Culture, bacterial; stool, aerobic, with isolation and preliminary examination (e.g., KIA, LIA), Salmonella and Shigella species |
|
87046 |
$8.33 |
Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate |
|
87070 |
$7.60 |
Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates |
|
87071 |
$8.72 |
Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool |
|
87073 |
$8.52 |
Culture, bacterial; quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool |
|
87075 |
$8.35 |
Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates |
|
87076 |
$7.13 |
Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate |
|
87077 |
$7.13 |
Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate |
|
87081 |
$5.85 |
Culture, presumptive, pathogenic organisms, screening only; |
|
87084 |
$23.88 |
Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart |
|
87086 |
$7.12 |
Culture, bacterial; quantitative colony count, urine |
|
87088 |
$7.14 |
Culture, bacterial; with isolation and presumptive identification of each isolate, urine |
|
87101 |
$6.80 |
Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail |
|
87102 |
$7.42 |
Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood) |
|
87103 |
$18.05 |
Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood |
|
87106 |
$9.10 |
Culture, fungi, definitive identification, each organism; yeast |
|
87107 |
$9.10 |
Culture, fungi, definitive identification, each organism; mold |
|
87109 |
$13.57 |
Culture, mycoplasma, any source |
|
87110 |
$17.29 |
Culture, chlamydia, any source |
|
87116 |
$9.53 |
Culture, tubercle or other acid-fast bacilli (e.g., TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates |
|
87118 |
$12.89 |
Culture, mycobacterial, definitive identification, each isolate |
|
87140 |
$4.91 |
Culture, typing; immunofluorescent method, each antiserum |
|
87143 |
$11.04 |
Culture, typing; gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method |
|
87147 |
$4.57 |
Culture, typing; immunologic method, other than immunofluorescence (e.g., agglutination grouping), per antiserum |
|
87149 |
$17.68 |
Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed |
|
87150 |
$30.95 |
Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed |
|
87152 |
$6.83 |
Culture, typing; identification by pulse field gel typing |
|
87154 |
$192.33 |
Culture, typing; identification of blood pathogen and resistance typing, when performed, by nucleic acid (DNA or RNA) probe, multiplexed amplified probe technique including multiplex reverse transcription, when performed, per culture or isolate, 6 or more targets |
|
87158 |
$6.83 |
Culture, typing; other methods |
|
87164 |
$9.47 |
Dark field examination, any source (e.g., penile, vaginal, oral, skin); includes specimen collection |
|
87166 |
$9.97 |
Dark field examination, any source (e.g., penile, vaginal, oral, skin); without collection |
|
87168 |
$3.77 |
Macroscopic examination; arthropod |
|
87169 |
$3.80 |
Macroscopic examination; parasite |
|
87172 |
$3.77 |
Pinworm exam (e.g., cellophane tape prep) |
|
87176 |
$5.19 |
Homogenization, tissue, for culture |
|
87177 |
$7.85 |
Ova and parasites, direct smears, concentration and identification |
|
87181 |
$4.19 |
Susceptibility studies, antimicrobial agent; agar dilution method, per agent (e.g., antibiotic gradient strip) |
|
87184 |
$6.60 |
Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) |
|
87185 |
$4.19 |
Susceptibility studies, antimicrobial agent; enzyme detection (e.g., beta lactamase), per enzyme |
|
87186 |
$7.63 |
Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate |
|
87187 |
$35.43 |
Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure) |
|
87188 |
$5.86 |
Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent |
|
87190 |
$6.45 |
Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent |
|
87197 |
$13.25 |
Serum bactericidal titer (Schlichter test) |
|
87205 |
$3.77 |
Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types |
|
87206 |
$4.75 |
Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types |
|
87207 |
$5.28 |
Smear, primary source with interpretation; special stain for inclusion bodies or parasites (e.g., malaria, coccidia, microsporidia, trypanosomes, herpes viruses) |
|
87209 |
$15.86 |
Smear, primary source with interpretation; complex special stain (e.g., trichrome, iron hemotoxylin) for ova and parasites |
|
87210 |
$5.13 |
Smear, primary source with interpretation; wet mount for infectious agents (e.g., saline, India ink, KOH preps) |
|
87220 |
$3.77 |
Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (e.g., scabies) |
|
87230 |
$17.41 |
Toxin or antitoxin assay, tissue culture (e.g., Clostridium difficile toxin) |
|
87250 |
$17.25 |
Virus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection |
|
87252 |
$22.99 |
Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect |
|
87253 |
$17.82 |
Virus isolation; tissue culture, additional studies or definitive identification (e.g., hemabsorption, neutralization, immunofluorescence stain), each isolate |
|
87254 |
$17.25 |
Virus isolation; centrifuge enhanced (shell vial) technique, includes identification with immunofluorescence stain, each virus |
|
87255 |
$29.86 |
Virus isolation; including identification by non-immunologic method, other than by cytopathic effect (e.g., virus specific enzymatic activity) |
|
87260 |
$12.73 |
Infectious agent antigen detection by immunofluorescent technique; adenovirus |
|
87265 |
$10.57 |
Infectious agent antigen detection by immunofluorescent technique; Bordetella pertussis/parapertussis |
|
87267 |
$11.84 |
Infectious agent antigen detection by immunofluorescent technique; Enterovirus, direct fluorescent antibody (DFA) |
|
87269 |
$12.00 |
Infectious agent antigen detection by immunofluorescent technique; giardia |
|
87270 |
$10.57 |
Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis |
|
87271 |
$11.84 |
Infectious agent antigen detection by immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody (DFA) |
|
87272 |
$10.57 |
Infectious agent antigen detection by immunofluorescent technique; cryptosporidium |
|
87273 |
$10.57 |
Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 2 |
|
87274 |
$10.57 |
Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 1 |
|
87275 |
$10.80 |
Infectious agent antigen detection by immunofluorescent technique; influenza B virus |
|
87276 |
$14.17 |
Infectious agent antigen detection by immunofluorescent technique; influenza A virus |
|
87278 |
$13.76 |
Infectious agent antigen detection by immunofluorescent technique; Legionella pneumophila |
|
87279 |
$14.49 |
Infectious agent antigen detection by immunofluorescent technique; Parainfluenza virus, each type |
|
87280 |
$11.84 |
Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus |
|
87281 |
$10.57 |
Infectious agent antigen detection by immunofluorescent technique; Pneumocystis carinii |
|
87283 |
$53.63 |
Infectious agent antigen detection by immunofluorescent technique; Rubeola |
|
87285 |
$10.74 |
Infectious agent antigen detection by immunofluorescent technique; Treponema pallidum |
|
87290 |
$11.84 |
Infectious agent antigen detection by immunofluorescent technique; Varicella zoster virus |
|
87299 |
$14.20 |
Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism |
|
87300 |
$10.57 |
Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum |
|
87301 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; adenovirus enteric types 40/41 |
|
87305 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Aspergillus |
|
87320 |
$13.23 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Chlamydia trachomatis |
|
87324 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Clostridium difficile toxin(s) |
|
87327 |
$11.84 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Cryptococcus neoformans |
|
87328 |
$12.19 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; cryptosporidium |
|
87329 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; giardia |
|
87332 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; cytomegalovirus |
|
87335 |
$11.17 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Escherichia coli 0157 |
|
87336 |
$14.11 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Entamoeba histolytica dispar group |
|
87337 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Entamoeba histolytica group |
|
87338 |
$12.68 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Helicobacter pylori, stool |
|
87339 |
$14.11 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Helicobacter pylori |
|
87340 |
$9.11 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) |
|
87341 |
$9.11 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) neutralization |
|
87350 |
$10.17 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis Be antigen (HBeAg) |
|
87380 |
$16.19 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis, delta agent |
|
87385 |
$11.69 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Histoplasma capsulatum |
|
87389 |
$21.24 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result |
|
87390 |
$21.22 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 |
|
87391 |
$19.32 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-2 |
|
87400 |
$12.46 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Influenza, A or B, each |
|
87420 |
$12.27 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; respiratory syncytial virus |
|
87425 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; rotavirus |
|
87426 |
$35.33 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) |
