carta circular pr prov19-011-002€¦ · carta circular pr prov19-011-002 7 de noviembre de 2019 a:...
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CARTA CIRCULAR PR PROV19-011-002
7 de noviembre de 2019
A: PROVEEDORES DE SERVICIOS DEL PLAN VITAL Y GRUPOS MÉDICOS
Re: CODIGOS DE HIGH COST HIGH NEED (HCHN)
Estimado Proveedor:
Para el proceso de certificación de pacientes “High Cost/High Need (HCHN)”, la
Administración de Seguros de Salud de Puerto Rico (ASES) ha establecido que los códigos
que sean relacionados a laboratorios o procedimientos de radiología que no provengan de una
reclamación IP, no se utilizaran para la certificación de HCHN. La ASES ha determinado los
siguientes “Revenue Codes” y Códigos de Procedimientos (HCPCS) utilizados por Milliman
para excluir reclamaciones del análisis de HCHN:
RevCode Description
0300 Laboratory-general classification
0301 Laboratory-chemistry
0302 Laboratory-immunology
0303 Laboratory-renal patient (home)
0304 Laboratory-non-routine dialysis
0305 Laboratory-hematology
0306 Laboratory-bacteriology & microbiology
0307 Laboratory-urology
0309 Laboratory-other laboratory
0310 Laboratory pathological-general classification
0311 Laboratory pathological-cytology
0312 Laboratory pathological-histology
0314 Laboratory pathological-biopsy
0319 Laboratory pathological-other
0320 Radiology diagnostic-general classification
0321 Radiology diagnostic-angiocardiography
0322 Radiology diagnostic-arthrography
0323 Radiology diagnostic-arteriography
0324 Radiology diagnostic-chest X-ray
0329 Radiology diagnostic-other
0330 Radiology therapeutic-general classification
0333 Radiology therapeutic-radiation therapy
0339 Radiology therapeutic-other
0340 Nuclear medicine-general classification
0341 Nuclear medicine-diagnostic procedures
0342 Nuclear medicine-therapeutic procedures
0343 Nuclear medicine-Diagnostic Radiopharmaceuticals (Eff 10/1/04)
0344 Nuclear medicine-Therapeutic Radiopharmaceuticals (Eff 10/1/04)
Page 1 of 55
0349 Nuclear medicine-other
0350 Computed tomographic (CT) scan-general-classification
0351 CT scan-head scan
0352 CT scan-body scan
0359 CT scan-other CT scans
0400 Other imaging services-general classification
0401 Other imaging services-diagnostic mammography
0402 Other imaging services-ultrasound
0403 Other imaging services-screening mammography-(eff 1/1/91)
0404 Other imaging services-positron emission-tomography (eff 10/94)
0409 Other imaging services-other
0610 Magnetic resonance imaging (MRI) and Magnetic Resonance Anigiography (MRA)-general-classification
0611 MRI-brain (including brainstem)
0612 MRI-spinal cord (including spine)
0614 MRI-other
0615 MRA-Head and Neck
0616 MRA-Lower Extremities
0618 MRA-other
0619 MRI-other
0923 Other diagnostic services-pap smear
0925 Other diagnostic services-pregnancy test
0971 Professional fees-laboratory
0972 Professional fees-radiology diagnostic
0973 Professional fees-radiology therapeutic
0974 Professional fees-radiology nuclear medicine
HCPCS Description
36415 Routine venipuncture
36416 Capillary blood draw
70010 Contrast x-ray of brain
70015 Contrast x-ray of brain
70030 X-ray eye for foreign body
70100 X-ray exam of jaw <4views
70110 X-ray exam of jaw 4/> views
70120 X-ray exam of mastoids
70130 X-ray exam of mastoids
70134 X-ray exam of middle ear
70140 X-ray exam of facial bones
70150 X-ray exam of facial bones
70160 X-ray exam of nasal bones
70170 X-ray exam of tear duct
70190 X-ray exam of eye sockets
70200 X-ray exam of eye sockets
70210 X-ray exam of sinuses
70220 X-ray exam of sinuses
70240 X-ray exam pituitary saddle
70250 X-ray exam of skull
70260 X-ray exam of skull
70300 X-ray exam of teeth
70310 X-ray exam of teeth
70320 Full mouth x-ray of teeth
70328 X-ray exam of jaw joint
70330 X-ray exam of jaw joints
70332 X-ray exam of jaw joint
70336 Magnetic image jaw joint
70350 X-ray head for orthodontia
Page 2 of 55
70355 Panoramic x-ray of jaws
70360 X-ray exam of neck
70370 Throat x-ray & fluoroscopy
70371 Speech evaluation complex
70373 Contrast x-ray of larynx
70380 X-ray exam of salivary gland
70390 X-ray exam of salivary duct
70450 Ct head/brain w/o dye
70460 Ct head/brain w/dye
70470 Ct head/brain w/o & w/dye
70480 Ct orbit/ear/fossa w/o dye
70481 Ct orbit/ear/fossa w/dye
70482 Ct orbit/ear/fossa w/o&w/dye
70486 Ct maxillofacial w/o dye
70487 Ct maxillofacial w/dye
70488 Ct maxillofacial w/o & w/dye
70490 Ct soft tissue neck w/o dye
70491 Ct soft tissue neck w/dye
70492 Ct sft tsue nck w/o & w/dye
70496 Ct angiography head
70498 Ct angiography neck
70540 Mri orbit/face/neck w/o dye
70542 Mri orbit/face/neck w/dye
70543 Mri orbt/fac/nck w/o &w/dye
70544 Mr angiography head w/o dye
70545 Mr angiography head w/dye
70546 Mr angiograph head w/o&w/dye
70547 Mr angiography neck w/o dye
70548 Mr angiography neck w/dye
70549 Mr angiograph neck w/o&w/dye
70551 Mri brain stem w/o dye
70552 Mri brain stem w/dye
70553 Mri brain stem w/o & w/dye
70554 Fmri brain by tech
70555 Fmri brain by phys/psych
70557 Mri brain w/o dye
70558 Mri brain w/dye
70559 Mri brain w/o & w/dye
71010 Chest x-ray 1 view frontal
71015 Chest x-ray stereo frontal
71020 Chest x-ray 2vw frontal&latl
71021 Chest x-ray frnt lat lordotc
71022 Chest x-ray frnt lat oblique
71023 Chest x-ray and fluoroscopy
71030 Chest x-ray 4/> views
71034 Chest x-ray&fluoro 4/> views
71035 Chest x-ray special views
71040 Contrast x-ray of bronchi
71045 X-ray exam chest 1 view
71046 X-ray exam chest 2 views
71047 X-ray exam chest 3 views
71048 X-ray exam chest 4+ views
71060 Contrast x-ray of bronchi
71100 X-ray exam ribs uni 2 views
71101 X-ray exam unilat ribs/chest
Page 3 of 55
71110 X-ray exam ribs bil 3 views
71111 X-ray exam ribs/chest4/> vws
71120 X-ray exam breastbone 2/>vws
71130 X-ray strenoclavic jt 3/>vws
71250 Ct thorax w/o dye
71260 Ct thorax w/dye
71270 Ct thorax w/o & w/dye
71275 Ct angiography chest
71550 Mri chest w/o dye
71551 Mri chest w/dye
71552 Mri chest w/o & w/dye
71555 Mri angio chest w or w/o dye
72010 X-ray exam spine ap&lat
72020 X-ray exam of spine 1 view
72040 X-ray exam neck spine 2-3 vw
72050 X-ray exam neck spine 4/5vws
72052 X-ray exam neck spine 6/>vws
72069 X-ray exam trunk spine stand
72070 X-ray exam thorac spine 2vws
72072 X-ray exam thorac spine 3vws
72074 X-ray exam thorac spine4/>vw
72080 X-ray exam thoracolmb 2/> vw
72081 X-ray exam entire spi 1 vw
72082 X-ray exam entire spi 2/3 vw
72083 X-ray exam entire spi 4/5 vw
72084 X-ray exam entire spi 6/> vw
72090 X-ray exam scloiosis erect
72100 X-ray exam l-s spine 2/3 vws
72110 X-ray exam l-2 spine 4/>vws
72114 X-ray exam l-s spine bending
72120 X-ray bend only l-s spine
72125 Ct neck spine w/o dye
72126 Ct neck spine w/dye
72127 Ct neck spine w/o & w/dye
72128 Ct chest spine w/o dye
72129 Ct chest spine w/dye
72130 Ct chest spine w/o & w/dye
72131 Ct lumbar spine w/o dye
72132 Ct lumbar spine w/dye
72133 Ct lumbar spine w/o & w/dye
72141 Mri neck spine w/o dye
72142 Mri neck spine w/dye
72146 Mri chest spine w/o dye
72147 Mri chest spine w/dye
72148 Mri lumbar spine w/o dye
72149 Mri lumbar spine w/dye
72156 Mri neck spine w/o & w/dye
72157 Mri chest spine w/o & w/dye
72158 Mri lumbar spine w/o & w/dye
72159 Mr angio spine w/o&w/dye
72170 X-ray exam of pelvis
72190 X-ray exam of pelvis
72191 Ct angiograph pelv w/o&w/dye
72192 Ct pelvis w/o dye
72193 Ct pelvis w/dye
Page 4 of 55
72194 Ct pelvis w/o & w/dye
72195 Mri pelvis w/o dye
72196 Mri pelvis w/dye
72197 Mri pelvis w/o & w/dye
72198 Mr angio pelvis w/o & w/dye
72200 X-ray exam si joints
72202 X-ray exam si joints 3/> vws
72220 X-ray exam sacrum tailbone
72240 Myelography neck spine
72255 Myelography thoracic spine
72265 Myelography l-s spine
72270 Myelogphy 2/> spine regions
72275 Epidurography
72285 Discography cerv/thor spine
72291 Perq verte/sacroplsty fluor
72292 Perq verte/sacroplsty ct
72295 X-ray of lower spine disk
73000 X-ray exam of collar bone
73010 X-ray exam of shoulder blade
73020 X-ray exam of shoulder
73030 X-ray exam of shoulder
73040 Contrast x-ray of shoulder
73050 X-ray exam of shoulders
73060 X-ray exam of humerus
73070 X-ray exam of elbow
73080 X-ray exam of elbow
73085 Contrast x-ray of elbow
73090 X-ray exam of forearm
73092 X-ray exam of arm infant
73100 X-ray exam of wrist
73110 X-ray exam of wrist
73115 Contrast x-ray of wrist
73120 X-ray exam of hand
73130 X-ray exam of hand
73140 X-ray exam of finger(s)
73200 Ct upper extremity w/o dye
73201 Ct upper extremity w/dye
73202 Ct uppr extremity w/o&w/dye
73206 Ct angio upr extrm w/o&w/dye
73218 Mri upper extremity w/o dye
73219 Mri upper extremity w/dye
73220 Mri uppr extremity w/o&w/dye
73221 Mri joint upr extrem w/o dye
73222 Mri joint upr extrem w/dye
73223 Mri joint upr extr w/o&w/dye
73225 Mr angio upr extr w/o&w/dye
73500 X-ray exam of hip
73501 X-ray exam hip uni 1 view
73502 X-ray exam hip uni 2-3 views
73503 X-ray exam hip uni 4/> views
73510 X-ray exam of hip
73520 X-ray exam of hips
73521 X-ray exam hips bi 2 views
73522 X-ray exam hips bi 3-4 views
73523 X-ray exam hips bi 5/> views
Page 5 of 55
73525 Contrast x-ray of hip
73530 X-ray exam of hip
73540 X-ray exam of pelvis & hips
73550 X-ray exam of thigh
73551 X-ray exam of femur 1
73552 X-ray exam of femur 2/>
73560 X-ray exam of knee 1 or 2
73562 X-ray exam of knee 3
73564 X-ray exam knee 4 or more
73565 X-ray exam of knees
73580 Contrast x-ray of knee joint
73590 X-ray exam of lower leg
73592 X-ray exam of leg infant
73600 X-ray exam of ankle
73610 X-ray exam of ankle
73615 Contrast x-ray of ankle
73620 X-ray exam of foot
73630 X-ray exam of foot
73650 X-ray exam of heel
73660 X-ray exam of toe(s)
73700 Ct lower extremity w/o dye
73701 Ct lower extremity w/dye
73702 Ct lwr extremity w/o&w/dye
73706 Ct angio lwr extr w/o&w/dye
73718 Mri lower extremity w/o dye
73719 Mri lower extremity w/dye
73720 Mri lwr extremity w/o&w/dye
73721 Mri jnt of lwr extre w/o dye
73722 Mri joint of lwr extr w/dye
73723 Mri joint lwr extr w/o&w/dye
73725 Mr ang lwr ext w or w/o dye
74000 X-ray exam of abdomen
74010 X-ray exam of abdomen
74018 X-ray exam abdomen 1 view
74019 X-ray exam abdomen 2 views
74020 X-ray exam of abdomen
74021 X-ray exam abdomen 3+ views
74022 X-ray exam series abdomen
74150 Ct abdomen w/o dye
74160 Ct abdomen w/dye
74170 Ct abdomen w/o & w/dye
74174 Ct angio abd&pelv w/o&w/dye
74175 Ct angio abdom w/o & w/dye
74176 Ct abd & pelvis w/o contrast
74177 Ct abd & pelv w/contrast
74178 Ct abd & pelv 1/> regns
74181 Mri abdomen w/o dye
74182 Mri abdomen w/dye
74183 Mri abdomen w/o & w/dye
74185 Mri angio abdom w orw/o dye
74190 X-ray exam of peritoneum
74210 Contrst x-ray exam of throat
74220 Contrast x-ray esophagus
74230 Cine/vid x-ray throat/esoph
74235 Remove esophagus obstruction
Page 6 of 55
74240 X-ray upper gi delay w/o kub
74241 X-ray upper gi delay w/kub
74245 X-ray upper gi&small intest
74246 Contrst x-ray uppr gi tract
74247 Contrst x-ray uppr gi tract
74249 Contrst x-ray uppr gi tract
74250 X-ray exam of small bowel
74251 X-ray exam of small bowel
74260 X-ray exam of small bowel
74261 Ct colonography dx
74262 Ct colonography dx w/dye
74263 Ct colonography screening
74270 Contrast x-ray exam of colon
74280 Contrast x-ray exam of colon
74283 Ther nma rdctj intus/obstrcj
74290 Contrast x-ray gallbladder
74291 Contrast x-rays gallbladder
74300 X-ray bile ducts/pancreas
74301 X-rays at surgery add-on
74305 X-ray bile ducts/pancreas
74320 Contrast x-ray of bile ducts
74327 X-ray bile stone removal
74328 X-ray bile duct endoscopy
74329 X-ray for pancreas endoscopy
74330 X-ray bile/panc endoscopy
74340 X-ray guide for gi tube
74355 X-ray guide intestinal tube
74360 X-ray guide gi dilation
74363 X-ray bile duct dilation
74400 Contrst x-ray urinary tract
74410 Contrst x-ray urinary tract
74415 Contrst x-ray urinary tract
74420 Contrst x-ray urinary tract
74425 Contrst x-ray urinary tract
74430 Contrast x-ray bladder
74440 X-ray male genital tract
74445 X-ray exam of penis
74450 X-ray urethra/bladder
74455 X-ray urethra/bladder
74470 X-ray exam of kidney lesion
74475 X-ray control cath insert
74480 X-ray control cath insert
74485 Dilation urtr/urt rs&i
74710 X-ray measurement of pelvis
74712 Mri fetal sngl/1st gestation
74713 MRI fetal ea addl gestation
74740 X-ray female genital tract
74742 X-ray fallopian tube
74775 X-ray exam of perineum
75557 Cardiac mri for morph
75559 Cardiac mri w/stress img
75561 Cardiac mri for morph w/dye
75563 Card mri w/stress img & dye
75565 Card mri veloc flow mapping
75571 Ct hrt w/o dye w/ca test
Page 7 of 55
75572 Ct hrt w/3d image
75573 Ct hrt w/3d image congen
75574 Ct angio hrt w/3d image
75600 Contrast exam thoracic aorta
75605 Contrast exam thoracic aorta
75625 Contrast exam abdominl aorta
75630 X-ray aorta leg arteries
75635 Ct angio abdominal arteries
75650 Artery x-rays head & neck
75658 Artery x-rays arm
75660 Artery x-rays head & neck
75662 Artery x-rays head & neck
75665 Artery x-rays head & neck
75671 Artery x-rays head & neck
75676 Artery x-rays neck
75680 Artery x-rays neck
75685 Artery x-rays spine
75705 Artery x-rays spine
75710 Artery x-rays arm/leg
75716 Artery x-rays arms/legs
75726 Artery x-rays abdomen
75731 Artery x-rays adrenal gland
75733 Artery x-rays adrenals
75736 Artery x-rays pelvis
75741 Artery x-rays lung
75743 Artery x-rays lungs
75746 Artery x-rays lung
75756 Artery x-rays chest
75774 Artery x-ray each vessel
75791 Av dialysis shunt imaging
75801 Lymph vessel x-ray arm/leg
75803 Lymph vessel x-ray arms/legs
75805 Lymph vessel x-ray trunk
75807 Lymph vessel x-ray trunk
75809 Nonvascular shunt x-ray
75810 Vein x-ray spleen/liver
75820 Vein x-ray arm/leg
75822 Vein x-ray arms/legs
75825 Vein x-ray trunk
75827 Vein x-ray chest
75831 Vein x-ray kidney
75833 Vein x-ray kidneys
75840 Vein x-ray adrenal gland
75842 Vein x-ray adrenal glands
75860 Vein x-ray neck
75870 Vein x-ray skull
75872 Vein x-ray skull epidural
75880 Vein x-ray eye socket
75885 Vein x-ray liver w/hemodynam
75887 Vein x-ray liver w/o hemodyn
75889 Vein x-ray liver w/hemodynam
75891 Vein x-ray liver
75893 Venous sampling by catheter
75894 X-rays transcath therapy
75896 X-rays transcath therapy
Page 8 of 55
75898 Follow-up angiography
75900 Intravascular cath exchange
75901 Remove cva device obstruct
75902 Remove cva lumen obstruct
75945 Intravascular us
75946 Intravascular us add-on
75952 Endovasc repair abdom aorta
75953 Abdom aneurysm endovas rpr
75954 Iliac aneurysm endovas rpr
75956 Xray endovasc thor ao repr
75957 Xray endovasc thor ao repr
75958 Xray place prox ext thor ao
75959 Xray place dist ext thor ao
75960 Transcath iv stent rs&i
75961 Retrieval broken catheter
75962 Repair arterial blockage
75964 Repair artery blockage each
75966 Repair arterial blockage
75968 Repair artery blockage each
75970 Vascular biopsy
75978 Repair venous blockage
75980 Contrast xray exam bile duct
75982 Contrast xray exam bile duct
75984 Xray control catheter change
75989 Abscess drainage under x-ray
76000 Fluoroscopy <1 hr phys/qhp
76001 Fluoroscope exam extensive
76010 X-ray nose to rectum
76080 X-ray exam of fistula
76098 X-ray exam surgical specimen
76100 X-ray exam of body section
76101 Complex body section x-ray
76102 Complex body section x-rays
76120 Cine/video x-rays
76125 Cine/video x-rays add-on
76140 X-ray consultation
76376 3d render w/intrp postproces
76377 3d render w/intrp postproces
76380 Cat scan follow-up study
76390 Mr spectroscopy
76496 Fluoroscopic procedure
76497 Ct procedure
76498 Mri procedure
76499 Radiographic procedure
76506 Echo exam of head
76510 Ophth us b & quant a
76511 Ophth us quant a only
76512 Ophth us b w/non-quant a
76513 Echo exam of eye water bath
76514 Echo exam of eye thickness
76516 Echo exam of eye
76519 Echo exam of eye
76529 Echo exam of eye
76536 Us exam of head and neck
76604 Us exam chest
Page 9 of 55
76641 Ultrasound breast complete
76642 Ultrasound breast limited
76645 Us exam breast(s)
76700 Us exam abdom complete
76705 Echo exam of abdomen
76706 Us abdl aorta screen aaa
76770 Us exam abdo back wall comp
76775 Us exam abdo back wall lim
76776 Us exam k transpl w/doppler
76800 Us exam spinal canal
76801 Ob us < 14 wks single fetus
76802 Ob us < 14 wks addl fetus
76805 Ob us >/= 14 wks sngl fetus
76810 Ob us >/= 14 wks addl fetus
76811 Ob us detailed sngl fetus
76812 Ob us detailed addl fetus
76813 Ob us nuchal meas 1 gest
76814 Ob us nuchal meas add-on
76815 Ob us limited fetus(s)
76816 Ob us follow-up per fetus
76817 Transvaginal us obstetric
76818 Fetal biophys profile w/nst
76819 Fetal biophys profil w/o nst
76820 Umbilical artery echo
76821 Middle cerebral artery echo
76825 Echo exam of fetal heart
76826 Echo exam of fetal heart
76827 Echo exam of fetal heart
76828 Echo exam of fetal heart
76830 Transvaginal us non-ob
76831 Echo exam uterus
76856 Us exam pelvic complete
76857 Us exam pelvic limited
76870 Us exam scrotum
76872 Us transrectal
76873 Echograp trans r pros study
76881 Us compl joint r-t w/img
76882 Us lmtd jt/nonvasc xtr strux
76885 Us exam infant hips dynamic
76886 Us exam infant hips static
76930 Echo guide cardiocentesis
76932 Echo guide for heart biopsy
76936 Echo guide for artery repair
76937 Us guide vascular access
76940 Us guide tissue ablation
76941 Echo guide for transfusion
76942 Echo guide for biopsy
76945 Echo guide villus sampling
76946 Echo guide for amniocentesis
76948 Echo guide ova aspiration
76950 Echo guidance radiotherapy
76965 Echo guidance radiotherapy
76970 Ultrasound exam follow-up
76975 Gi endoscopic ultrasound
76977 Us bone density measure
Page 10 of 55
76998 Us guide intraop
76999 Echo examination procedure
77001 Fluoroguide for vein device
77002 Needle localization by xray
77003 Fluoroguide for spine inject
77011 Ct scan for localization
77012 Ct scan for needle biopsy
77013 Ct guide for tissue ablation
77014 Ct scan for therapy guide
77021 Mri guidance ndl plmt rs&i
77022 Mri gdn parnchyma tiss abltj
77031 Stereotact guide for brst bx
77032 Guidance for needle breast
77051 Computer dx mammogram add-on
77052 Comp screen mammogram add-on
77053 X-ray of mammary duct
77054 X-ray of mammary ducts
77055 Mammogram one breast
77056 Mammogram both breasts
77057 Mammogram screening
77058 Mri one breast
77059 Mri both breasts
77061 Breast tomosynthesis uni
77062 Breast tomosynthesis bi
77063 Breast tomosynthesis bi
77065 Dx mammo incl cad uni
77066 Dx mammo incl cad bi
77067 Scr mammo bi incl cad
77071 X-ray stress view
77072 X-rays for bone age
77073 X-rays bone length studies
77074 X-rays bone survey limited
77075 X-rays bone survey complete
77076 X-rays bone survey infant
77077 Joint survey single view
77078 Ct bone density axial
77080 Dxa bone density axial
77081 Dxa bone density/peripheral
77082 Dxa bone density vert fx
77084 Magnetic image bone marrow
77085 Dxa bone density study
77086 Fracture assessment via dxa
77261 Radiation therapy planning
77262 Radiation therapy planning
77263 Radiation therapy planning
77280 Set radiation therapy field
77285 Set radiation therapy field
77290 Set radiation therapy field
77293 Respirator motion mgmt simul
77295 3-d radiotherapy plan
77299 Radiation therapy planning
77300 Radiation therapy dose plan
77301 Radiotherapy dose plan imrt
77305 Teletx isodose plan simple
77306 Telethx isodose plan simple
Page 11 of 55
77307 Telethx isodose plan cplx
77310 Teletx isodose plan intermed
77315 Teletx isodose plan complex
77316 Brachytx isodose plan simple
77317 Brachytx isodose intermed
77318 Brachytx isodose complex
77321 Special teletx port plan
77326 Brachytx isodose calc simp
77327 Brachytx isodose calc interm
77328 Brachytx isodose plan compl
77331 Special radiation dosimetry
77332 Radiation treatment aid(s)
77333 Radiation treatment aid(s)
77334 Radiation treatment aid(s)
77336 Radiation physics consult
77338 Design mlc device for imrt
77370 Radiation physics consult
77371 Srs multisource
77372 Srs linear based
77373 Sbrt delivery
77385 Ntsty modul rad tx dlvr smpl
77386 Ntsty modul rad tx dlvr cplx
77387 Guidance for radj tx dlvr
77399 External radiation dosimetry
77401 Radiation treatment delivery
77402 Radiation treatment delivery
77403 Radiation treatment delivery
77404 Radiation treatment delivery
77406 Radiation treatment delivery
77407 Radiation treatment delivery
77408 Radiation treatment delivery
77409 Radiation treatment delivery
77411 Radiation treatment delivery
77412 Radiation treatment delivery
77413 Radiation treatment delivery
77414 Radiation treatment delivery
77416 Radiation treatment delivery
77417 Radiology port images(s)
77418 Radiation tx delivery imrt
77421 Stereoscopic x-ray guidance
77422 Neutron beam tx simple
77423 Neutron beam tx complex
77424 Io rad tx delivery by x-ray
77425 Io rad tx deliver by elctrns
77427 Radiation tx management x5
77431 Radiation therapy management
77432 Stereotactic radiation trmt
77435 Sbrt management
77469 Io radiation tx management
77470 Special radiation treatment
77499 Radiation therapy management
77520 Proton trmt simple w/o comp
77522 Proton trmt simple w/comp
77523 Proton trmt intermediate
77525 Proton treatment complex
Page 12 of 55
77600 Hyperthermia treatment
77605 Hyperthermia treatment
77610 Hyperthermia treatment
77615 Hyperthermia treatment
77620 Hyperthermia treatment
77750 Infuse radioactive materials
77761 Apply intrcav radiat simple
77762 Apply intrcav radiat interm
77763 Apply intrcav radiat compl
77767 Hdr rdncl skn surf brachytx
77768 Hdr rdncl skn surf brachytx
77770 Hdr rdncl ntrstl/icav brchtx
77771 Hdr rdncl ntrstl/icav brchtx
77772 Hdr rdncl ntrstl/icav brchtx
77776 Apply interstit radiat simpl
77777 Apply interstit radiat inter
77778 Apply interstit radiat compl
77785 Hdr brachytx 1 channel
77786 Hdr brachytx 2-12 channel
77787 Hdr brachytx over 12 chan
77789 Apply surf ldr radionuclide
77790 Radiation handling
77799 Radium/radioisotope therapy
78000 Thyroid single uptake
78001 Thyroid multiple uptakes
78003 Thyroid suppress/stimul
78006 Thyroid imaging with uptake
78007 Thyroid image mult uptakes
78010 Thyroid imaging
78011 Thyroid imaging with flow
78012 Thyroid uptake measurement
78013 Thyroid imaging w/blood flow
78014 Thyroid imaging w/blood flow