|
87427 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Shiga-like toxin |
|
87428 |
$63.59 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B |
|
87430 |
$14.83 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Streptococcus, group A |
|
87449 |
$10.57 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; not otherwise specified, each organism |
|
87451 |
$9.27 |
Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; polyvalent for multiple organisms, each polyvalent antiserum |
|
87471 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique |
|
87472 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, quantification |
|
87475 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, direct probe technique |
|
87476 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique |
|
87480 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique |
|
87481 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique |
|
87482 |
$49.16 |
Infectious agent detection by nucleic acid (DNA or RNA); Candida species, quantification |
|
87483 |
$367.60 |
Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (e.g., Neisseria meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenzae, E. coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster virus, Cryptococcus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets |
|
87485 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, direct probe technique |
|
87486 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique |
|
87487 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, quantification |
|
87490 |
$20.07 |
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique |
|
87491 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique |
|
87492 |
$47.16 |
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification |
|
87493 |
$32.87 |
Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique |
|
87495 |
$26.49 |
Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, direct probe technique |
|
87496 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique |
|
87497 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification |
|
87498 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, amplified probe technique, includes reverse transcription when performed |
|
87500 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (e.g., enterococcus species van A, van B), amplified probe technique |
|
87501 |
$45.26 |
Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype |
|
87502 |
$84.50 |
Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types |
|
87503 |
$25.77 |
Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary procedure) |
|
87505 |
$113.15 |
Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (e.g., Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets |
|
87506 |
$231.96 |
Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (e.g., Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets |
|
87507 |
$367.60 |
Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (e.g., Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets |
|
87510 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, direct probe technique |
|
87511 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique |
|
87512 |
$36.83 |
Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, quantification |
|
87516 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, amplified probe technique |
|
87517 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification |
|
87520 |
$27.54 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique |
|
87521 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed |
|
87522 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed |
|
87525 |
$26.28 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, direct probe technique |
|
87526 |
$34.63 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, amplified probe technique |
|
87527 |
$36.83 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, quantification |
|
87528 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, direct probe technique |
|
87529 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique |
|
87530 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, quantification |
|
87531 |
$51.16 |
Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, direct probe technique |
|
87532 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, amplified probe technique |
|
87533 |
$36.83 |
Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, quantification |
|
87534 |
$19.33 |
Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique |
|
87535 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, includes reverse transcription when performed |
|
87536 |
$75.06 |
Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed |
|
87537 |
$19.33 |
Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, direct probe technique |
|
87538 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe technique, includes reverse transcription when performed |
|
87539 |
$51.70 |
Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, quantification, includes reverse transcription when performed |
|
87540 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, direct probe technique |
|
87541 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique |
|
87542 |
$36.83 |
Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, quantification |
|
87550 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, direct probe technique |
|
87551 |
$42.55 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, amplified probe technique |
|
87552 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, quantification |
|
87555 |
$23.71 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, direct probe technique |
|
87556 |
$36.76 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, amplified probe technique |
|
87557 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, quantification |
|
87560 |
$24.07 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, direct probe technique |
|
87561 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique |
|
87562 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, quantification |
|
87563 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma genitalium, amplified probe technique |
|
87580 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, direct probe technique |
|
87581 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique |
|
87582 |
$266.91 |
Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, quantification |
|
87590 |
$23.71 |
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique |
|
87591 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique |
|
87592 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, quantification |
|
87623 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (e.g., 6, 11, 42, 43, 44) |
|
87624 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) |
|
87625 |
$35.77 |
Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed |
|
87631 |
$125.80 |
Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets |
|
87632 |
$192.33 |
Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets |
|
87633 |
$367.60 |
Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets |
|
87634 |
$61.92 |
Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe technique |
|
87635 |
$51.31 |
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique |
|
87636 |
$142.63 |
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique |
|
87637 |
$142.63 |
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique |
|
87640 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique |
|
87641 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique |
|
87650 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, direct probe technique |
|
87651 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique |
|
87652 |
$36.83 |
Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, quantification |
|
87653 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique |
|
87660 |
$17.68 |
Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, direct probe technique |
|
87661 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique |
|
87662 |
$45.26 |
Infectious agent detection by nucleic acid (DNA or RNA); Zika virus, amplified probe technique |
|
87797 |
$26.49 |
Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism |
|
87798 |
$30.95 |
Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
|
87799 |
$37.78 |
Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism |
|
87800 |
$38.52 |
Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique |
|
87801 |
$61.92 |
Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique |
|
87802 |
$11.23 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; Streptococcus, group B |
|
87803 |
$14.11 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; Clostridium difficile toxin A |
|
87804 |
$14.60 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; Influenza |
|
87806 |
$28.90 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies |
|
87807 |
$11.55 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; respiratory syncytial virus |
|
87808 |
$13.49 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; Trichomonas vaginalis |
|
87809 |
$19.19 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; adenovirus |
|
87810 |
$31.13 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; Chlamydia trachomatis |
|
87811 |
$41.38 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
|
87850 |
$21.66 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; Neisseria gonorrhoeae |
|
87880 |
$14.58 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; Streptococcus, group A |
|
87899 |
$14.17 |
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; not otherwise specified |
|
87900 |
$114.97 |
Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics |
|
87901 |
$227.07 |
Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions |
|
87902 |
$227.07 |
Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus |
|
87903 |
$431.00 |
Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested |
|
87904 |
$22.99 |
Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure) |
|
87905 |
$10.78 |
Infectious agent enzymatic activity other than virus (e.g., sialidase activity in vaginal fluid) |
|
87906 |
$113.54 |
Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (e.g., integrase, fusion) |
|
87910 |
$227.07 |
Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus |
|
87912 |
$227.07 |
Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis B virus |
|
87999 |
I.C. |
Unlisted microbiology procedure |
|
Anatomic Pathology |
||
|
88000 |
I.C. |
Necropsy (autopsy), gross examination only; without CNS |
|
88005 |
I.C. |
Necropsy (autopsy), gross examination only; with brain |
|
88007 |
I.C. |
Necropsy (autopsy), gross examination only; with brain and spinal cord |
|
88012 |
I.C. |
Necropsy (autopsy), gross examination only; infant with brain |
|
88014 |
I.C. |
Necropsy (autopsy), gross examination only; stillborn or newborn with brain |
|
88016 |
I.C. |
Necropsy (autopsy), gross examination only; macerated stillborn |
|
88020 |
I.C. |
Necropsy (autopsy), gross and microscopic; without CNS |
|
88025 |
I.C. |
Necropsy (autopsy), gross and microscopic; with brain |
|
88027 |
I.C. |
Necropsy (autopsy), gross and microscopic; with brain and spinal cord |
|
88028 |
I.C. |
Necropsy (autopsy), gross and microscopic; infant with brain |
|
88029 |
I.C. |
Necropsy (autopsy), gross and microscopic; stillborn or newborn with brain |
|
88036 |
I.C. |
Necropsy (autopsy), limited, gross and/or microscopic; regional |
|
88037 |
I.C. |
Necropsy (autopsy), limited, gross and/or microscopic; single organ |
|
88040 |
I.C. |
Necropsy (autopsy); forensic examination |
|
88045 |
I.C. |
Necropsy (autopsy); coroner's call |
|
88099 |
I.C. |
Unlisted necropsy (autopsy) procedure |
|
Cytopathology |
||
|
88130 |
$15.86 |
Sex chromatin identification; Barr bodies |
|
88140 |
$7.05 |
Sex chromatin identification; peripheral blood smear, polymorphonuclear drumsticks |
|
88142 |
$17.87 |
Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision |
|
88143 |
$20.32 |
Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision |
|
88147 |
$44.59 |
Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision |
|
88148 |
$14.11 |
Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision |
|
88150 |
$13.36 |
Cytopathology, slides, cervical or vaginal; manual screening under physician supervision |
|
88152 |
$24.38 |
Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision |
|
88153 |
$21.19 |
Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision |
|
88155 |
$12.92 |
Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (e.g., maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code[s] for other technical and interpretation services) |
|
88164 |
$13.36 |
Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision |
|
88165 |
$37.24 |
Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision |
|
88166 |
$13.36 |
Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening under physician supervision |
|
88167 |
$13.36 |
Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening using cell selection and review under physician supervision |
|
88174 |
$22.38 |
Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision |
|
88175 |
$23.47 |
Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision |
|
Cytogenic Studies |
||
|
88230 |
$102.74 |
Tissue culture for non-neoplastic disorders; lymphocyte |
|
88233 |
$124.12 |
Tissue culture for non-neoplastic disorders; skin or other solid tissue biopsy |
|
88235 |
$132.56 |
Tissue culture for non-neoplastic disorders; amniotic fluid or chorionic villus cells |
|
88237 |
$126.79 |
Tissue culture for neoplastic disorders; bone marrow, blood cells |
|
88239 |
$130.11 |
Tissue culture for neoplastic disorders; solid tumor |
|
88240 |
$11.53 |
Cryopreservation, freezing and storage of cells, each cell line |
|
88241 |
$10.66 |
Thawing and expansion of frozen cells, each aliquot |
|
88245 |
$152.74 |
Chromosome analysis for breakage syndromes; baseline Sister Chromatid Exchange (SCE), 20-25 cells |
|
88248 |
$152.74 |
Chromosome analysis for breakage syndromes; baseline breakage, score 50-100 cells, count 20 cells, 2 karyotypes (e.g., for ataxia telangiectasia, Fanconi anemia, fragile X) |
|
88249 |
$152.74 |
Chromosome analysis for breakage syndromes; score 100 cells, clastogen stress (e.g., diepoxybutane, mitomycin C, ionizing radiation, UV radiation) |
|
88261 |
$233.15 |
Chromosome analysis; count 5 cells, 1 karyotype, with banding |
|
88262 |
$110.68 |
Chromosome analysis; count 15-20 cells, 2 karyotypes, with banding |
|
88263 |
$132.56 |
Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding |
|
88264 |
$127.55 |
Chromosome analysis; analyze 20-25 cells |
|
88267 |
$166.32 |
Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, 1 karyotype, with banding |
|
88269 |
$153.17 |
Chromosome analysis, in situ for amniotic fluid cells, count cells from 6-12 colonies, 1 karyotype, with banding |
|
88271 |
$18.89 |
Molecular cytogenetics; DNA probe, each (e.g., FISH) |
|
88272 |
$35.90 |
Molecular cytogenetics; chromosomal in situ hybridization, analyze 3-5 cells (e.g., for derivatives and markers) |
|
88273 |
$30.70 |
Molecular cytogenetics; chromosomal in situ hybridization, analyze 10-30 cells (e.g., for microdeletions) |
|
88274 |
$37.38 |
Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells |
|
88275 |
$45.15 |
Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells |
|
88280 |
$29.52 |
Chromosome analysis; additional karyotypes, each study |
|
88283 |
$60.51 |
Chromosome analysis; additional specialized banding technique (e.g., NOR, C-banding) |
|
88285 |
$23.73 |
Chromosome analysis; additional cells counted, each study |
|
88289 |
$30.37 |
Chromosome analysis; additional high resolution study |
|
88371 |
$19.61 |
Protein analysis of tissue by Western Blot, with interpretation and report; |
|
88372 |
$23.13 |
Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each |
|
In vivo, (e.g., Transcutaneous) Laboratory Procedures |
||
|
88720 |
$4.43 |
Bilirubin, total, transcutaneous |
|
88738 |
$4.43 |
Hemoglobin (Hgb), quantitative, transcutaneous |
|
88740 |
$8.26 |
Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin |
|
88741 |
$8.26 |
Hemoglobin, quantitative, transcutaneous, per day; methemoglobin |
|
Other Procedures |
||
|
89050 |
$4.16 |
Cell count, miscellaneous body fluids (e.g., cerebrospinal fluid, joint fluid), except blood; |
|
89051 |
$4.94 |
Cell count, miscellaneous body fluids (e.g., cerebrospinal fluid, joint fluid), except blood; with differential count |
|
89055 |
$3.77 |
Leukocyte assessment, fecal, qualitative or semiquantitative |
|
89060 |
$6.47 |
Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine) |
|
89125 |
$5.19 |
Fat stain, feces, urine, or respiratory secretions |
|
89160 |
$4.28 |
Meat fibers, feces |
|
89190 |
$5.11 |
Nasal smear for eosinophils |
|
Reproductive Medicine Procedures |
||
|
89250 |
I.C. |
Culture of oocyte(s)/embryo(s), less than four days; |
|
89251 |
I.C. |
Culture of oocyte(s)/embryo(s), less than four days; with co-culture of oocyte(s)/embryos |
|
89253 |
I.C. |
Assisted embryo hatching, microtechniques (any method) |
|
89254 |
I.C. |
Oocyte identification from follicular fluid |
|
89255 |
I.C. |
Preparation of embryo for transfer (any method) |
|
89257 |
I.C. |
Sperm identification from aspiration (other than seminal fluid) |
|
89258 |
I.C. |
Cryopreservation; embryo(s) |
|
89259 |
I.C. |
Cryopreservation; sperm |
|
89264 |
I.C. |
Sperm identification from testis tissue, fresh or cryopreserved |
|
89268 |
I.C. |
Insemination of oocytes |
|
89272 |
I.C. |
Extended culture of oocyte(s)/embryo(s), 4-7 days |
|
89280 |
I.C. |
Assisted oocyte fertilization, microtechnique; less than or equal to ten oocytes |
|
89281 |
I.C. |
Assisted oocyte fertilization, microtechnique; greater than ten oocytes |
|
89290 |
I.C. |
Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); less than or equal to five embryos |
|
89291 |
I.C. |
Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); greater than five embryos |
|
89300 |
$8.68 |
Semen analysis; presence and/or motility of sperm including Huhner test (post coital) |
|
89310 |
$7.59 |
Semen analysis; motility and count (not including Huhner test) |
|
89320 |
$10.86 |
Semen analysis; volume, count, motility, and differential |
|
89321 |
$10.63 |
Semen analysis; sperm presence and motility of sperm, if performed |
|
89322 |
$13.67 |
Semen analysis; volume, count, motility, and differential using strict morphologic criteria (e.g., Kruger) |
|
89325 |
$9.41 |
Sperm antibodies |
|
89329 |
$17.28 |
Sperm evaluation; hamster penetration test |
|
89330 |
$9.16 |
Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test |
|
89331 |
$17.28 |
Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated) |
|
89335 |
I.C. |
Cryopreservation, reproductive tissue, testicular |
|
89342 |
I.C. |
Storage (per year); embryo(s) |
|