78015 Thyroid met imaging
78016 Thyroid met imaging/studies
78018 Thyroid met imaging body
78020 Thyroid met uptake
78070 Parathyroid planar imaging
78071 Parathyrd planar w/wo subtrj
78072 Parathyrd planar w/spect&ct
78075 Adrenal cortex & medulla img
78099 Endocrine nuclear procedure
78102 Bone marrow imaging ltd
78103 Bone marrow imaging mult
78104 Bone marrow imaging body
78110 Plasma volume single
78111 Plasma volume multiple
78120 Red cell mass single
78121 Red cell mass multiple
78122 Blood volume
78130 Red cell survival study
78135 Red cell survival kinetics
78140 Red cell sequestration
78185 Spleen imaging
78190 Platelet survival kinetics
Page 13 of 55
78191 Platelet survival
78195 Lymph system imaging
78199 Blood/lymph nuclear exam
78201 Liver imaging
78202 Liver imaging with flow
78205 Liver imaging (3d)
78206 Liver image (3d) with flow
78215 Liver and spleen imaging
78216 Liver & spleen image/flow
78226 Hepatobiliary system imaging
78227 Hepatobil syst image w/drug
78230 Salivary gland imaging
78231 Serial salivary imaging
78232 Salivary gland function exam
78258 Esophageal motility study
78261 Gastric mucosa imaging
78262 Gastroesophageal reflux exam
78264 Gastric emptying imag study
78265 Gastric emptying imag study
78266 Gastric emptying imag study
78267 Breath tst attain/anal c-14
78268 Breath test analysis c-14
78270 Vit b-12 absorption exam
78271 Vit b-12 absrp exam int fac
78272 Vit b-12 absorp combined
78278 Acute gi blood loss imaging
78282 Gi protein loss exam
78290 Meckels divert exam
78291 Leveen/shunt patency exam
78299 Gi nuclear procedure
78300 Bone imaging limited area
78305 Bone imaging multiple areas
78306 Bone imaging whole body
78315 Bone imaging 3 phase
78320 Bone imaging (3d)
78350 Bone mineral single photon
78351 Bone mineral dual photon
78399 Musculoskeletal nuclear exam
78414 Non-imaging heart function
78428 Cardiac shunt imaging
78445 Vascular flow imaging
78451 Ht muscle image spect sing
78452 Ht muscle image spect mult
78453 Ht muscle image planar sing
78454 Ht musc image planar mult
78456 Acute venous thrombus image
78457 Venous thrombosis imaging
78458 Ven thrombosis images bilat
78459 Heart muscle imaging (pet)
78466 Heart infarct image
78468 Heart infarct image (ef)
78469 Heart infarct image (3d)
78472 Gated heart planar single
78473 Gated heart multiple
78481 Heart first pass single
Page 14 of 55
78483 Heart first pass multiple
78491 Heart image (pet) single
78492 Heart image (pet) multiple
78494 Heart image spect
78496 Heart first pass add-on
78499 Cardiovascular nuclear exam
78579 Lung ventilation imaging
78580 Lung perfusion imaging
78582 Lung ventilat&perfus imaging
78597 Lung perfusion differential
78598 Lung perf&ventilat diferentl
78599 Respiratory nuclear exam
78600 Brain image < 4 views
78601 Brain image w/flow < 4 views
78605 Brain image 4+ views
78606 Brain image w/flow 4 + views
78607 Brain imaging (3d)
78608 Brain imaging (pet)
78609 Brain imaging (pet)
78610 Brain flow imaging only
78630 Cerebrospinal fluid scan
78635 Csf ventriculography
78645 Csf shunt evaluation
78647 Cerebrospinal fluid scan
78650 Csf leakage imaging
78660 Nuclear exam of tear flow
78699 Nervous system nuclear exam
78700 Kidney imaging morphol
78701 Kidney imaging with flow
78707 K flow/funct image w/o drug
78708 K flow/funct image w/drug
78709 K flow/funct image multiple
78710 Kidney imaging (3d)
78725 Kidney function study
78730 Urinary bladder retention
78740 Ureteral reflux study
78761 Testicular imaging w/flow
78799 Genitourinary nuclear exam
78800 Tumor imaging limited area
78801 Tumor imaging mult areas
78802 Tumor imaging whole body
78803 Tumor imaging (3d)
78804 Tumor imaging whole body
78805 Abscess imaging ltd area
78806 Abscess imaging whole body
78807 Nuclear localization/abscess
78808 Iv inj ra drug dx study
78811 Pet image ltd area
78812 Pet image skull-thigh
78813 Pet image full body
78814 Pet image w/ct lmtd
78815 Pet image w/ct skull-thigh
78816 Pet image w/ct full body
78999 Nuclear diagnostic exam
79005 Nuclear rx oral admin
Page 15 of 55
79101 Nuclear rx iv admin
79200 Nuclear rx intracav admin
79300 Nuclr rx interstit colloid
79403 Hematopoietic nuclear tx
79440 Nuclear rx intra-articular
79445 Nuclear rx intra-arterial
79999 Nuclear medicine therapy
80047 Metabolic panel ionized ca
80048 Metabolic panel total ca
80050 General health panel
80051 Electrolyte panel
80053 Comprehen metabolic panel
80055 Obstetric panel
80061 Lipid panel
80069 Renal function panel
80074 Acute hepatitis panel
80076 Hepatic function panel
80081 Obstetric panel
80100 Drug screen qualitate/multi
80101 Drug screen single
80102 Drug confirmation
80103 Drug analysis tissue prep
80104 Drug scrn 1+ class nonchromo
80150 Assay of amikacin
80152 Assay of amitriptyline
80154 Assay of benzodiazepines
80155 Drug assay caffeine
80156 Assay carbamazepine total
80157 Assay carbamazepine free
80158 Drug assay cyclosporine
80159 Drug assay clozapine
80160 Assay of desipramine
80162 Assay of digoxin total
80163 Assay of digoxin free
80164 Assay dipropylacetic acd tot
80165 Dipropylacetic acid free
80166 Assay of doxepin
80168 Assay of ethosuximide
80169 Drug assay everolimus
80170 Assay of gentamicin
80171 Drug screen quant gabapentin
80172 Assay of gold
80173 Assay of haloperidol
80174 Assay of imipramine
80175 Drug screen quan lamotrigine
80176 Assay of lidocaine
80177 Drug scrn quan levetiracetam
80178 Assay of lithium
80180 Drug scrn quan mycophenolate
80182 Assay of nortriptyline
80183 Drug scrn quant oxcarbazepin
80184 Assay of phenobarbital
80185 Assay of phenytoin total
80186 Assay of phenytoin free
80188 Assay of primidone
Page 16 of 55
80190 Assay of procainamide
80192 Assay of procainamide
80194 Assay of quinidine
80195 Assay of sirolimus
80196 Assay of salicylate
80197 Assay of tacrolimus
80198 Assay of theophylline
80199 Drug screen quant tiagabine
80200 Assay of tobramycin
80201 Assay of topiramate
80202 Assay of vancomycin
80203 Drug screen quant zonisamide
80299 Quantitative assay drug
80300 Drug screen non tlc devices
80301 Drug screen class list a
80302 Drug screen prsmptv 1 class
80303 Drug screen one/mult class
80304 Drug screen one/mult class
80305 Drug test prsmv dir opt obs
80306 Drug test prsmv instrmnt
80307 Drug test prsmv chem anlyzr
80320 Drug screen quantalcohols
80321 Alcohols biomarkers 1or 2
80322 Alcohols biomarkers 3/more
80323 Alkaloids nos
80324 Drug screen amphetamines 1/2
80325 Amphetamines 3or 4
80326 Amphetamines 5 or more
80327 Anabolic steroid 1 or 2
80328 Anabolic steroid 3 or more
80329 Analgesics non-opioid 1 or 2
80330 Analgesics non-opioid 3-5
80331 Analgesics non-opioid 6/more
80332 Antidepressants class 1 or 2
80333 Antidepressants class 3-5
80334 Antidepressants class 6/more
80335 Antidepressant tricyclic 1/2
80336 Antidepressant tricyclic 3-5
80337 Tricyclic & cyclicals 6/more
80338 Antidepressant not specified
80339 Antiepileptics nos 1-3
80340 Antiepileptics nos 4-6
80341 Antiepileptics nos 7/more
80342 Antipsychotics nos 1-3
80343 Antipsychotics nos 4-6
80344 Antipsychotics nos 7/more
80345 Drug screening barbiturates
80346 Benzodiazepines1-12
80347 Benzodiazepines 13 or more
80348 Drug screening buprenorphine
80349 Cannabinoids natural
80350 Cannabinoids synthetic 1-3
80351 Cannabinoids synthetic 4-6
80352 Cannabinoid synthetic 7/more
80353 Drug screening cocaine
Page 17 of 55
80354 Drug screening fentanyl
80355 Gabapentin non-blood
80356 Heroin metabolite
80357 Ketamine and norketamine
80358 Drug screening methadone
80359 Methylenedioxyamphetamines
80360 Methylphenidate
80361 Opiates 1 or more
80362 Opioids & opiate analogs 1/2
80363 Opioids & opiate analogs 3/4
80364 Opioid &opiate analog 5/more
80365 Drug screening oxycodone
80366 Drug screening pregabalin
80367 Drug screening propoxyphene
80368 Sedative hypnotics
80369 Skeletal muscle relaxant 1/2
80370 Skel musc relaxant 3 or more
80371 Stimulants synthetic
80372 Drug screening tapentadol
80373 Drug screening tramadol
80374 Stereoisomer analysis
80375 Drug/substance nos 1-3
80376 Drug/substance nos 4-6
80377 Drug/substance nos 7/more
80400 Acth stimulation panel
80402 Acth stimulation panel
80406 Acth stimulation panel
80408 Aldosterone suppression eval
80410 Calcitonin stimul panel
80412 CRH stimulation panel
80414 Testosterone response
80415 Estradiol response panel
80416 Renin stimulation panel
80417 Renin stimulation panel
80418 Pituitary evaluation panel
80420 Dexamethasone panel
80422 Glucagon tolerance panel
80424 Glucagon tolerance panel
80426 Gonadotropin hormone panel
80428 Growth hormone panel
80430 Growth hormone panel
80432 Insulin suppression panel
80434 Insulin tolerance panel
80435 Insulin tolerance panel
80436 Metyrapone panel
80438 TRH stimulation panel
80439 TRH stimulation panel
80440 Trh stimulation panel
80500 Lab pathology consultation
80502 Lab pathology consultation
81000 Urinalysis nonauto w/scope
81001 Urinalysis auto w/scope
81002 Urinalysis nonauto w/o scope
81003 Urinalysis auto w/o scope
81005 Urinalysis
Page 18 of 55
81007 Urine screen for bacteria
81015 Microscopic exam of urine
81020 Urinalysis glass test
81025 Urine pregnancy test
81050 Urinalysis volume measure
81099 Urinalysis test procedure
81105 Hpa-1 genotyping
81106 Hpa-2 genotyping
81107 Hpa-3 genotyping
81108 Hpa-4 genotyping
81109 Hpa-5 genotyping
81110 Hpa-6 genotyping
81111 Hpa-9 genotyping
81112 Hpa-15 genotyping
81120 Idh1 common variants
81121 Idh2 common variants
81161 Dmd dup/delet analysis
81162 Brca1&2 gen full seq dup/del
81170 Abl1 gene
81175 Asxl1 full gene sequence
81176 Asxl1 gene target seq alys
81200 Aspa gene
81201 Apc gene full sequence
81202 Apc gene known fam variants
81203 Apc gene dup/delet variants
81205 Bckdhb gene
81206 Bcr/abl1 gene major bp
81207 Bcr/abl1 gene minor bp
81208 Bcr/abl1 gene other bp
81209 Blm gene
81210 Braf gene
81211 Brca1&2 seq & com dup/del
81212 Brca1&2 185&5385&6174 vrnt
81213 Brca1&2 uncom dup/del var
81214 Brca1 full seq & com dup/del
81215 Brca1 gene known famil vrnt
81216 Brca2 gene full seq alys
81217 Brca2 gene known famil vrnt
81218 Cebpa gene full sequence
81219 Calr gene com variants
81220 Cftr gene com variants
81221 Cftr gene known fam variants
81222 Cftr gene dup/delet variants
81223 Cftr gene full sequence
81224 Cftr gene intron poly t
81225 Cyp2c19 gene com variants
81226 Cyp2d6 gene com variants
81227 Cyp2c9 gene com variants
81228 Cytogen micrarray copy nmbr
81229 Cytogen m array copy no&snp
81230 Cyp3a4 gene common variants
81231 Cyp3a5 gene common variants
81232 Dpyd gene common variants
81235 Egfr gene com variants
81238 F9 full gene sequence
Page 19 of 55
81240 F2 gene
81241 F5 gene
81242 Fancc gene
81243 Fmr1 gene detection
81244 Fmr1 gene charac alleles
81245 Flt3 gene
81246 Flt3 gene analysis
81247 G6pd gene alys cmn variant
81248 G6pd known familial variant
81249 G6pd full gene sequence
81250 G6pc gene
81251 Gba gene
81252 Gjb2 gene full sequence
81253 Gjb2 gene known fam variants
81254 Gjb6 gene com variants
81255 Hexa gene
81256 Hfe gene
81257 Hba1/hba2 gene