89343 |
I.C. |
Storage (per year); sperm/semen |
|
89344 |
I.C. |
Storage (per year); reproductive tissue, testicular/ovarian |
|
89346 |
I.C. |
Storage (per year); oocyte(s) |
|
89352 |
I.C. |
Thawing of cryopreserved; embryo(s) |
|
89353 |
I.C. |
Thawing of cryopreserved; sperm/semen, each aliquot |
|
89354 |
I.C. |
Thawing of cryopreserved; reproductive tissue, testicular/ovarian |
|
89356 |
I.C. |
Thawing of cryopreserved; oocytes, each aliquot |
|
89398 |
I.C. |
Unlisted reproductive medicine laboratory procedure |
|
Other Pathology and Laboratory |
||
|
36415 |
$2.65 |
Collection of venous blood by venipuncture |
|
78267 |
$9.75 |
Urea breath test, C-14 (isotopic); acquisition for analysis |
|
78268 |
$83.27 |
Urea breath test, C-14 (isotopic); analysis |
|
81105 |
$107.80 |
Human Platelet Antigen 1 genotyping (HPA-1), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-1a/b (L33P) |
|
81106 |
$107.80 |
Human Platelet Antigen 2 genotyping (HPA-2), GP1BA (glycoprotein Ib [platelet], alpha polypeptide [GPIba]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-2a/b (T145M) |
|
81107 |
$107.80 |
Human Platelet Antigen 3 genotyping (HPA-3), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex], antigen CD41 [GPIIb]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-3a/b (I843S) |
|
81108 |
$107.80 |
Human Platelet Antigen 4 genotyping (HPA-4), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-4a/b (R143Q) |
|
81109 |
$107.80 |
Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant (e.g., HPA-5a/b (K505E)) |
|
81110 |
$107.80 |
Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61] [GPIIIa]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-6a/b (R489Q) |
|
81111 |
$107.80 |
Human Platelet Antigen 9 genotyping (HPA-9w), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex, antigen CD41] [GPIIb]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-9a/b (V837M) |
|
81112 |
$107.80 |
Human Platelet Antigen 15 genotyping (HPA-15), CD109 (CD109 molecule) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-15a/b (S682Y) |
|
81120 |
$170.45 |
IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (e.g., glioma), common variants (e.g., R132H, R132C) |
|
81121 |
$260.89 |
IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (e.g., glioma), common variants (e.g., R140W, R172M) |
|
81161 |
$246.08 |
DMD (dystrophin) (e.g., Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed |
|
81162 |
$1,609.54 |
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (i.e., detection of large gene rearrangements) |
|
81163 |
$412.78 |
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis |
|
81164 |
$515.29 |
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements) |
|
81165 |
$249.50 |
BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis |
|
81166 |
$265.79 |
BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements) |
|
Other Pathology and Laboratory |
||
|
81167 |
$249.50 |
BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements) |
|
81168 |
$182.85 |
CCND1/IGH (t(11;14)) (e.g., mantle cell lymphoma) translocation analysis, major breakpoint, qualitative and quantitative, if performed |
|
81170 |
$264.60 |
ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (e.g., acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain |
|
81171 |
$120.83 |
AFF2 (AF4/FMR2 family, member 2 [FMR2]) (e.g., fragile X mental retardation 2 [FRAXE]) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles |
|
81172 |
$242.40 |
AFF2 (AF4/FMR2 family, member 2 [FMR2]) (e.g., fragile X mental retardation 2 [FRAXE]) gene analysis; characterization of alleles (e.g., expanded size and methylation status) |
|
81173 |
$265.79 |
AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; full gene sequence |
|
81174 |
$163.35 |
AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; known familial variant |
|
81175 |
$596.67 |
ASXL1 (additional sex combs like 1, transcriptional regulator) (e.g., myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; full gene sequence |
|
81176 |
$213.36 |
ASXL1 (additional sex combs like 1, transcriptional regulator) (e.g., myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; targeted sequence analysis (e.g., exon 12) |
|
81177 |
$120.83 |
ATN1 (atrophin 1) (e.g., dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81178 |
$120.83 |
ATXN1 (ataxin 1) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81179 |
$120.83 |
ATXN2 (ataxin 2) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81180 |
$120.83 |
ATXN3 (ataxin 3) (e.g., spinocerebellar ataxia, Machado-Joseph disease) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81181 |
$120.83 |
ATXN7 (ataxin 7) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81182 |
$120.83 |
ATXN8OS (ATXN8 opposite strand [non-protein coding]) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81183 |
$120.83 |
ATXN10 (ataxin 10) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81184 |
$120.83 |
CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles |
|
81185 |
$746.41 |
CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; full gene sequence |
|
81186 |
$163.35 |
CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; known familial variant |
|
81187 |
$120.83 |
CNBP (CCHC-type zinc finger nucleic acid binding protein) (e.g., myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81188 |
$120.83 |
CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles |
|
81189 |
$242.40 |
CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; full gene sequence |
|
81190 |
$163.35 |
CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; known familial variant(s) |
|
81191 |
$182.85 |
NTRK1 (neurotrophic receptor tyrosine kinase 1) (e.g., solid tumors) translocation analysis |
|
81192 |
$182.85 |
NTRK2 (neurotrophic receptor tyrosine kinase 2) (e.g., solid tumors) translocation analysis |
|
81193 |
$182.85 |
NTRK3 (neurotrophic receptor tyrosine kinase 3) (e.g., solid tumors) translocation analysis |
|
81194 |
$457.12 |
NTRK (neurotrophic-tropomyosin receptor tyrosine kinase 1, 2, and 3) (e.g., solid tumors) translocation analysis |
|
81200 |
$41.67 |
ASPA (aspartoacylase) (e.g., Canavan disease) gene analysis, common variants (e.g., E285A, Y231X) |
|
81201 |
$687.96 |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence |
|
81202 |
$246.96 |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants |
|
81203 |
$176.40 |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants |
|
81204 |
$120.83 |
AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; characterization of alleles (e.g., expanded size or methylation status) |
|
81205 |
$83.78 |
BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (e.g., maple syrup urine disease) gene analysis, common variants (e.g., R183P, G278S, E422X) |
|
81206 |
$144.61 |
BCR/ABL1 (t(9;22)) (e.g., chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative |
|
81207 |
$127.75 |
BCR/ABL1 (t(9;22)) (e.g., chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative |
|
81208 |
$189.29 |
BCR/ABL1 (t(9;22)) (e.g., chronic myelogenous leukemia) translocation analysis; other breakpoint, qualitative or quantitative |
|
81209 |
$34.67 |
BLM (Bloom syndrome, RecQ helicase-like) (e.g., Bloom syndrome) gene analysis, 2281del6ins7 variant |
|
81210 |
$154.70 |
BRAF (B-Raf proto-oncogene, serine/threonine kinase) (e.g., colon cancer, melanoma), gene analysis, V600 variant(s) |
|
81212 |
$388.08 |
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; 185delAG, 5385insC, 6174delT variants |
|
81215 |
$330.97 |
BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; known familial variant |
|
81216 |
$163.28 |
BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis |
|
81217 |
$330.97 |
BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; known familial variant |
|
81218 |
$213.36 |
CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (e.g., acute myeloid leukemia), gene analysis, full gene sequence |
|
81219 |
$107.28 |
CALR (calreticulin) (e.g., myeloproliferative disorders), gene analysis, common variants in exon 9 |
|
81220 |
$490.92 |
CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; common variants (e.g., ACMG/ACOG guidelines) |
|
81221 |
$85.75 |
CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; known familial variants |
|
81222 |
$383.73 |
CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; duplication/deletion variants |
|
81223 |
$440.12 |
CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; full gene sequence |
|
81224 |
$148.84 |
CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; intron 8 poly-T analysis (e.g., male infertility) |
|
81225 |
$256.98 |
CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (e.g., drug metabolism), gene analysis, common variants (e.g., *2, *3, *4, *8, *17) |
|
81226 |
$397.70 |
CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism), gene analysis, common variants (e.g., *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN) |
|
81227 |
$154.18 |
CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (e.g., drug metabolism), gene analysis, common variants (e.g., *2, *3, *5, *6) |
|
81228 |
$793.80 |
Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants (e.g., bacterial artificial chromosome [BAC] or oligo-based comparative genomic hybridization [CGH] microarray analysis) |
|
81229 |
$1,023.12 |
Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities |
|
81230 |
$154.18 |
CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (e.g., drug metabolism), gene analysis, common variant(s) (e.g., *2, *22) |
|
81231 |
$154.18 |
CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (e.g., drug metabolism), gene analysis, common variants (e.g., *2, *3, *4, *5, *6, *7) |
|
81232 |
$154.18 |
DPYD (dihydropyrimidine dehydrogenase) (e.g., 5-fluorouracil/5-FU and capecitabine drug metabolism), gene analysis, common variant(s) (e.g., *2A, *4, *5, *6) |
|
81233 |
$154.70 |
BTK (Bruton's tyrosine kinase) (e.g., chronic lymphocytic leukemia) gene analysis, common variants (e.g., C481S, C481R, C481F) |
|
81234 |
$120.83 |
DMPK (DM1 protein kinase) (e.g., myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal (expanded) alleles |
|
81235 |
$286.28 |
EGFR (epidermal growth factor receptor) (e.g., non-small cell lung cancer) gene analysis, common variants (e.g., exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q) |
|
81236 |
$249.50 |
EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (e.g., myelodysplastic syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence |
|
81237 |
$154.70 |
EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (e.g., diffuse large B-cell lymphoma) gene analysis, common variant(s) (e.g., codon 646) |
|
81238 |
$529.20 |
F9 (coagulation factor IX) (e.g., hemophilia B), full gene sequence |
|
81239 |
$242.40 |
DMPK (DM1 protein kinase) (e.g., myotonic dystrophy type 1) gene analysis; characterization of alleles (e.g., expanded size) |
|
81240 |
$57.94 |
F2 (prothrombin, coagulation factor II) (e.g., hereditary hypercoagulability) gene analysis, 20210G>A variant |
|
81241 |
$64.71 |
F5 (coagulation factor V) (e.g., hereditary hypercoagulability) gene analysis, Leiden variant |
|
81242 |
$32.30 |
FANCC (Fanconi anemia, complementation group C) (e.g., Fanconi anemia, type C) gene analysis, common variant (e.g., IVS4+4A>T) |
|
81243 |
$50.31 |
FMR1 (fragile X mental retardation 1) (e.g., fragile X mental retardation) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles |
|
81244 |
$39.59 |
FMR1 (fragile X mental retardation 1) (e.g., fragile X mental retardation) gene analysis; characterization of alleles (e.g., expanded size and promoter methylation status) |
|
81245 |
$145.98 |
FLT3 (fms-related tyrosine kinase 3) (e.g., acute myeloid leukemia), gene analysis; internal tandem duplication (ITD) variants (i.e., exons 14, 15) |
|
81246 |
$73.21 |
FLT3 (fms-related tyrosine kinase 3) (e.g., acute myeloid leukemia), gene analysis; tyrosine kinase domain (TKD) variants (e.g., D835, I836) |
|
81247 |
$154.18 |
G6PD (glucose-6-phosphate dehydrogenase) (e.g., hemolytic anemia, jaundice), gene analysis; common variant(s) (e.g., A, A-) |
|
81248 |
$330.97 |
G6PD (glucose-6-phosphate dehydrogenase) (e.g., hemolytic anemia, jaundice), gene analysis; known familial variant(s) |
|
81249 |
$529.20 |
G6PD (glucose-6-phosphate dehydrogenase) (e.g., hemolytic anemia, jaundice), gene analysis; full gene sequence |
|
81250 |
$51.59 |
G6PC (glucose-6-phosphatase, catalytic subunit) (e.g., Glycogen storage disease, type 1a, von Gierke disease) gene analysis, common variants (e.g., R83C, Q347X) |
|
81251 |
$41.67 |
GBA (glucosidase, beta, acid) (e.g., Gaucher disease) gene analysis, common variants (e.g., N370S, 84GG, L444P, IVS2+1G>A) |
|
81252 |
$89.19 |
GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (e.g., nonsyndromic hearing loss) gene analysis; full gene sequence |
|
81253 |
$54.26 |
GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (e.g., nonsyndromic hearing loss) gene analysis; known familial variants |
|
81254 |
$30.87 |
GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (e.g., nonsyndromic hearing loss) gene analysis, common variants (e.g., 309kb [del(GJB6-D13S1830)] and 232kb [del(GJB6-D13S1854)]) |
|
81255 |
$45.38 |
HEXA (hexosaminidase A [alpha polypeptide]) (e.g., Tay-Sachs disease) gene analysis, common variants (e.g., 1278insTATC, 1421+1G>C, G269S) |
|
81256 |
$57.65 |
HFE (hemochromatosis) (e.g., hereditary hemochromatosis) gene analysis, common variants (e.g., C282Y, H63D) |
|
81257 |
$90.19 |
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (e.g., Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring) |
|
81258 |
$330.97 |
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; known familial variant |
|
81259 |
$529.20 |
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence |
|
81260 |
$34.67 |
IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein) (e.g., familial dysautonomia) gene analysis, common variants (e.g., 2507+6T>C, R696P) |
|
81261 |
$174.63 |
IGH@ (Immunoglobulin heavy chain locus) (e.g., leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (e.g., polymerase chain reaction) |
|
81262 |
$60.46 |
IGH@ (Immunoglobulin heavy chain locus) (e.g., leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); direct probe methodology (e.g., Southern blot) |
|
81263 |
$259.77 |
IGH@ (Immunoglobulin heavy chain locus) (e.g., leukemia and lymphoma, B-cell), variable region somatic mutation analysis |
|
81264 |
$152.35 |
IGK@ (Immunoglobulin kappa light chain locus) (e.g., leukemia and lymphoma, B-cell), gene rearrangement analysis, evaluation to detect abnormal clonal population(s) |
|
81265 |
$205.57 |
Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (e.g., pre-transplant recipient and donor germline testing, post-transplant non-hematopoietic recipient germline [e.g., buccal swab or other germline tissue sample] and donor testing, twin zygosity testing, or maternal cell contamination of fetal cells) |
|
81266 |
$268.84 |
Comparative analysis using Short Tandem Repeat (STR) markers; each additional specimen (e.g., additional cord blood donor, additional fetal samples from different cultures, or additional zygosity in multiple birth pregnancies). (List separately in addition to code for primary procedure) |
|
81267 |
$182.98 |
Chimerism (engraftment) analysis, post transplantation specimen (e.g., hematopoietic stem cell), includes comparison to previously performed baseline analyses; without cell selection |
|
81268 |
$230.02 |
Chimerism (engraftment) analysis, post transplantation specimen (e.g., hematopoietic stem cell), includes comparison to previously performed baseline analyses; with cell selection (e.g., CD3, CD33), each cell type |
|
81269 |
$178.52 |
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; duplication/deletion variants |
|
81270 |
$80.84 |
JAK2 (Janus kinase 2) (e.g., myeloproliferative disorder) gene analysis, p.Val617Phe (V617F) variant |
|
81271 |
$120.83 |
HTT (huntingtin) (e.g., Huntington disease) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles |
|
81272 |
$290.63 |
KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (e.g., gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (e.g., exons 8, 11, 13, 17, 18) |
|
81273 |
$110.14 |
KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (e.g., mastocytosis), gene analysis, D816 variant(s) |
|
81274 |
$242.40 |
HTT (huntingtin) (e.g., Huntington disease) gene analysis; characterization of alleles (e.g., expanded size) |
|
81275 |
$170.45 |
KRAS (Kirsten rat sarcoma viral oncogene homolog) (e.g., carcinoma) gene analysis; variants in exon 2 (e.g., codons 12 and 13) |
|
81276 |
$170.45 |
KRAS (Kirsten rat sarcoma viral oncogene homolog) (e.g., carcinoma) gene analysis; additional variant(s) (e.g., codon 61, codon 146) |
|
81277 |
$1,023.12 |
Cytogenomic neoplasia (genome-wide) microarray analysis, interrogation of genomic regions for copy number and loss-of-heterozygosity variants for chromosomal abnormalities |
|
81278 |
$182.85 |
IGH@/BCL2 (t(14;18)) (e.g., follicular lymphoma) translocation analysis, major breakpoint region (MBR) and minor cluster region (mcr) breakpoints, qualitative or quantitative |
|
81279 |
$163.35 |
JAK2 (Janus kinase 2) (e.g., myeloproliferative disorder) targeted sequence analysis (e.g., exons 12 and 13) |
|
81283 |
$64.71 |
IFNL3 (interferon, lambda 3) (e.g., drug response), gene analysis, rs12979860 variant |
|
81284 |
$120.83 |
FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles |
|
81285 |
$242.40 |
FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; characterization of alleles (e.g., expanded size) |
|
81286 |
$242.40 |
FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; full gene sequence |
|
81287 |
$109.93 |
MGMT (O-6-methylguanine-DNA methyltransferase) (e.g., glioblastoma multiforme) promoter methylation analysis |
|
81288 |
$169.63 |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis |
|
81289 |
$163.35 |
FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; known familial variant(s) |
|
81290 |
$34.67 |
MCOLN1 (mucolipin 1) (e.g., Mucolipidosis, type IV) gene analysis, common variants (e.g., IVS3-2A>G, del6.4kb) |
|
81291 |
$57.63 |
MTHFR (5,10-methylenetetrahydrofolate reductase) (e.g., hereditary hypercoagulability) gene analysis, common variants (e.g., 677T, 1298C) |
|
81292 |
$595.70 |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis |
|
81293 |
$291.94 |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants |
|
81294 |
$178.52 |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants |
|
81295 |
$336.66 |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis |
|
81296 |
$297.88 |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants |
|
81297 |
$188.13 |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants |
|
81298 |
$566.11 |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis |
|
81299 |
$271.66 |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants |
|
81300 |
$209.92 |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants |
|
81301 |
$307.43 |
Microsatellite instability analysis (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) of markers for mismatch repair deficiency (e.g., BAT25, BAT26), includes comparison of neoplastic and normal tissue, if performed |
|
81302 |
$465.58 |
MECP2 (methyl CpG binding protein 2) (e.g., Rett syndrome) gene analysis; full sequence analysis |
|
81303 |
$105.84 |
MECP2 (methyl CpG binding protein 2) (e.g., Rett syndrome) gene analysis; known familial variant |
|
81304 |
$132.30 |
MECP2 (methyl CpG binding protein 2) (e.g., Rett syndrome) gene analysis; duplication/deletion variants |
|
81305 |
$154.70 |
MYD88 (myeloid differentiation primary response 88) (e.g., Waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant |
|
81306 |
$256.98 |
NUDT15 (nudix hydrolase 15) (e.g., drug metabolism) gene analysis, common variant(s) (e.g., *2, *3, *4, *5, *6) |
|
81307 |
$596.67 |
PALB2 (partner and localizer of BRCA2) (e.g., breast and pancreatic cancer) gene analysis; full gene sequence |
|
81308 |
$265.79 |
PALB2 (partner and localizer of BRCA2) (e.g., breast and pancreatic cancer) gene analysis; known familial variant |
|
81309 |
$242.40 |
PIK3CA (phosphatidylinositol-4, 5-biphosphate 3-kinase, catalytic subunit alpha) (e.g., colorectal and breast cancer) gene analysis, targeted sequence analysis (e.g., exons 7, 9, 20) |
|
81310 |
$217.43 |
NPM1 (nucleophosmin) (e.g., acute myeloid leukemia) gene analysis, exon 12 variants |
|
81311 |
$260.89 |
NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (e.g., colorectal carcinoma), gene analysis, variants in exon 2 (e.g., codons 12 and 13) and exon 3 (e.g., codon 61) |
|
81312 |
$120.83 |
PABPN1 (poly[A] binding protein nuclear 1) (e.g., oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81313 |
$224.95 |
PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related peptidase 3 [prostate specific antigen]) ratio (e.g., prostate cancer) |
|
81314 |
$290.63 |
PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (e.g., gastrointestinal stromal tumor [GIST]), gene analysis, targeted sequence analysis (e.g., exons 12, 18) |
|
81315 |
$182.85 |
PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (e.g., promyelocytic leukemia) translocation analysis; common breakpoints (e.g., intron 3 and intron 6), qualitative or quantitative |
|
81316 |
$182.85 |
PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (e.g., promyelocytic leukemia) translocation analysis; single breakpoint (e.g., intron 3, intron 6 or exon 6), qualitative or quantitative |
|
81317 |
$596.67 |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis |
|
81318 |
$291.94 |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants |
|
81319 |
$179.49 |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants |
|
81320 |
$256.98 |
PLCG2 (phospholipase C gamma 2) (e.g., chronic lymphocytic leukemia) gene analysis, common variants (e.g., R665W, S707F, L845F) |
|
81321 |
$529.20 |
PTEN (phosphatase and tensin homolog) (e.g., Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; full sequence analysis |
|
81322 |
$41.10 |
PTEN (phosphatase and tensin homolog) (e.g., Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; known familial variant |
|
81323 |
$264.60 |
PTEN (phosphatase and tensin homolog) (e.g., Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; duplication/deletion variant |
|
81324 |
$668.87 |
PMP22 (peripheral myelin protein 22) (e.g., Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; duplication/deletion analysis |
|
81325 |
$678.77 |
PMP22 (peripheral myelin protein 22) (e.g., Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; full sequence analysis |
|
81326 |
$41.10 |
PMP22 (peripheral myelin protein 22) (e.g., Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; known familial variant |
|
81327 |
$169.34 |
SEPT9 (Septin9) (e.g., colorectal cancer) promoter methylation analysis |
|
81328 |
$154.18 |
SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (e.g., adverse drug reaction), gene analysis, common variant(s) (e.g., *5) |
|
81329 |
$120.83 |
SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; dosage/deletion analysis (e.g., carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed |
|
81330 |
$41.45 |
SMPD1(sphingomyelin phosphodiesterase 1, acid lysosomal) (e.g., Niemann-Pick disease, Type A) gene analysis, common variants (e.g., R496L, L302P, fsP330) |
|
81331 |
$45.04 |
SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A) (e.g., Prader-Willi syndrome and/or Angelman syndrome), methylation analysis |
|
81332 |
$38.50 |
SERPINA1 (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1) (e.g., alpha-1-antitrypsin deficiency), gene analysis, common variants (e.g., *S and *Z) |
|
81333 |
$120.83 |
TGFBI (transforming growth factor beta-induced) (e.g., corneal dystrophy) gene analysis, common variants (e.g., R124H, R124C, R124L, R555W, R555Q) |
|
81334 |
$290.63 |
RUNX1 (runt related transcription factor 1) (e.g., acute myeloid leukemia, familial platelet disorder with associated myeloid malignancy), gene analysis, targeted sequence analysis (e.g., exons 3-8) |
|
81335 |
$154.18 |
TPMT (thiopurine S-methyltransferase) (e.g., drug metabolism), gene analysis, common variants (e.g., *2, *3) |
|
81336 |
$265.79 |
SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; full gene sequence |
|
81337 |
$163.35 |
SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; known familial sequence variant(s) |
|
81338 |
$132.59 |
MPL (MPL proto-oncogene, thrombopoietin receptor) (e.g., myeloproliferative disorder) gene analysis; common variants (e.g., W515A, W515K, W515L, W515R) |
|
81339 |
$163.35 |
MPL (MPL proto-oncogene, thrombopoietin receptor) (e.g., myeloproliferative disorder) gene analysis; sequence analysis, exon 10 |
|
81340 |
$184.27 |
TRB@ (T cell antigen receptor, beta) (e.g., leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using amplification methodology (e.g., polymerase chain reaction) |
|
81341 |
$43.74 |
TRB@ (T cell antigen receptor, beta) (e.g., leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using direct probe methodology (e.g., Southern blot) |
|
81342 |
$177.72 |
TRG@ (T cell antigen receptor, gamma) (e.g., leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population(s) |
|
81343 |
$120.83 |
PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81344 |
$120.83 |
TBP (TATA box binding protein) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles |
|
81345 |
$163.35 |
TERT (telomerase reverse transcriptase) (e.g., thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (e.g., promoter region) |
|
81346 |
$154.18 |
TYMS (thymidylate synthetase) (e.g., 5-fluorouracil/5-FU drug metabolism), gene analysis, common variant(s) (e.g., tandem repeat variant) |
|
81347 |
$170.45 |
SF3B1 (splicing factor [3b] subunit B1) (e.g., myelodysplastic syndrome/acute myeloid leukemia) gene analysis, common variants (e.g., A672T, E622D, L833F, R625C, R625L) |
|
81348 |
$154.70 |
SRSF2 (serine and arginine-rich splicing factor 2) (e.g., myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variants (e.g., P95H, P95L) |
|
81349 |
$0 |
Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and loss-of-heterozygosity variants, low-pass sequencing analysis |
|
81350 |
$206.39 |
UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (e.g., drug metabolism, hereditary unconjugated hyperbilirubinemia [Gilbert syndrome]) gene analysis, common variants (e.g., *28, *36, *37) |
|
81351 |
$566.11 |
TP53 (tumor protein 53) (e.g., Li-Fraumeni syndrome) gene analysis; full gene sequence |
|
81352 |
$290.63 |
TP53 (tumor protein 53) (e.g., Li-Fraumeni syndrome) gene analysis; targeted sequence analysis (e.g., 4 oncology) |
|
81353 |
$271.66 |
TP53 (tumor protein 53) (e.g., Li-Fraumeni syndrome) gene analysis; known familial variant |
|
81355 |
$77.79 |
VKORC1 (vitamin K epoxide reductase complex, subunit 1) (e.g., warfarin metabolism), gene analysis, common variant(s) (e.g., -1639G>A, c.173+1000C>T) |
|
81357 |
$170.45 |
U2AF1 (U2 small nuclear RNA auxiliary factor 1) (e.g., myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variants (e.g., S34F, S34Y, Q157R, Q157P) |
|
81360 |
$170.45 |
ZRSR2 (zinc finger CCCH-type, RNA binding motif and serine/arginine-rich 2) (e.g., myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variant(s) (e.g., E65fs, E122fs, R448fs) |
|
81361 |
$154.18 |
HBB (hemoglobin, subunit beta) (e.g., sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (e.g., HbS, HbC, HbE) |
|
81362 |
$330.97 |
HBB (hemoglobin, subunit beta) (e.g., sickle cell anemia, beta thalassemia, hemoglobinopathy); known familial variant(s) |
|
81363 |
$178.52 |
HBB (hemoglobin, subunit beta) (e.g., sickle cell anemia, beta thalassemia, hemoglobinopathy); duplication/deletion variant(s) |
|
81364 |
$286.28 |
HBB (hemoglobin, subunit beta) (e.g., sickle cell anemia, beta thalassemia, hemoglobinopathy); full gene sequence |
|
81370 |
$354.67 |
HLA Class I and II typing, low resolution (e.g., antigen equivalents); HLA-A, -B, -C, -DRB1/3/4/5, and -DQB1 |
|
81371 |
$356.79 |
HLA Class I and II typing, low resolution (e.g., antigen equivalents); HLA-A, -B, and -DRB1 (e.g., verification typing) |
|
81372 |
$355.97 |
HLA Class I typing, low resolution (e.g., antigen equivalents); complete (i.e., HLA-A, -B, and -C) |
|
81373 |
$112.39 |
HLA Class I typing, low resolution (e.g., antigen equivalents); one locus (e.g., HLA-A, -B, or -C), each |
|
81374 |
$65.56 |