81258 Hba1/hba2 gene fam vrnt
81259 Hba1/hba2 full gene sequence
81260 Ikbkap gene
81261 Igh gene rearrange amp meth
81262 Igh gene rearrang dir probe
81263 Igh vari regional mutation
81264 Igk rearrangeabn clonal pop
81265 Str markers specimen anal
81266 Str markers spec anal addl
81267 Chimerism anal no cell selec
81268 Chimerism anal w/cell select
81269 Hba1/hba2 gene dup/del vrnts
81270 Jak2 gene
81272 Kit gene targeted seq analys
81273 Kit gene analys d816 variant
81275 Kras gene variants exon 2
81276 Kras gene addl variants
81280 Long qt synd gene full seq
81281 Long qt synd known fam var
81282 Long qt syn gene dup/dlt var
81283 Ifnl3 gene
81287 Mgmt gene prmtr mthyltn alys
81288 Mlh1 gene
81290 Mcoln1 gene
81291 Mthfr gene
81292 Mlh1 gene full seq
81293 Mlh1 gene known variants
81294 Mlh1 gene dup/delete variant
81295 Msh2 gene full seq
81296 Msh2 gene known variants
81297 Msh2 gene dup/delete variant
81298 Msh6 gene full seq
81299 Msh6 gene known variants
81300 Msh6 gene dup/delete variant
81301 Microsatellite instability
81302 Mecp2 gene full seq
81303 Mecp2 gene known variant
Page 20 of 55
81304 Mecp2 gene dup/delet variant
81310 Npm1 gene
81311 Nras gene variants exon 2&3
81313 Pca3/klk3 antigen
81314 Pdgfra gene
81315 Pml/raralpha com breakpoints
81316 Pml/raralpha 1 breakpoint
81317 Pms2 gene full seq analysis
81318 Pms2 known familial variants
81319 Pms2 gene dup/delet variants
81321 Pten gene full sequence
81322 Pten gene known fam variant
81323 Pten gene dup/delet variant
81324 Pmp22 gene dup/delet
81325 Pmp22 gene full sequence
81326 Pmp22 gene known fam variant
81327 Sept9 gen prmtr mthyltn alys
81328 Slco1b1 gene com variants
81330 Smpd1 gene common variants
81331 Snrpn/ube3a gene
81332 Serpina1 gene
81334 Runx1 gene targeted seq alys
81335 Tpmt gene com variants
81340 Trb@ gene rearrange amplify
81341 Trb@ gene rearrange dirprobe
81342 Trg gene rearrangement anal
81346 Tyms gene com variants
81350 Ugt1a1 gene
81355 Vkorc1 gene
81361 Hbb gene com variants
81362 Hbb gene known fam variant
81363 Hbb gene dup/del variants
81364 Hbb full gene sequence
81370 Hla i & ii typing lr
81371 Hla i & ii type verify lr
81372 Hla i typing complete lr
81373 Hla i typing 1 locus lr
81374 Hla i typing 1 antigen lr
81375 Hla ii typing ag equiv lr
81376 Hla ii typing 1 locus lr
81377 Hla ii type 1 ag equiv lr
81378 Hla i & ii typing hr
81379 Hla i typing complete hr
81380 Hla i typing 1 locus hr
81381 Hla i typing 1 allele hr
81382 Hla ii typing 1 loc hr
81383 Hla ii typing 1 allele hr
81400 Mopath procedure level 1
81401 Mopath procedure level 2
81402 Mopath procedure level 3
81403 Mopath procedure level 4
81404 Mopath procedure level 5
81405 Mopath procedure level 6
81406 Mopath procedure level 7
81407 Mopath procedure level 8
Page 21 of 55
81408 Mopath procedure level 9
81410 Aortic dysfunction/dilation
81411 Aortic dysfunction/dilation
81412 Ashkenazi jewish assoc dis
81413 Car ion chnnlpath inc 10 gns
81414 Car ion chnnlpath inc 2 gns
81415 Exome sequence analysis
81416 Exome sequence analysis
81417 Exome re-evaluation
81420 Fetal chrmoml aneuploidy
81422 Fetal chrmoml microdeltj
81425 Genome sequence analysis
81426 Genome sequence analysis
81427 Genome re-evaluation
81430 Hearing loss sequence analys
81431 Hearing loss dup/del analys
81432 Hrdtry brst ca-rlatd dsordrs
81433 Hrdtry brst ca-rlatd dsordrs
81434 Hereditary retinal disorders
81435 Hereditary colon ca dsordrs
81436 Hereditary colon ca dsordrs
81437 Heredtry nurondcrn tum dsrdr
81438 Heredtry nurondcrn tum dsrdr
81439 Hrdtry cardmypy gene panel
81440 Mitochondrial gene
81442 Noonan spectrum disorders
81445 Targeted genomic seq analys
81448 Hrdtry perph neurphy panel
81450 Targeted genomic seq analys
81455 Targeted genomic seq analys
81460 Whole mitochondrial genome
81465 Whole mitochondrial genome
81470 X-linked intellectual dblt
81471 X-linked intellectual dblt
81479 Unlisted molecular pathology
81490 Autoimmune rheumatoid arthr
81493 Cor artery disease mrna
81500 Onco (ovar) two proteins
81503 Onco (ovar) five proteins
81504 Oncology tissue of origin
81506 Endo assay seven anal
81507 Fetal aneuploidy trisom risk
81508 Ftl cgen abnor two proteins
81509 Ftl cgen abnor 3 proteins
81510 Ftl cgen abnor three anal
81511 Ftl cgen abnor four anal
81512 Ftl cgen abnor five anal
81519 Oncology breast mrna
81520 Onc breast mrna 58 genes
81521 Onc breast mrna 70 genes
81525 Oncology colon MRNA
81528 Oncology colorectal scr
81535 Oncology gynecologic
81536 Oncology gynecologic
81538 Oncology lung
Page 22 of 55
81539 Oncology prostate prob score
81540 Oncology tum unknown origin
81541 Onc prostate mrna 46 genes
81545 Oncology thyroid
81551 Onc prostate 3 genes
81595 Cardiology hrt trnspl mrna
81599 Unlisted maaa
82000 Assay of blood acetaldehyde
82003 Assay of acetaminophen
82009 Test for acetone/ketones
82010 Acetone assay
82013 Acetylcholinesterase assay
82016 Acylcarnitines qual
82017 Acylcarnitines quant
82024 Assay of acth
82030 Assay of adp & amp
82040 Assay of serum albumin
82042 Other source albumin quan ea
82043 Ur albumin quantitative
82044 Ur albumin semiquantitative
82045 Albumin ischemia modified
82055 Assay of ethanol
82075 Assay of breath ethanol
82085 Assay of aldolase
82088 Assay of aldosterone
82101 Assay of urine alkaloids
82103 Alpha-1-antitrypsin total
82104 Alpha-1-antitrypsin pheno
82105 Alpha-fetoprotein serum
82106 Alpha-fetoprotein amniotic
82107 Alpha-fetoprotein l3
82108 Assay of aluminum
82120 Amines vaginal fluid qual
82127 Amino acid single qual
82128 Amino acids mult qual
82131 Amino acids single quant
82135 Assay aminolevulinic acid
82136 Amino acids quant 2-5
82139 Amino acids quan 6 or more
82140 Assay of ammonia
82143 Amniotic fluid scan
82145 Assay of amphetamines
82150 Assay of amylase
82154 Androstanediol glucuronide
82157 Assay of androstenedione
82160 Assay of androsterone
82163 Assay of angiotensin II
82164 Angiotensin I enzyme test
82172 Assay of apolipoprotein
82175 Assay of arsenic
82180 Assay of ascorbic acid
82190 Atomic absorption
82205 Assay of barbiturates
82232 Assay of beta-2 protein
82239 Bile acids total
Page 23 of 55
82240 Bile acids cholylglycine
82247 Bilirubin total
82248 Bilirubin direct
82252 Fecal bilirubin test
82261 Assay of biotinidase
82270 Occult blood feces
82271 Occult blood other sources
82272 Occult bld feces 1-3 tests
82274 Assay test for blood fecal
82286 Assay of bradykinin
82300 Assay of cadmium
82306 Vitamin d 25 hydroxy
82308 Assay of calcitonin
82310 Assay of calcium
82330 Assay of calcium
82331 Calcium infusion test
82340 Assay of calcium in urine
82355 Calculus analysis qual
82360 Calculus assay quant
82365 Calculus spectroscopy
82370 X-ray assay calculus
82373 Assay c-d transfer measure
82374 Assay blood carbon dioxide
82375 Assay carboxyhb quant
82376 Assay carboxyhb qual
82378 Carcinoembryonic antigen
82379 Assay of carnitine
82380 Assay of carotene
82382 Assay urine catecholamines
82383 Assay blood catecholamines
82384 Assay three catecholamines
82387 Assay of cathepsin-d
82390 Assay of ceruloplasmin
82397 Chemiluminescent assay
82415 Assay of chloramphenicol
82435 Assay of blood chloride
82436 Assay of urine chloride
82438 Assay other fluid chlorides
82441 Test for chlorohydrocarbons
82465 Assay bld/serum cholesterol
82480 Assay serum cholinesterase
82482 Assay rbc cholinesterase
82485 Assay chondroitin sulfate
82486 Gas/liquid chromatography
82487 Paper chromatography
82488 Paper chromatography
82489 Thin layer chromatography
82491 Chromotography quant sing
82492 Chromotography quant mult
82495 Assay of chromium
82507 Assay of citrate
82520 Assay of cocaine
82523 Collagen crosslinks
82525 Assay of copper
82528 Assay of corticosterone
Page 24 of 55
82530 Cortisol free
82533 Total cortisol
82540 Assay of creatine
82541 Column chromotography qual
82542 Col chromotography qual/quan
82543 Column chromotograph/isotope
82544 Column chromotograph/isotope
82550 Assay of ck (cpk)
82552 Assay of cpk in blood
82553 Creatine mb fraction
82554 Creatine isoforms
82565 Assay of creatinine
82570 Assay of urine creatinine
82575 Creatinine clearance test
82585 Assay of cryofibrinogen
82595 Assay of cryoglobulin
82600 Assay of cyanide
82607 Vitamin B-12
82608 B-12 binding capacity
82610 Cystatin c
82615 Test for urine cystines
82626 Dehydroepiandrosterone
82627 Dehydroepiandrosterone
82633 Desoxycorticosterone
82634 Deoxycortisol
82638 Assay of dibucaine number
82646 Assay of dihydrocodeinone
82649 Assay of dihydromorphinone
82651 Assay of dihydrotestosterone
82652 Vit d 1 25-dihydroxy
82654 Assay of dimethadione
82656 Pancreatic elastase fecal
82657 Enzyme cell activity
82658 Enzyme cell activity ra
82664 Electrophoretic test
82666 Assay of epiandrosterone
82668 Assay of erythropoietin
82670 Assay of estradiol
82671 Assay of estrogens
82672 Assay of estrogen
82677 Assay of estriol
82679 Assay of estrone
82690 Assay of ethchlorvynol
82693 Assay of ethylene glycol
82696 Assay of etiocholanolone
82705 Fats/lipids feces qual
82710 Fats/lipids feces quant
82715 Assay of fecal fat
82725 Assay of blood fatty acids
82726 Long chain fatty acids
82728 Assay of ferritin
82731 Assay of fetal fibronectin
82735 Assay of fluoride
82742 Assay of flurazepam
82746 Assay of folic acid serum
Page 25 of 55
82747 Assay of folic acid rbc
82757 Assay of semen fructose
82759 Assay of rbc galactokinase
82760 Assay of galactose
82775 Assay galactose transferase
82776 Galactose transferase test
82777 Galectin-3
82784 Assay iga/igd/igg/igm each
82785 Assay of ige
82787 Igg 1 2 3 or 4 each
82800 Blood pH
82803 Blood gases any combination
82805 Blood gases w/o2 saturation
82810 Blood gases o2 sat only
82820 Hemoglobin-oxygen affinity
82930 Gastric analy w/ph ea spec
82938 Gastrin test
82941 Assay of gastrin
82943 Assay of glucagon
82945 Glucose other fluid
82946 Glucagon tolerance test
82947 Assay glucose blood quant
82948 Reagent strip/blood glucose
82950 Glucose test
82951 Glucose tolerance test (GTT)
82952 GTT-added samples
82953 Glucose-tolbutamide test
82955 Assay of g6pd enzyme
82960 Test for G6PD enzyme
82962 Glucose blood test
82963 Assay of glucosidase
82965 Assay of gdh enzyme
82975 Assay of glutamine
82977 Assay of GGT
82978 Assay of glutathione
82979 Assay rbc glutathione
82980 Assay of glutethimide
82985 Assay of glycated protein
83001 Assay of gonadotropin (fsh)
83002 Assay of gonadotropin (lh)
83003 Assay growth hormone (hgh)
83006 Growth stimulation gene 2
83008 Assay of guanosine
83009 H pylori (c-13) blood
83010 Assay of haptoglobin quant
83012 Assay of haptoglobins
83013 H pylori (c-13) breath
83014 H pylori drug admin
83015 Heavy metal qual any anal
83018 Heavy metal quant each nes
83020 Hemoglobin electrophoresis
83021 Hemoglobin chromotography
83026 Hemoglobin copper sulfate
83030 Fetal hemoglobin chemical
83033 Fetal hemoglobin assay qual
Page 26 of 55
83036 Glycosylated hemoglobin test
83037 Glycosylated hb home device
83045 Blood methemoglobin test
83050 Blood methemoglobin assay
83051 Assay of plasma hemoglobin
83055 Blood sulfhemoglobin test
83060 Blood sulfhemoglobin assay
83065 Assay of hemoglobin heat
83068 Hemoglobin stability screen
83069 Assay of urine hemoglobin
83070 Assay of hemosiderin qual
83071 Assay of hemosiderin quant
83080 Assay of b hexosaminidase
83088 Assay of histamine
83090 Assay of homocystine
83150 Assay of homovanillic acid
83491 Assay of corticosteroids 17
83497 Assay of 5-hiaa
83498 Assay of progesterone 17-d
83499 Assay of progesterone 20-
83500 Assay free hydroxyproline
83505 Assay total hydroxyproline
83516 Immunoassay nonantibody
83518 Immunoassay dipstick
83519 Ria nonantibody
83520 Immunoassay quant nos nonab
83525 Assay of insulin
83527 Assay of insulin
83528 Assay of intrinsic factor
83540 Assay of iron
83550 Iron binding test
83570 Assay of idh enzyme
83582 Assay of ketogenic steroids
83586 Assay 17- ketosteroids
83593 Fractionation ketosteroids
83605 Assay of lactic acid
83615 Lactate (LD) (LDH) enzyme
83625 Assay of ldh enzymes
83630 Lactoferrin fecal (qual)
83631 Lactoferrin fecal (quant)
83632 Placental lactogen
83633 Test urine for lactose
83634 Assay of urine for lactose
83655 Assay of lead
83661 L/s ratio fetal lung
83662 Foam stability fetal lung
83663 Fluoro polarize fetal lung
83664 Lamellar bdy fetal lung
83670 Assay of lap enzyme
83690 Assay of lipase
83695 Assay of lipoprotein(a)
83698 Assay lipoprotein pla2
83700 Lipopro bld electrophoretic
83701 Lipoprotein bld hr fraction
83704 Lipoprotein bld quan part
Page 27 of 55
83718 Assay of lipoprotein
83719 Assay of blood lipoprotein
83721 Assay of blood lipoprotein
83727 Assay of lrh hormone
83735 Assay of magnesium
83775 Assay malate dehydrogenase
83785 Assay of manganese
83788 Mass spectrometry qual
83789 Mass spectrometry qual/quan
83805 Assay of meprobamate
83825 Assay of mercury
83835 Assay of metanephrines
83840 Assay of methadone
83857 Assay of methemalbumin
83858 Assay of methsuximide
83861 Microfluid analy tears
83864 Mucopolysaccharides
83866 Mucopolysaccharides screen
83872 Assay synovial fluid mucin
83873 Assay of csf protein
83874 Assay of myoglobin
83876 Assay myeloperoxidase
83880 Assay of natriuretic peptide
83883 Assay nephelometry not spec
83885 Assay of nickel
83887 Assay of nicotine
83890 Molecule isolate
83891 Molecule isolate nucleic
83892 Molecular diagnostics
83893 Molecule dot/slot/blot
83894 Molecule gel electrophor
83896 Molecular diagnostics
83897 Molecule nucleic transfer
83898 Molecule nucleic ampli each
83900 Molecule nucleic ampli 2 seq
83901 Molecule nucleic ampli addon
83902 Molecular diagnostics
83903 Molecule mutation scan
83904 Molecule mutation identify
83905 Molecule mutation identify
83906 Molecule mutation identify
83907 Lyse cells for nucleic ext
83908 Nucleic acid signal ampli
83909 Nucleic acid high resolute
83912 Genetic examination
83913 Molecular rna stabilization
83914 Mutation ident ola/sbce/aspe
83915 Assay of nucleotidase
83916 Oligoclonal bands
83918 Organic acids total quant
83919 Organic acids qual each
83921 Organic acid single quant
83925 Assay of opiates
83930 Assay of blood osmolality
83935 Assay of urine osmolality
Page 28 of 55
83937 Assay of osteocalcin
83945 Assay of oxalate
83950 Oncoprotein her-2/neu
83951 Oncoprotein dcp
83970 Assay of parathormone
83986 Assay ph body fluid nos
83987 Exhaled breath condensate
83992 Assay for phencyclidine
83993 Assay for calprotectin fecal
84022 Assay of phenothiazine
84030 Assay of blood pku
84035 Assay of phenylketones
84060 Assay acid phosphatase
84061 Phosphatase forensic exam
84066 Assay prostate phosphatase
84075 Assay alkaline phosphatase
84078 Assay alkaline phosphatase
84080 Assay alkaline phosphatases
84081 Assay phosphatidylglycerol
84085 Assay of rbc pg6d enzyme
84087 Assay phosphohexose enzymes
84100 Assay of phosphorus
84105 Assay of urine phosphorus
84106 Test for porphobilinogen
84110 Assay of porphobilinogen
84112 Eval amniotic fluid protein
84119 Test urine for porphyrins
84120 Assay of urine porphyrins
84126 Assay of feces porphyrins
84127 Assay of feces porphyrins
84132 Assay of serum potassium
84133 Assay of urine potassium
84134 Assay of prealbumin
84135 Assay of pregnanediol
84138 Assay of pregnanetriol
84140 Assay of pregnenolone
84143 Assay of 17-hydroxypregneno
84144 Assay of progesterone
84145 Procalcitonin (pct)
84146 Assay of prolactin
84150 Assay of prostaglandin
84152 Assay of psa complexed
84153 Assay of psa total
84154 Assay of psa free
84155 Assay of protein serum
84156 Assay of protein urine
84157 Assay of protein other
84160 Assay of protein any source
84163 Pappa serum
84165 Protein e-phoresis serum
84166 Protein e-phoresis/urine/csf
84181 Western blot test
84182 Protein western blot test
84202 Assay RBC protoporphyrin
84203 Test RBC protoporphyrin
Page 29 of 55
84206 Assay of proinsulin
84207 Assay of vitamin b-6
84210 Assay of pyruvate
84220 Assay of pyruvate kinase
84228 Assay of quinine
84233 Assay of estrogen
84234 Assay of progesterone
84235 Assay of endocrine hormone
84238 Assay nonendocrine receptor
84244 Assay of renin
84252 Assay of vitamin b-2
84255 Assay of selenium
84260 Assay of serotonin
84270 Assay of sex hormone globul
84275 Assay of sialic acid
84285 Assay of silica
84295 Assay of serum sodium
84300 Assay of urine sodium
84302 Assay of sweat sodium
84305 Assay of somatomedin
84307 Assay of somatostatin
84311 Spectrophotometry
84315 Body fluid specific gravity
84375 Chromatogram assay sugars
84376 Sugars single qual
84377 Sugars multiple qual
84378 Sugars single quant
84379 Sugars multiple quant
84392 Assay of urine sulfate
84402 Assay of free testosterone
84403 Assay of total testosterone
84410 Testosterone bioavailable
84425 Assay of vitamin b-1
84430 Assay of thiocyanate
84431 Thromboxane urine
84432 Assay of thyroglobulin
84436 Assay of total thyroxine
84437 Assay of neonatal thyroxine
84439 Assay of free thyroxine
84442 Assay of thyroid activity
84443 Assay thyroid stim hormone
84445 Assay of tsi globulin
84446 Assay of vitamin e
84449 Assay of transcortin
84450 Transferase (AST) (SGOT)
84460 Alanine amino (ALT) (SGPT)
84466 Assay of transferrin
84478 Assay of triglycerides
84479 Assay of thyroid (t3 or t4)
84480 Assay triiodothyronine (t3)
84481 Free assay (FT-3)
84482 T3 reverse
84484 Assay of troponin quant
84485 Assay duodenal fluid trypsin
84488 Test feces for trypsin
Page 30 of 55
84490 Assay of feces for trypsin
84510 Assay of tyrosine
84512 Assay of troponin qual
84520 Assay of urea nitrogen
84525 Urea nitrogen semi-quant
84540 Assay of urine/urea-n
84545 Urea-N clearance test
84550 Assay of blood/uric acid
84560 Assay of urine/uric acid
84577 Assay of feces/urobilinogen
84578 Test urine urobilinogen
84580 Assay of urine urobilinogen
84583 Assay of urine urobilinogen
84585 Assay of urine vma
84586 Assay of vip
84588 Assay of vasopressin
84590 Assay of vitamin a
84591 Assay of nos vitamin
84597 Assay of vitamin k
84600 Assay of volatiles
84620 Xylose tolerance test
84630 Assay of zinc
84681 Assay of c-peptide
84702 Chorionic gonadotropin test
84703 Chorionic gonadotropin assay
84704 Hcg free betachain test
84830 Ovulation tests
84999 Clinical chemistry test
85002 Bleeding time test
85004 Automated diff wbc count
85007 Bl smear w/diff wbc count
85008 Bl smear w/o diff wbc count
85009 Manual diff wbc count b-coat
85013 Spun microhematocrit
85014 Hematocrit
85018 Hemoglobin
85025 Complete cbc w/auto diff wbc
85027 Complete cbc automated
85032 Manual cell count each
85041 Automated rbc count
85044 Manual reticulocyte count
85045 Automated reticulocyte count
85046 Reticyte/hgb concentrate
85048 Automated leukocyte count
85049 Automated platelet count
85055 Reticulated platelet assay
85060 Blood smear interpretation
85097 Bone marrow interpretation
85130 Chromogenic substrate assay
85170 Blood clot retraction
85175 Blood clot lysis time
85210 Clot factor ii prothrom spec
85220 Blooc clot factor v test
85230 Clot factor vii proconvertin
85240 Clot factor viii ahg 1 stage
Page 31 of 55
85244 Clot factor viii reltd antgn
85245 Clot factor viii vw ristoctn
85246 Clot factor viii vw antigen
85247 Clot factor viii multimetric
85250 Clot factor ix ptc/chrstmas
85260 Clot factor x stuart-power
85270 Clot factor xi pta
85280 Clot factor xii hageman
85290 Clot factor xiii fibrin stab
85291 Clot factor xiii fibrin scrn
85292 Clot factor fletcher fact
85293 Clot factor wght kininogen
85300 Antithrombin iii activity
85301 Antithrombin iii antigen
85302 Clot inhibit prot c antigen
85303 Clot inhibit prot c activity
85305 Clot inhibit prot s total
85306 Clot inhibit prot s free
85307 Assay activated protein c
85335 Factor inhibitor test
85337 Thrombomodulin
85345 Coagulation time lee & white
85347 Coagulation time activated
85348 Coagulation time otr method
85360 Euglobulin lysis
85362 Fibrin degradation products
85366 Fibrinogen test
85370 Fibrinogen test
85378 Fibrin degrade semiquant
85379 Fibrin degradation quant
85380 Fibrin degradj d-dimer
85384 Fibrinogen activity
85385 Fibrinogen antigen
85390 Fibrinolysins screen i&r
85396 Clotting assay whole blood
85397 Clotting funct activity
85400 Fibrinolytic plasmin
85410 Fibrinolytic antiplasmin
85415 Fibrinolytic plasminogen
85420 Fibrinolytic plasminogen
85421 Fibrinolytic plasminogen
85441 Heinz bodies direct
85445 Heinz bodies induced
85460 Hemoglobin fetal
85461 Hemoglobin fetal
85475 Hemolysin acid
85520 Heparin assay
85525 Heparin neutralization
85530 Heparin-protamine tolerance
85536 Iron stain peripheral blood
85540 Wbc alkaline phosphatase
85547 RBC mechanical fragility
85549 Muramidase
85555 RBC osmotic fragility
85557 RBC osmotic fragility
Page 32 of 55
85576 Blood platelet aggregation
85597 Phospholipid pltlt neutraliz
85598 Hexagnal phosph pltlt neutrl
85610 Prothrombin time
85611 Prothrombin test
85612 Viper venom prothrombin time
85613 Russell viper venom diluted
85635 Reptilase test
85651 Rbc sed rate nonautomated
85652 Rbc sed rate automated
85660 RBC sickle cell test
85670 Thrombin time plasma
85675 Thrombin time titer
85705 Thromboplastin inhibition
85730 Thromboplastin time partial
85732 Thromboplastin time partial
85810 Blood viscosity examination
85999 Hematology procedure
86000 Agglutinins febrile antigen
86001 Allergen specific igg
86003 Allg spec ige crude xtrc ea
86005 Allg spec ige multiallg scr
86008 Allg spec ige recomb ea
86021 WBC antibody identification
86022 Platelet antibodies
86023 Immunoglobulin assay
86038 Antinuclear antibodies
86039 Antinuclear antibodies (ANA)
86060 Antistreptolysin o titer
86063 Antistreptolysin o screen
86077 Phys blood bank serv xmatch
86078 Phys blood bank serv reactj
86079 Phys blood bank serv authrj
86140 C-reactive protein
86141 C-reactive protein hs
86146 Beta-2 glycoprotein antibody
86147 Cardiolipin antibody ea ig
86148 Anti-phospholipid antibody
86152 Cell enumeration & id
86153 Cell enumeration phys interp
86155 Chemotaxis assay
86156 Cold agglutinin screen
86157 Cold agglutinin titer
86160 Complement antigen
86161 Complement/function activity
86162 Complement total (ch50)
86171 Complement fixation each
86185 Counterimmunoelectrophoresis