HLA Class I typing, low resolution (e.g., antigen equivalents); one antigen equivalent (e.g., B*27), each |
|
81375 |
$194.69 |
HLA Class II typing, low resolution (e.g., antigen equivalents); HLA-DRB1/3/4/5 and -DQB1 |
|
81376 |
$107.80 |
HLA Class II typing, low resolution (e.g., antigen equivalents); one locus (e.g., HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each |
|
81377 |
$83.56 |
HLA Class II typing, low resolution (e.g., antigen equivalents); one antigen equivalent, each |
|
81378 |
$304.79 |
HLA Class I and II typing, high resolution (i.e., alleles or allele groups), HLA-A, -B, -C, and -DRB1 |
|
81379 |
$295.81 |
HLA Class I typing, high resolution (i.e., alleles or allele groups); complete (i.e. HLA-A, -B, and -C) |
|
81380 |
$156.33 |
HLA Class I typing, high resolution (i.e., alleles or allele groups); one locus (e.g., HLA-A, -B, or -C), each |
|
81381 |
$149.85 |
HLA Class I typing, high resolution (i.e., alleles or allele groups); one allele or allele group (e.g., B*57:01P), each |
|
81382 |
$109.09 |
HLA Class II typing, high resolution (i.e., alleles or allele groups); one locus (e.g., HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each |
|
81383 |
$96.25 |
HLA Class II typing, high resolution (i.e., alleles or allele groups); one allele or allele group (e.g., HLA-DQB1*06:02P), each |
|
81400 |
$56.41 |
Molecular Pathology Procedure Level 1 |
|
81401 |
$120.83 |
Molecular Pathology Procedure Level 2 |
|
81402 |
$132.59 |
Molecular Pathology Procedure Level 3 |
|
81403 |
$163.35 |
Molecular Pathology Procedure Level 4 |
|
81404 |
$242.40 |
Molecular Pathology Procedure Level 5 |
|
81405 |
$265.79 |
Molecular Pathology Procedure Level 6 |
|
81406 |
$249.50 |
Molecular Pathology Procedure Level 7 |
|
81407 |
$746.41 |
Molecular Pathology Procedure Level 8 |
|
81408 |
$1,764.00 |
Molecular Pathology Procedure Level 9 |
|
81410 |
$444.53 |
Aortic dysfunction or dilation (e.g., Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK |
|
81411 |
$1,190.87 |
Aortic dysfunction or dilation (e.g., Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1 |
|
81412 |
$2,159.63 |
Ashkenazi Jewish associated disorders (e.g., Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1 |
|
81413 |
$515.88 |
Cardiac ion channelopathies (e.g., Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia); genomic sequence analysis panel, must include sequencing of at least test genes, including ANK2, CASQ2, CAV3, KCNE1, KCNE2, KCNH2, KCNJ2, KCNQ1, RYR2, and SCN5A |
|
81414 |
$515.88 |
Cardiac ion channelopathies (e.g., Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia); duplication/deletion gene analysis panel, must include analysis of at least two genes, including KCNH2 and KCNQ1 |
|
81415 |
$4,215.96 |
Exome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis |
|
81416 |
$10,584.00 |
Exome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (e.g., parents, siblings) (List separately in addition to code for primary procedure) |
|
81417 |
$282.24 |
Exome (e.g., unexplained constitutional or heritable disorder or syndrome); reevaluation of previously obtained exome sequence (e.g., updated knowledge or unrelated condition/syndrome) |
|
81419 |
$2,159.63 |
Epilepsy genomic sequence analysis panel, must include analyses for ALDH7A1, CACNA1A, CDKL5, CHD2, GABRG2, GRIN2A, KCNQ2, MECP2, PCDH19, POLG, PRRT2, SCN1A, SCN1B, SCN2A, SCN8A, SLC2A1, SLC9A6, STXBP1, SYNGAP1, TCF4, TPP1, TSC1, TSC2, and ZEB2 |
|
81420 |
$669.48 |
Fetal chromosomal aneuploidy (e.g., trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 |
|
81422 |
$669.48 |
Fetal chromosomal microdeletion(s) genomic sequence analysis (e.g., DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood |
|
81425 |
$4,437.52 |
Genome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis |
|
81426 |
$2,390.18 |
Genome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome (e.g., parents, siblings) (List separately in addition to code for primary procedure) |
|
81427 |
$2,061.81 |
Genome (e.g., unexplained constitutional or heritable disorder or syndrome); reevaluation of previously obtained genome sequence (e.g., updated knowledge or unrelated condition/syndrome) |
|
81430 |
$1,433.25 |
Hearing loss (e.g., nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); genomic sequence analysis panel, must include sequencing of at least 60 genes, including CDH23, CLRN1, GJB2, GPR98, MTRNR1, MYO7A, MYO15A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS1 |
|
81431 |
$599.38 |
Hearing loss (e.g., nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); duplication/deletion analysis panel, must include copy number analyses for STRC and DFNB1 deletions in GJB2 and GJB6 genes |
|
81432 |
$598.92 |
Hereditary breast cancer-related disorders (e.g., hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least ten genes, always including BRCA1, BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN, STK11, and TP53 |
|
81433 |
$387.14 |
Hereditary breast cancer-related disorders (e.g., hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11 |
|
81434 |
$527.36 |
Hereditary retinal disorders (e.g., retinitis pigmentosa, Leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, RP2, RPE65, RPGR, and USH2A |
|
81435 |
$515.88 |
Hereditary colon cancer disorders (e.g., Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include sequencing of at least ten genes, including APC, BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and STK11 |
|
81436 |
$515.88 |
Hereditary colon cancer disorders (e.g., Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); duplication/deletion analysis panel, must include analysis of at least five genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11 |
|
81437 |
$387.14 |
Hereditary neuroendocrine tumor disorders (e.g., medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); genomic sequence analysis panel, must include sequencing of at least six genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL |
|
81438 |
$387.14 |
Hereditary neuroendocrine tumor disorders (e.g., medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD, and VHL |
|
81439 |
$515.88 |
Hereditary cardiomyopathy (e.g., hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy), genomic sequence analysis panel, must include sequencing of at least five cardiomyopathy-related genes (e.g., DSG2, MYBPC3, MYH7, PKP2, TTN) |
|
81440 |
$2,931.77 |
Nuclear encoded mitochondrial genes (e.g., neurologic or myopathic phenotypes), genomic sequence panel, must include analysis of at least 100 genes, including BCS1L, C10orf2, COQ2, COX10, DGUOK, MPV17, OPA1, PDSS2, POLG, POLG2, RRM2B, SCO1, SCO2, SLC25A4, SUCLA2, SUCLG1, TAZ, TK2, and TYMP |
|
81442 |
$1,890.66 |
Noonan spectrum disorders (e.g., Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence analysis panel, must include sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1 |
|
81443 |
$2,159.63 |
Genetic testing for severe inherited conditions (e.g., cystic fibrosis, Ashkenazi Jewish-associated disorders [e.g., Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (e.g., ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH) |
|
81445 |
$527.36 |
Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, and RNA analysis when performed, 5-50 genes (e.g., ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed |
|
81448 |
$515.88 |
Hereditary peripheral neuropathies (e.g., Charcot-Marie-Tooth, spastic paraplegia), genomic sequence analysis panel, must include sequencing of at least 5 peripheral neuropathy-related genes (e.g., BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST, SPG11, SPTLC1) |
|
81450 |
$669.91 |
Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA analysis, and RNA analysis when performed, 5-50 genes (e.g., BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KRAS, KIT, MLL, NRAS, NPM1, NOTCH1), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed |
|
81455 |
$2,575.09 |
Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA analysis, and RNA analysis when performed, 51 or greater genes (e.g., ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NPM1, NRAS, MET, NOTCH1, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed |
|
81460 |
$1,135.13 |
Whole mitochondrial genome (e.g., Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes [MELAS], myoclonic epilepsy with ragged-red fibers [MERFF], neuropathy, ataxia, and retinitis pigmentosa [NARP], Leber hereditary optic neuropathy [LHON]), genomic sequence, must include sequence analysis of entire mitochondrial genome with heteroplasmy detection |
|
81465 |
$825.55 |
Whole mitochondrial genome large deletion analysis panel (e.g., Kearns-Sayre syndrome, chronic progressive external ophthalmoplegia), including heteroplasmy detection, if performed |
|
81470 |
$806.15 |
X-linked intellectual disability (XLID) (e.g., syndromic and non-syndromic XLID); genomic sequence analysis panel, must include sequencing of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2 |
|
81471 |
$806.15 |
X-linked intellectual disability (XLID) (e.g., syndromic and non-syndromic XLID); duplication/deletion gene analysis, must include analysis of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2 |
|
81479 |
I.C. |
Unlisted molecular pathology procedure |
|
81490 |
$741.45 |
Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score |
|
81493 |
$926.10 |
Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score |
|
81500 |
$229.76 |
Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score |
|
81503 |
$791.15 |