86200 Ccp antibody
86215 Deoxyribonuclease antibody
86225 Dna antibody native
86226 Dna antibody single strand
86235 Nuclear antigen antibody
86243 Fc receptor
86255 Fluorescent antibody screen
Page 33 of 55
86256 Fluorescent antibody titer
86277 Growth hormone antibody
86280 Hemagglutination inhibition
86294 Immunoassay tumor qual
86300 Immunoassay tumor ca 15-3
86301 Immunoassay tumor ca 19-9
86304 Immunoassay tumor ca 125
86305 Human epididymis protein 4
86308 Heterophile antibody screen
86309 Heterophile antibody titer
86310 Heterophile antibody absrbj
86316 Immunoassay tumor other
86317 Immunoassay infectious agent
86318 Immunoassay infectious agent
86320 Serum immunoelectrophoresis
86325 Other immunoelectrophoresis
86327 Immunoelectrophoresis assay
86329 Immunodiffusion nes
86331 Immunodiffusion ouchterlony
86332 Immune complex assay
86334 Immunofix e-phoresis serum
86335 Immunfix e-phorsis/urine/csf
86336 Inhibin A
86337 Insulin antibodies
86340 Intrinsic factor antibody
86341 Islet cell antibody
86343 Leukocyte histamine release
86344 Leukocyte phagocytosis
86352 Cell function assay w/stim
86353 Lymphocyte transformation
86355 B cells total count
86356 Mononuclear cell antigen
86357 Nk cells total count
86359 T cells total count
86360 T cell absolute count/ratio
86361 T cell absolute count
86367 Stem cells total count
86376 Microsomal antibody each
86378 Migration inhibitory factor
86382 Neutralization test viral
86384 Nitroblue tetrazolium dye
86386 Nuclear matrix protein 22
86403 Particle agglut antbdy scrn
86406 Particle agglut antbdy titr
86430 Rheumatoid factor test qual
86431 Rheumatoid factor quant
86480 Tb test cell immun measure
86481 Tb ag response t-cell susp
86485 Skin test candida
86486 Skin test nos antigen
86490 Coccidioidomycosis skin test
86510 Histoplasmosis skin test
86580 Tb intradermal test
86590 Streptokinase antibody
86592 Syphilis test non-trep qual
Page 34 of 55
86593 Syphilis test non-trep quant
86602 Antinomyces antibody
86603 Adenovirus antibody
86606 Aspergillus antibody
86609 Bacterium antibody
86611 Bartonella antibody
86612 Blastomyces antibody
86615 Bordetella antibody
86617 Lyme disease antibody
86618 Lyme disease antibody
86619 Borrelia antibody
86622 Brucella antibody
86625 Campylobacter antibody
86628 Candida antibody
86631 Chlamydia antibody
86632 Chlamydia igm antibody
86635 Coccidioides antibody
86638 Q fever antibody
86641 Cryptococcus antibody
86644 CMV antibody
86645 Cmv antibody igm
86648 Diphtheria antibody
86651 Encephalitis californ antbdy
86652 Encephaltis east eqne anbdy
86653 Encephaltis st louis antbody
86654 Encephaltis west eqne antbdy
86658 Enterovirus antibody
86663 Epstein-barr antibody
86664 Epstein-barr nuclear antigen
86665 Epstein-barr capsid vca
86666 Ehrlichia antibody
86668 Francisella tularensis
86671 Fungus nes antibody
86674 Giardia lamblia antibody
86677 Helicobacter pylori antibody
86682 Helminth antibody
86684 Hemophilus influenza antibdy
86687 Htlv-i antibody
86688 Htlv-ii antibody
86689 Htlv/hiv confirmj antibody
86692 Hepatitis delta agent antbdy
86694 Herpes simplex nes antbdy
86695 Herpes simplex type 1 test
86696 Herpes simplex type 2 test
86698 Histoplasma antibody
86701 Hiv-1antibody
86702 Hiv-2 antibody
86703 Hiv-1/hiv-2 1 result antbdy
86704 Hep b core antibody total
86705 Hep b core antibody igm
86706 Hep b surface antibody
86707 Hepatitis be antibody
86708 Hepatitis a antibody
86709 Hepatitis a igm antibody
86710 Influenza virus antibody
Page 35 of 55
86711 John cunningham antibody
86713 Legionella antibody
86717 Leishmania antibody
86720 Leptospira antibody
86723 Listeria monocytogenes
86727 Lymph choriomeningitis ab
86729 Lympho venereum antibody
86732 Mucormycosis antibody
86735 Mumps antibody
86738 Mycoplasma antibody
86741 Neisseria meningitidis
86744 Nocardia antibody
86747 Parvovirus antibody
86750 Malaria antibody
86753 Protozoa antibody nos
86756 Respiratory virus antibody
86757 Rickettsia antibody
86759 Rotavirus antibody
86762 Rubella antibody
86765 Rubeola antibody
86768 Salmonella antibody
86771 Shigella antibody
86774 Tetanus antibody
86777 Toxoplasma antibody
86778 Toxoplasma antibody igm
86780 Treponema pallidum
86784 Trichinella antibody
86787 Varicella-zoster antibody
86788 West nile virus ab igm
86789 West nile virus antibody
86790 Virus antibody nos
86793 Yersinia antibody
86794 Zika virus igm antibody
86800 Thyroglobulin antibody
86803 Hepatitis c ab test
86804 Hep c ab test confirm
86805 Lymphocytotoxicity assay
86806 Lymphocytotoxicity assay
86807 Cytotoxic antibody screening
86808 Cytotoxic antibody screening
86812 Hla typing a b or c
86813 Hla typing a b or c
86816 Hla typing dr/dq
86817 Hla typing dr/dq
86821 Lymphocyte culture mixed
86822 Lymphocyte culture primed
86825 Hla x-math non-cytotoxic
86826 Hla x-match noncytotoxc addl
86828 Hla class i&ii antibody qual
86829 Hla class i/ii antibody qual
86830 Hla class i phenotype qual
86831 Hla class ii phenotype qual
86832 Hla class i high defin qual
86833 Hla class ii high defin qual
86834 Hla class i semiquant panel
Page 36 of 55
86835 Hla class ii semiquant panel
86849 Immunology procedure
86850 Rbc antibody screen
86860 Rbc antibody elution
86870 Rbc antibody identification
86880 Coombs test direct
86885 Coombs test indirect qual
86886 Coombs test indirect titer
86890 Autologous blood process
86891 Autologous blood op salvage
86900 Blood typing serologic abo
86901 Blood typing serologic rh(d)
86902 Blood type antigen donor ea
86904 Blood typing patient serum
86905 Blood typing rbc antigens
86906 Bld typing serologic rh phnt
86910 Blood typing paternity test
86911 Blood typing antigen system
86920 Compatibility test spin
86921 Compatibility test incubate
86922 Compatibility test antiglob
86923 Compatibility test electric
86927 Plasma fresh frozen
86930 Frozen blood prep
86931 Frozen blood thaw
86932 Frozen blood freeze/thaw
86940 Hemolysins/agglutinins auto
86941 Hemolysins/agglutinins
86945 Blood product/irradiation
86950 Leukacyte transfusion
86960 Vol reduction of blood/prod
86965 Pooling blood platelets
86970 Rbc pretx incubatj w/chemicl
86971 Rbc pretx incubatj w/enzymes
86972 Rbc pretx incubatj w/density
86975 Rbc serum pretx incubj drugs
86976 Rbc serum pretx id dilution
86977 Rbc serum pretx incubj/inhib
86978 Rbc pretreatment serum
86985 Split blood or products
86999 Transfusion procedure
87001 Small animal inoculation
87003 Small animal inoculation
87015 Specimen infect agnt concntj
87040 Blood culture for bacteria
87045 Feces culture aerobic bact
87046 Stool cultr aerobic bact ea
87070 Culture othr specimn aerobic
87071 Culture aerobic quant other
87073 Culture bacteria anaerobic
87075 Cultr bacteria except blood
87076 Culture anaerobe ident each
87077 Culture aerobic identify
87081 Culture screen only
87084 Culture of specimen by kit
Page 37 of 55
87086 Urine culture/colony count
87088 Urine bacteria culture
87101 Skin fungi culture
87102 Fungus isolation culture
87103 Blood fungus culture
87106 Fungi identification yeast
87107 Fungi identification mold
87109 Mycoplasma
87110 Chlamydia culture
87116 Mycobacteria culture
87118 Mycobacteric identification
87140 Culture type immunofluoresc
87143 Culture typing glc/hplc
87147 Culture type immunologic
87149 Dna/rna direct probe
87150 Dna/rna amplified probe
87152 Culture type pulse field gel
87153 Dna/rna sequencing
87158 Culture typing added method
87164 Dark field examination
87166 Dark field examination
87168 Macroscopic exam arthropod
87169 Macroscopic exam parasite
87172 Pinworm exam
87176 Tissue homogenization cultr
87177 Ova and parasites smears
87181 Microbe susceptible diffuse
87184 Microbe susceptible disk
87185 Microbe susceptible enzyme
87186 Microbe susceptible mic
87187 Microbe susceptible mlc
87188 Microbe suscept macrobroth
87190 Microbe suscept mycobacteri
87197 Bactericidal level serum
87205 Smear gram stain
87206 Smear fluorescent/acid stai
87207 Smear special stain
87209 Smear complex stain
87210 Smear wet mount saline/ink
87220 Tissue exam for fungi
87230 Assay toxin or antitoxin
87250 Virus inoculate eggs/animal
87252 Virus inoculation tissue
87253 Virus inoculate tissue addl
87254 Virus inoculation shell via
87255 Genet virus isolate hsv
87260 Adenovirus ag if
87265 Pertussis ag if
87267 Enterovirus antibody dfa
87269 Giardia ag if
87270 Chlamydia trachomatis ag if
87271 Cytomegalovirus dfa
87272 Cryptosporidium ag if
87273 Herpes simplex 2 ag if
87274 Herpes simplex 1 ag if
Page 38 of 55
87275 Influenza b ag if
87276 Influenza a ag if
87277 Legionella micdadei ag if
87278 Legion pneumophilia ag if
87279 Parainfluenza ag if
87280 Respiratory syncytial ag if
87281 Pneumocystis carinii ag if
87283 Rubeola ag if
87285 Treponema pallidum ag if
87290 Varicella zoster ag if
87299 Antibody detection nos if
87300 Ag detection polyval if
87301 Adenovirus ag ia
87305 Aspergillus ag ia
87320 Chylmd trach ag ia
87324 Clostridium ag ia
87327 Cryptococcus neoform ag ia
87328 Cryptosporidium ag ia
87329 Giardia ag ia
87332 Cytomegalovirus ag ia
87335 E coli 0157 ag ia
87336 Entamoeb hist dispr ag ia
87337 Entamoeb hist group ag ia
87338 Hpylori stool ia
87339 H pylori ag ia
87340 Hepatitis b surface ag ia
87341 Hepatitis b surface ag ia
87350 Hepatitis be ag ia
87380 Hepatitis delta ag ia
87385 Histoplasma capsul ag ia
87389 Hiv-1 ag w/hiv-1 & hiv-2 ab
87390 Hiv-1 ag ia
87391 Hiv-2 ag ia
87400 Influenza a/b ag ia
87420 Resp syncytial ag ia
87425 Rotavirus ag ia
87427 Shiga-like toxin ag ia
87430 Strep a ag ia
87449 Ag detect nos ia mult
87450 Ag detect nos ia single
87451 Ag detect polyval ia mult
87470 Bartonella dna dir probe
87471 Bartonella dna amp probe
87472 Bartonella dna quant
87475 Lyme dis dna dir probe
87476 Lyme dis dna amp probe
87477 Lyme dis dna quant
87480 Candida dna dir probe
87481 Candida dna amp probe
87482 Candida dna quant
87483 Cns dna amp probe type 12-25
87485 Chylmd pneum dna dir probe
87486 Chylmd pneum dna amp probe
87487 Chylmd pneum dna quant
87490 Chylmd trach dna dir probe
Page 39 of 55
87491 Chylmd trach dna amp probe
87492 Chylmd trach dna quant
87493 C diff amplified probe
87495 Cytomeg dna dir probe
87496 Cytomeg dna amp probe
87497 Cytomeg dna quant
87498 Enterovirus probe&revrs trns
87500 Vanomycin dna amp probe
87501 Influenza dna amp prob 1+
87502 Influenza dna amp probe
87503 Influenza dna amp prob addl
87505 Nfct agent detection gi
87506 Iadna-dna/rna probe tq 6-11
87507 Iadna-dna/rna probe tq 12-25
87510 Gardner vag dna dir probe
87511 Gardner vag dna amp probe
87512 Gardner vag dna quant
87515 Hepatitis b dna dir probe
87516 Hepatitis b dna amp probe
87517 Hepatitis b dna quant
87520 Hepatitis c rna dir probe
87521 Hepatitis c probe&rvrs trnsc
87522 Hepatitis c revrs trnscrpj
87525 Hepatitis g dna dir probe
87526 Hepatitis g dna amp probe
87527 Hepatitis g dna quant
87528 Hsv dna dir probe
87529 Hsv dna amp probe
87530 Hsv dna quant
87531 Hhv-6 dna dir probe
87532 Hhv-6 dna amp probe
87533 Hhv-6 dna quant
87534 Hiv-1 dna dir probe
87535 Hiv-1 probe&reverse trnscrpj
87536 Hiv-1 quant&revrse trnscrpj
87537 Hiv-2 dna dir probe
87538 Hiv-2 probe&revrse trnscripj
87539 Hiv-2 quant&revrse trnscripj
87540 Legion pneumo dna dir prob
87541 Legion pneumo dna amp prob
87542 Legion pneumo dna quant
87550 Mycobacteria dna dir probe
87551 Mycobacteria dna amp probe
87552 Mycobacteria dna quant
87555 M.tuberculo dna dir probe
87556 M.tuberculo dna amp probe
87557 M.tuberculo dna quant
87560 M.avium-intra dna dir prob
87561 M.avium-intra dna amp prob
87562 M.avium-intra dna quant
87580 M.pneumon dna dir probe
87581 M.pneumon dna amp probe
87582 M.pneumon dna quant
87590 N.gonorrhoeae dna dir prob
87591 N.gonorrhoeae dna amp prob
Page 40 of 55
87592 N.gonorrhoeae dna quant
87620 Hpv dna dir probe
87621 Hpv dna amp probe
87622 Hpv dna quant
87623 Hpv low-risk types
87624 Hpv high-risk types
87625 Hpv types 16 & 18 only
87631 Resp virus 3-5 targets
87632 Resp virus 6-11 targets
87633 Resp virus 12-25 targets
87634 Rsv dna/rna amp probe
87640 Staph a dna amp probe
87641 Mr-staph dna amp probe
87650 Strep a dna dir probe
87651 Strep a dna amp probe
87652 Strep a dna quant
87653 Strep b dna amp probe
87660 Trichomonas vagin dir probe
87661 Trichomonas vaginalis amplif
87662 Zika virus dna/rna amp probe
87797 Detect agent nos dna dir
87798 Detect agent nos dna amp
87799 Detect agent nos dna quant
87800 Detect agnt mult dna direc
87801 Detect agnt mult dna ampli
87802 Strep b assay w/optic
87803 Clostridium toxin a w/optic
87804 Influenza assay w/optic
87806 Hiv antigen w/hiv antibodies
87807 Rsv assay w/optic
87808 Trichomonas assay w/optic
87809 Adenovirus assay w/optic
87810 Chylmd trach assay w/optic
87850 N. gonorrhoeae assay w/optic
87880 Strep a assay w/optic
87899 Agent nos assay w/optic
87900 Phenotype infect agent drug
87901 Genotype dna hiv reverse t
87902 Genotype dna/rna hep c
87903 Phenotype dna hiv w/culture
87904 Phenotype dna hiv w/clt add
87905 Sialidase enzyme assay
87906 Genotype dna/rna hiv
87910 Genotype cytomegalovirus
87912 Genotype dna hepatitis b
87999 Microbiology procedure
88000 Autopsy (necropsy) gross
88005 Autopsy (necropsy) gross
88007 Autopsy (necropsy) gross
88012 Autopsy (necropsy) gross
88014 Autopsy (necropsy) gross
88016 Autopsy (necropsy) gross
88020 Autopsy (necropsy) complete
88025 Autopsy (necropsy) complete
88027 Autopsy (necropsy) complete
Page 41 of 55
88028 Autopsy (necropsy) complete
88029 Autopsy (necropsy) complete
88036 Limited autopsy
88037 Limited autopsy
88040 Forensic autopsy (necropsy)
88045 Coroners autopsy (necropsy)
88099 Necropsy (autopsy) procedure
88104 Cytopath fl nongyn smears
88106 Cytopath fl nongyn filter
88108 Cytopath concentrate tech
88112 Cytopath cell enhance tech
88120 Cytp urne 3-5 probes ea spec
88121 Cytp urine 3-5 probes cmptr
88125 Forensic cytopathology
88130 Sex chromatin identification
88140 Sex chromatin identification
88141 Cytopath c/v interpret
88142 Cytopath c/v thin layer
88143 Cytopath c/v thin layer redo
88147 Cytopath c/v automated
88148 Cytopath c/v auto rescreen
88150 Cytopath c/v manual
88152 Cytopath c/v auto redo
88153 Cytopath c/v redo
88154 Cytopath c/v select
88155 Cytopath c/v index add-on
88160 Cytopath smear other source
88161 Cytopath smear other source
88162 Cytopath smear other source
88164 Cytopath tbs c/v manual
88165 Cytopath tbs c/v redo
88166 Cytopath tbs c/v auto redo
88167 Cytopath tbs c/v select
88172 Cytp dx eval fna 1st ea site
88173 Cytopath eval fna report
88174 Cytopath c/v auto in fluid
88175 Cytopath c/v auto fluid redo
88177 Cytp fna eval ea addl
88182 Cell marker study
88184 Flowcytometry/ tc 1 marker
88185 Flowcytometry/tc add-on
88187 Flowcytometry/read 2-8
88188 Flowcytometry/read 9-15
88189 Flowcytometry/read 16 & >
88199 Cytopathology procedure
88230 Tissue culture lymphocyte
88233 Tissue culture skin/biopsy
88235 Tissue culture placenta
88237 Tissue culture bone marrow
88239 Tissue culture tumor
88240 Cell cryopreserve/storage
88241 Frozen cell preparation
88245 Chromosome analysis 20-25
88248 Chromosome analysis 50-100
88249 Chromosome analysis 100
Page 42 of 55
88261 Chromosome analysis 5
88262 Chromosome analysis 15-20
88263 Chromosome analysis 45
88264 Chromosome analysis 20-25
88267 Chromosome analys placenta
88269 Chromosome analys amniotic
88271 Cytogenetics dna probe
88272 Cytogenetics 3-5
88273 Cytogenetics 10-30
88274 Cytogenetics 25-99
88275 Cytogenetics 100-300
88280 Chromosome karyotype study
88283 Chromosome banding study
88285 Chromosome count additional
88289 Chromosome study additional
88291 Cyto/molecular report
88299 Cytogenetic study
88300 Surgical path gross
88302 Tissue exam by pathologist
88304 Tissue exam by pathologist
88305 Tissue exam by pathologist
88307 Tissue exam by pathologist
88309 Tissue exam by pathologist
88311 Decalcify tissue
88312 Special stains group 1
88313 Special stains group 2
88314 Histochemical stains add-on
88319 Enzyme histochemistry
88321 Microslide consultation
88323 Microslide consultation
88325 Comprehensive review of data
88329 Path consult introp
88331 Path consult intraop 1 bloc
88332 Path consult intraop addl
88333 Intraop cyto path consult 1
88334 Intraop cyto path consult 2
88341 Immunohisto antb addl slide
88342 Immunohisto antb 1st stain
88343 Immunohisto antibod add slid
88344 Immunohisto antibody slide
88346 Immunofluor antb 1st stain
88347 Immunofluorescent study
88348 Electron microscopy
88349 Scanning electron microscopy
88350 Immunofluor antb addl stain
88355 Analysis skeletal muscle
88356 Analysis nerve
88358 Analysis tumor
88360 Tumor immunohistochem/manual
88361 Tumor immunohistochem/comput
88362 Nerve teasing preparations
88363 Xm archive tissue molec anal
88364 Insitu hybridization (fish)
88365 Insitu hybridization (fish)
88366 Insitu hybridization (fish)
Page 43 of 55
88367 Insitu hybridization auto
88368 Insitu hybridization manual
88369 M/phmtrc alysishquant/semiq
88371 Protein western blot tissue
88372 Protein analysis w/probe
88373 M/phmtrc alys ishquant/semiq
88374 M/phmtrc alys ishquant/semiq
88375 Optical endomicroscpy interp
88377 M/phmtrc alys ishquant/semiq
88380 Microdissection laser
88381 Microdissection manual
88384 Eval molecular probes 11-50
88385 Eval molecul probes 51-250
88386 Eval molecul probes 251-500
88387 Tiss exam molecular study
88388 Tiss ex molecul study add-on
88399 Surgical pathology procedure
88720 Bilirubin total transcut
88738 Hgb quant transcutaneous
88740 Transcutaneous carboxyhb
88741 Transcutaneous methb
88749 In vivo lab service
89049 Chct for mal hyperthermia
89050 Body fluid cell count
89051 Body fluid cell count
89055 Leukocyte assessment fecal
89060 Exam synovial fluid crystals
89125 Specimen fat stain
89160 Exam feces for meat fibers
89190 Nasal smear for eosinophils
89220 Sputum specimen collection
89230 Collect sweat for test
89240 Pathology lab procedure
89250 Cultr oocyte/embryo <4 days
89251 Cultr oocyte/embryo <4 days
89253 Embryo hatching
89254 Oocyte identification
89255 Prepare embryo for transfer
89257 Sperm identification
89258 Cryopreservation embryo(s)
89259 Cryopreservation sperm
89260 Sperm isolation simple
89261 Sperm isolation complex
89264 Identify sperm tissue
89268 Insemination of oocytes
89272 Extended culture of oocytes
89280 Assist oocyte fertilization
89281 Assist oocyte fertilization
89290 Biopsy oocyte polar body
89291 Biopsy oocyte polar body
89300 Semen analysis w/huhner
89310 Semen analysis w/count
89320 Semen anal vol/count/mot
89321 Semen anal sperm detection
89322 Semen anal strict criteria
Page 44 of 55
89325 Sperm antibody test
89329 Sperm evaluation test
89330 Evaluation cervical mucus
89331 Retrograde ejaculation anal
89335 Cryopreserve testicular tiss
89337 Cryopreservation oocyte(s)
89342 Storage/year embryo(s)
89343 Storage/year sperm/semen
89344 Storage/year reprod tissue
89346 Storage/year oocyte(s)
89352 Thawing cryopresrved embryo
89353 Thawing cryopresrved sperm
89354 Thaw cryoprsvrd reprod tiss
89356 Thawing cryopresrved oocyte
89398 Unlisted reprod med lab proc
0001M Infectious dis hcv 6 assays
0001U Rbn dna hea 35 ag 11 bld grp
0002M Liver dis 10 assays w/ash
0002U Onc clrct 3 ur metab alg plp
0003M Liver dis 10 assays w/nash
0003U Onc ovar 5 prtn ser alg scor
0004M Scoliosis dna alys
0004U Nfct ds dna 27 resist genes
0005U Onco prst8 3 gene ur alg
0006M Onc hep gene risk classifier
0006U Detc ia meds 120+ analytes
0007M Onc gastro 51 gene nomogram
0007U Rx test prsmv ur w/def conf
0008M Onc breast risk score
0008U Hpylori detcj abx rstnc dna
0009M Fetal aneuploidy trisom risk
0009U Onc brst ca erbb2 amp/nonamp
0010M Onc Prostate prob score
0010U Nfct ds strn typ whl gen seq
0011U Rx mntr lc-ms/ms oral fluid
0012U Germln do gene reargmt detcj
0013U Onc sld org neo gene reargmt
0014U Hem hmtlmf neo gene reargmt
0015U Rx metab advrs rx rxn dna
0016U Onc hmtlmf neo rna bcr/abl1
0017U Onc hmtlmf neo jak2 mut dna
0018U Onc thyr 10 microrna seq alg
0019U Onc rna tiss predict alg
0020U Rx test prsmv ur w/def conf
0021U Onc prst8 detcj 8 autoantb
0022U Trgt gen seq dna&rna 23 gene
0023U Onc aml dna detcj/nondetcj
0024U Glyca nuc mr spectrsc quan
0025U Tenofovir liq chrom ur quan
0026U Onc thyr dna&mrna 112 genes
0027U JAK2 gene trgt seq alys
0028U CYP2D6 gene cpy nmr cmn vrnt
0029U Rx metab advrs trgt seq alys
0030T Antiprothrombin antibody
0030U Rx metab warf trgt seq alys
Page 45 of 55
0031U CYP1A2 gene
0032U Comt gene
0033U HTR2A HTR2C genes
0034U Tpmt NUDT15 genes
0042T Ct perfusion w/contrast cbf
0073T Delivery comp imrt
0085T Breath test heart reject
0103T Holotranscobalamin
0111T Rbc membranes fatty acids
0159T Cad breast mri
0174T Cad cxr with interp
0175T Cad cxr remote
0182T Hdr elect brachytherapy
0197T Intrafraction track motion
0279T Ctc test
0280T Ctc test w/i & r
0291T Iv oct for proc init vessel
0292T Iv oct for proc addl vessel
0342T Thxp apheresis w/hdl delip
0346T Ultrasound elastography
0348T Rsa spine exam
0349T Rsa upper extr exam
0350T Rsa lower extr exam
0351T Intraop oct brst/node spec
0352T Oct brst/node i&r per spec
0353T Intraop oct breast cavity
0354T Oct breast surg cavity i&r
0394T Hdr elctrnc skn surf brchytx
0395T Hdr elctr ntrst/ntrcv brchtx
0398T Mrgfus strtctc les abltj
0423T Assay secretory type ii pla2
0470T Oct skn img acquisj i&r 1st
0471T Oct skn img acquisj i&r addl
0475T rec ftl car sgl 3 ch i&r
0476T rec ftl car sgl elec tr data
0477T rec ftl car sgl xrtj alys
0478T rec ftl car 3 ch rev i&r
0482T Absl quan myocrd bld flo pet
0485T Oct mid ear i&r unilateral
0486T Oct mid ear i&r bilateral
0487T Trvg biomchn mapg w/reprt
0500T Hpv 5+ hi risk hpv types
0501T Cor ffr derived cor cta data
0502T Cor ffr data prep & transmis
0503T Cor ffr alys gnrj ffr mdl
0504T Cor ffr data review i&r
ATP02 Auto.Test Panel Pricing Code, 1-2 Tests
ATP03 Auto.Test Panel Pricing Code, 3 Tests
ATP04 Auto.Test Panel Pricing Code, 4 Tests
ATP05 Auto.Test Panel Pricing Code, 5 Tests
ATP06 Auto.Test Panel Pricing Code, 6 Tests
ATP07 Auto.Test Panel Pricing Code, 7 Tests
ATP08 Auto.Test Panel Pricing Code, 8 Tests
ATP09 Auto.Test Panel Pricing Code, 9 Tests