Oncology (ovarian), biochemical assays of five proteins (CA-125, apolipoprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score |
|
81506 |
$60.79 |
Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, HbA1c, insulin, hs-CRP, adiponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk score |
|
81508 |
$47.89 |
Fetal congenital abnormalities, biochemical assays of two proteins (PAPP-A, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score |
|
81509 |
$1,311.86 |
Fetal congenital abnormalities, biochemical assays of three proteins (PAPP-A, hCG [any form], DIA), utilizing maternal serum, algorithm reported as a risk score |
|
81510 |
$48.99 |
Fetal congenital abnormalities, biochemical assays of three analytes (AFP, uE3, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score |
|
81511 |
$135.39 |
Fetal congenital abnormalities, biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) utilizing maternal serum, algorithm reported as a risk score (may include additional results from previous biochemical testing) |
|
81512 |
$61.32 |
Fetal congenital abnormalities, biochemical assays of five analytes (AFP, uE3, total hCG, hyperglycosylated hCG, DIA) utilizing maternal serum, algorithm reported as a risk score |
|
81513 |
$125.80 |
Infectious disease, bacterial vaginosis, quantitative real-time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species, utilizing vaginal-fluid specimens, algorithm reported as a positive or negative result for bacterial vaginosis |
|
81514 |
$231.96 |
Infectious disease, bacterial vaginosis and vaginitis, quantitative real-time amplification of DNA markers for Gardnerella vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), and Lactobacillus species (L. crispatus and L. jensenii), utilizing vaginal-fluid specimens, algorithm reported as a positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and/or Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata, Candida krusei, when reported |
|
81518 |
$3,415.99 |
Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy |
|
81519 |
$3,415.99 |
Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score |
|
81520 |
$2,214.01 |
Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence risk score |
|
81521 |
$3,415.99 |
Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes and 465 housekeeping genes, utilizing fresh frozen or formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk of distant metastasis |
|
81522 |
$3,415.99 |
Oncology (breast), mRNA, gene expression profiling by RT-PCR of 12 genes (8 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk score |
|
81523 |
$3,415.99 |
Oncology (breast), mRNA, next-generation sequencing gene expression profiling of 70 content genes and 31 housekeeping genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk to distant metastasis |
|
81525 |
$2,748.31 |
Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score |
|
81528 |
$448.82 |
Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result |
|
81529 |
$6,344.23 |
Oncology (cutaneous melanoma), mRNA, gene expression profiling by real-time RT-PCR of 31 genes (28 content and 3 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk, including likelihood of sentinel lymph node metastasis |
|
81535 |
$511.08 |
Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combination |
|
81536 |
$156.61 |
Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; each additional single drug or drug combination (List separately in addition to code for primary procedure) |
|
81538 |
$2,532.22 |
Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival |
|
81539 |
$670.32 |
Oncology (high-grade prostate cancer), biochemical assay of four proteins (Total PSA, Free PSA, Intact PSA, and human kallikrein-2 [hK2]), utilizing plasma or serum, prognostic algorithm reported as a probability score |
|
81540 |
$3,307.50 |
Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype |
|
81541 |
$3,415.99 |
Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a disease-specific mortality risk score |
|
81542 |
$3,415.99 |
Oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as metastasis risk score |
|
81546 |
$3,175.20 |
Oncology (thyroid), mRNA, gene expression analysis of 10,196 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (e.g., benign or suspicious) |
|
81551 |
$1,790.46 |
Oncology (prostate), promoter methylation profiling by real-time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a likelihood of prostate cancer detection on repeat biopsy |
|
81552 |
$6,858.43 |
Oncology (uveal melanoma), mRNA, gene expression profiling by real-time RT-PCR of 15 genes (12 content and 3 housekeeping), utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported as risk of metastasis |
|
81554 |
$4,851.00 |
Pulmonary disease (idiopathic pulmonary fibrosis [IPF]), mRNA, gene expression analysis of 190 genes, utilizing transbronchial biopsies, diagnostic algorithm reported as categorical result (e.g., positive or negative for high probability of usual interstitial pneumonia [UIP]) |
|
81560 |
$0 |
Transplantation medicine (allograft rejection, pediatric liver and small bowel), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorithm reported as a rejection risk score |
|
81595 |
$2,857.68 |
Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score |
|
81596 |
$63.67 |
Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver |
|
81599 |
I.C. |
Unlisted multianalyte assay with algorithmic analysis |
|
G0027 |
$5.73 |
Semen analysis; presence and/or motility of sperm excluding Huhner |
|
G0103 |
$17.03 |
Prostate cancer screening; prostate specific antigen test (PSA) |
|
G0123 |
$17.87 |
creening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
|
G0143 |
$23.86 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision |
|
G0144 |
$38.78 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision |
|
G0145 |
$23.36 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
|
G0147 |
$13.36 |
Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision |
|
G0148 |
$28.17 |
Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening |
|
G0306 |
$6.85 |
Complete CBC, automated (HgB, HCT, RBC, WBC, without platelet count) and automated WBC differential count |
|
G0307 |
$5.71 |
Complete CBC, automated (HgB, HCT, RBC, WBC; without platelet count) |
|
G0328 |
$15.92 |
Colorectal cancer screening; fecal occult blood test, immunoassay, one to three simultaneous determinations |
|
G0432 |
$17.26 |
Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening |
|
G0433 |
$16.13 |
Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening |
|
G0435 |
$10.57 |
Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening |
|
G0480 |
$59.69 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
|
G0481 |
$91.84 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
|
G0482 |
$123.97 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed |
|
G0483 |
$160.71 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed |
|
G2023 |
$23.46 |
Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source |
|
G2023 CG |
$44.27 |
Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source. [Used when provider 1) has a qualified ordering clinician present at the specimen collection site available to order medically necessary COVID-19 diagnostic tests; and 2) ensures the test results are provided to the patient (along with any initial follow-up counseling, as appropriate), either directly or through the patient's ordering clinician.] |
|
G2024 |
$25.46 |
Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source |
|
G2024 CG |
$46.27 |
Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source. [Used when provider 1) has a qualified ordering clinician present at the specimen collection site available to order medically necessary COVID-19 diagnostic tests; and 2) ensures the test results are provided to the patient (along with any initial follow-up counseling, as appropriate), either directly or through the patient's ordering clinician.] |
|
G9143 |
$106.48 |
Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s) |
|
P2028 |
$4.37 |
Cephalin floculation, blood |
|
P2029 |
$4.37 |
Congo red, blood |
|
P2031 |
$4.37 |
Hair analysis (excluding arsenic) |
|
P2033 |
$4.37 |
Thymol turbidity, blood |
|
P2038 |
$4.37 |
Mucoprotein, blood (seromucoid) (medical necessity procedure) |
|
P9604 |
$4.65 |
Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated trip charge |
|
P9612 |
$2.65 |
Catheterization for collection of specimen, single patient, all places of service |
|
P9615 |
$2.65 |
Catheterization for collection of specimen(s) (multiple patients) |
|
Q0111 |
$13.36 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
|
Q0112 |
$5.14 |
All potassium hydroxide (KOH) preparations |
|
Q0113 |
$3.77 |
Pinworm examinations |
|
Q0114 |
$8.59 |
Fern test |
|
Q0115 |
$22.05 |
Postcoital direct, qualitative examinations of vaginal or cervical mucous |
|
U0002 |
$51.31 |
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC |
|
U0003 |
$75.00 |
Infectious agent detection by nucleic acid (DNA or RNA); Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R |
|
U0004 |
$75.00 |
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R |
|
U0005 |
$25.00 |
Infectious agent detection by nucleic acid (DNA or RNA); Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, CDC or non-CDC, making use of high throughput technologies, completed within two calendar days from date of specimen collection (list separately in addition to either HCPCS code U0003 or U0004) as described by CMS-2020-01-R2 |