ATP10 Auto.Test Panel Pricing Code, 10 Tests
Page 46 of 55
ATP11 Auto.Test Panel Pricing Code, 11 Tests
ATP12 Auto.Test Panel Pricing Code, 12 Tests
ATP16 Auto Test Panel Pricing Code 13-16 Test
ATP18 Auto Test Panel Pricing Code, 17-18 Test
ATP19 Auto Test Panel Pricing Code, 19 Tests
ATP20 Auto Test Panel Pricing Code, 20 Tests
ATP21 Auto Test Panel Pricing Code, 21 Tests
ATP22 Auto.Test Panel Pricing Code, 22+ Tests
ATP23 Auto.Test Panel Pricing Code, 23+ Tests
C1716 Brachytx, non-str, Gold-198
C1717 Brachytx, non-str,HDR Ir-192
C1719 Brachytx, NS, Non-HDRIr-192
C2616 Brachytx, non-str,Yttrium-90
C2634 Brachytx, non-str, HA, I-125
C2635 Brachytx, non-str, HA, P-103
C2636 Brachy linear, non-str,P-103
C2637 Brachy,non-str,Ytterbium-169
C2638 Brachytx, stranded, I-125
C2639 Brachytx, non-stranded,I-125
C2640 Brachytx, stranded, P-103
C2641 Brachytx, non-stranded,P-103
C2642 Brachytx, stranded, C-131
C2643 Brachytx, non-stranded,C-131
C2644 Brachytx cesium-131 chloride
C2645 Brachytx planar, p-103
C2698 Brachytx, stranded, NOS
C2699 Brachytx, non-stranded, NOS
C8900 MRA w/cont, abd
C8901 MRA w/o cont, abd
C8902 MRA w/o fol w/cont, abd
C8903 Mri w/cont, breast, uni
C8904 MRI w/o cont, breast, uni
C8905 MRI w/o fol w/cont, brst, un
C8906 Mri w/cont, breast, bi
C8907 MRI w/o cont, breast, bi
C8908 MRI w/o fol w/cont, breast,
C8909 MRA w/cont, chest
C8910 MRA w/o cont, chest
C8911 MRA w/o fol w/cont, chest
C8912 MRA w/cont, lwr ext
C8913 MRA w/o cont, lwr ext
C8914 MRA w/o fol w/cont, lwr ext
C8918 MRA w/cont, pelvis
C8919 MRA w/o cont, pelvis
C8920 MRA w/o fol w/cont, pelvis
C8931 MRA, w/dye, spinal canal
C8932 MRA, w/o dye, spinal canal
C8933 MRA, w/o&w/dye, spinal canal
C8934 MRA, w/dye, upper extremity
C8935 MRA, w/o dye, upper extr
C8936 MRA, w/o&w/dye, upper extr
C9728 Place device/marker, non pro
C9733 Non-ophthalmic FVA
C9744 Abd us w/contrast
G0027 Semen analysis
Page 47 of 55
G0103 PSA screening
G0123 Screen cerv/vag thin layer
G0124 Screen c/v thin layer by MD
G0130 Single energy x-ray study
G0141 Scr c/v cyto,autosys and md
G0143 Scr c/v cyto,thinlayer,rescr
G0144 Scr c/v cyto,thinlayer,rescr
G0145 Scr c/v cyto,thinlayer,rescr
G0147 Scr c/v cyto, automated sys
G0148 Scr c/v cyto, autosys, rescr
G0202 Scr mammo bi incl cad
G0204 Dx mammo incl cad bi
G0206 Dx mammo incl cad uni
G0219 PET img wholbod melano nonco
G0235 PET not otherwise specified
G0252 PET imaging initial dx
G0275 Renal angio, cardiac cath
G0278 Iliac art angio,cardiac cath
G0279 Tomosynthesis, mammo
G0288 Recon, CTA for surg plan
G0297 Ldct for lung ca screen
G0298 Hiv combination assay
G0306 CBC/diffwbc w/o platelet
G0307 CBC without platelet
G0328 Fecal blood scrn immunoassay
G0389 Ultrasound exam AAA screen
G0416 Prostate biopsy, any mthd
G0417 Sat biopsy prostate 21-40
G0418 Sat biopsy prostate 41-60
G0419 Sat biopsy prostate: >60
G0431 Drug screen multiple class
G0432 EIA HIV-1/HIV-2 screen
G0433 ELISA HIV-1/HIV-2 screen
G0434 Drug screen multi drug class
G0435 Oral HIV-1/HIV-2 screen
G0450 Screen STI w four lab test
G0452 Molecular pathology interpr
G0458 LDR prostate brachy comp rat
G0461 Immunohisto/cyto chem 1st st
G0462 Immunohisto/cyto chem add
G0464 Colorec ca scr, sto bas dna
G0471 Ven blood coll SNF/HHA
G0472 Hep c screen high risk/other
G0475 Hiv combination assay
G0476 Hpv combo assay ca screen
G0477 Drug test presump optical
G0478 Drug test presump opt inst
G0479 Drug test presump not opt
G0480 Drug test def 1-7 classes
G0481 Drug test def 8-14 classes
G0482 Drug test def 15-21 classes
G0483 Drug test def 22+ classes
G0499 Hepb screen high risk indiv
G0659 Drug test def simple all cl
G6001 Echo guidance radiotherapy
Page 48 of 55
G6002 Stereoscopic x-ray guidance
G6003 Radiation treatment delivery
G6004 Radiation treatment delivery
G6005 Radiation treatment delivery
G6006 Radiation treatment delivery
G6007 Radiation treatment delivery
G6008 Radiation treatment delivery
G6009 Radiation treatment delivery
G6010 Radiation treatment delivery
G6011 Radiation treatment delivery
G6012 Radiation treatment delivery
G6013 Radiation treatment delivery
G6014 Radiation treatment delivery
G6015 Radiation tx delivery imrt
G6016 Delivery comp imrt
G6017 Intrafraction track motion
G6030 Assay of amitriptyline
G6031 Assay of benzodiazepines
G6032 Assay of desipramine
G6034 Assay of doxepin
G6035 Assay of gold
G6036 Assay of imipramine
G6037 Assay of nortiptyline
G6038 Assay of salicylate
G6039 Assay of acetaminophen
G6040 Assay of ethanol
G6041 Assay of urine alkaloids
G6042 Assay of amphetamines
G6043 Assay of barbiturates
G6044 Assay of cocaine
G6045 Assay of dihydrocodeinone
G6046 Assay of dihydromorphinone
G6047 Assay of dihydrotestosterone
G6048 Assay of dimethadione
G6049 Asssay of epiandrosterone
G6050 Assay of ethchlorvynol
G6051 Assay of flurazepam
G6052 Assay of meprobamate
G6053 Assay of methadone
G6054 Assay of methsuximide
G6055 Assay of nicotine
G6056 Assay of opiates
G6057 Assay of phenothiazine
G6058 Drug confirmation
G9143 Warfarin respon genetic test
P2028 Cephalin floculation test
P2029 Congo red blood test
P2031 Hair analysis
P2033 Blood thymol turbidity
P2038 Blood mucoprotein
P3000 Screen pap by tech w md supv
P3001 Screening pap smear by phys
P7001 Culture bacterial urine
Q0092 Set up port xray equipment
Q0111 Wet mounts/ w preparations
Page 49 of 55
Q0112 Potassium hydroxide preps
Q0113 Pinworm examinations
Q0114 Fern test
Q0115 Post-coital mucous exam
Q3031 Collagen skin test
R0070 Transport portable x-ray
R0075 Transport port x-ray multipl
R0076 Transport portable EKG
S0832 Low dose ct lung screening
S2120 Low density lipoprotein(LDL)
S3600 Stat lab
S3601 Stat lab home/nf
S3620 Newborn metabolic screening
S3625 Maternal triple screen test
S3626 Maternal serum quad screen
S3630 Eosinophil blood count
S3645 HIV-1 antibody testing of or
S3650 Saliva test, hormone level;
S3652 Saliva test, hormone level;
S3655 Antisperm antibodies test
S3708 Gastrointestinal fat absorpt
S3721 Pca3 testing
S3722 Dose optimization AUC - 5FU
S3800 Genetic testing ALS
S3833 Comp APC sequence
S3834 Sing mutation APC
S3840 DNA analysis RET-oncogene
S3841 Gene test retinoblastoma
S3842 Gene test Hippel-Lindau
S3844 DNA analysis deafness
S3845 Gene test alpha-thalassemia
S3846 Gene test beta-thalassemia
S3849 Gene test Niemann-Pick
S3850 Gene test sickle cell
S3852 DNA analysis APOE alzheimer
S3853 Gene test myo musclr dyst
S3854 Gene profile panel breast
S3855 Gene test presenilin-1 gene
S3861 Genetic test brugada
S3865 comp genet test hyp cardiomy
S3866 spec gene test hyp cardiomy
S3870 CGH test developmental delay
S3890 Fecal DNA analysis
S8030 Tantalum ring application
S8032 Low dose CT lung screening
S8035 Magnetic source imaging
S8037 mrcp
S8042 MRI low field
S8055 Us guidance fetal reduct
S8080 Scintimammography
S8085 Fluorine-18 fluorodeoxygluco
S8092 Electron beam computed tomog
S9024 Paranasal sinus ultrasound
S9529 Venipuncture home/snf
71090 X-ray & pacemaker insertion
Page 50 of 55
73542 X-ray exam sacroiliac joint
75722 Artery x-rays kidney
75724 Artery x-rays kidneys
75940 X-ray placement vein filter
77079 Ct bone density peripheral
77083 Radiographic absorptiometry
78220 Liver function study
78223 Hepatobiliary imaging
78584 Lung V/Q image single breath
78585 Lung V/Q imaging
78586 Aerosol lung image single
78587 Aerosol lung image multiple
78588 Perfusion lung image
78591 Vent image 1 breath 1 proj
78593 Vent image 1 proj gas
78594 Vent image mult proj gas
78596 Lung differential function
88107 Cytopath fl nongyn sm/fltr
88318 Chemical histochemistry
S3711 Circulating tumor cell test
S3713 KRAS mutation analysis
S3818 BRCA1 gene anal
S3819 BRCA2 gene anal
S3820 Comp BRCA1/BRCA2
S3822 Sing mutation brst/ovar
S3823 3 mutation brst/ovar
S3828 Comp MLH1 gene
S3829 Comp MSH2 gene
S3830 Gene test HNPCC comp
S3831 Gene test HNPCC single
S3835 Gene test cystic fibrosis
S3837 Gene test hemochromato
S3843 DNA analysis factor v
S3847 Gene test Tay-Sachs
S3848 Gene test Gaucher
S3851 Gene test canavan
S3860 Genet test cardiac ion-comp
S3862 Genet test cardiac ion-spec
S8049 Intraoperative radiation the
75992 Atherectomy, x-ray exam
75993 Atherectomy, x-ray exam
75994 Atherectomy, x-ray exam
75995 Atherectomy, x-ray exam
75996 Atherectomy, x-ray exam
76150 X-ray exam, dry process
76350 Special x-ray contrast study
76880 Us exam, extremity
82926 Assay of gastric acid
82928 Assay of gastric acid
86903 Blood typing, antigen screen
89100 Sample intestinal contents
89105 Sample intestinal contents
89130 Sample stomach contents
89132 Sample stomach contents
89135 Sample stomach contents
Page 51 of 55
89136 Sample stomach contents
89140 Sample stomach contents
89141 Sample stomach contents
89225 Starch granules, feces
89235 Water load test
0140T Exhaled breath condensate ph
G0430 Drug screen multi class
S3628 PAMG-1 rapid assay for ROM
75558 Cardiac mri flow/velocity
75560 Cardiac mri flow/vel/stress
75562 Card mri flow/vel w/dye
75564 Ht mri w/flo/vel/strs & dye
75790 Visualize A-V shunt
78460 Heart muscle blood, single
78461 Heart muscle blood, multiple
78464 Heart image (3d), single
78465 Heart image (3d), multiple
78478 Heart wall motion add-on
78480 Heart function add-on
82307 Assay of vitamin D
86781 Treponema pallidum, confirm
0066T Ct colonography;screen
0067T Ct colonography;dx
0144T CT heart wo dye; qual calc
0145T CT heart w/wo dye funct
0146T CCTA w/wo dye
0147T CCTA w/wo, quan calcium
0148T CCTA w/wo, strxr
0149T CCTA w/wo, strxr quan calc
0150T CCTA w/wo, disease strxr
0151T CT heart funct add-on
0194T Procalcitonin (pct)
0026T Measure remnant lipoproteins
0028T Dexa body composition study
0041T Detect ur infect agnt w/cpas
0043T Co expired gas analysis
0060T Electrical impedance scan
74350 X-ray guide, stomach tube
75552 Heart mri for morph w/o dye
75553 Heart mri for morph w/dye
75554 Cardiac MRI/function
75555 Cardiac MRI/limited study
75556 Cardiac MRI/flow mapping
77781 High intensity brachytherapy
77782 High intensity brachytherapy
77783 High intensity brachytherapy
77784 High intensity brachytherapy
78615 Cerebral vascular flow image
78890 Nuclear medicine data proc
78891 Nuclear med data proc
86586 Skin test, unlisted
88400 Bilirubin total transcut
G0394 Blood occult test,colorectal
0082T Stereotactic rad delivery
0083T Stereotactic rad tx mngmt
Page 52 of 55
75998 Fluoroguide for vein device
76003 Needle localization by x-ray
76005 Fluoroguide for spine inject
76006 X-ray stress view
76012 Percut vertebroplasty fluor
76013 Percut vertebroplasty, ct
76020 X-rays for bone age
76040 X-rays, bone evaluation
76061 X-rays, bone survey
76062 X-rays, bone survey
76065 X-rays, bone evaluation
76066 Joint survey, single view
76070 Ct bone density, axial
76071 Ct bone density, peripheral
76075 Dxa bone density, axial
76076 Dxa bone density/peripheral
76077 Dxa bone density/v-fracture
76078 Radiographic absorptiometry
76082 Computer mammogram add-on
76083 Computer mammogram add-on
76086 X-ray of mammary duct
76088 X-ray of mammary ducts
76090 Mammogram, one breast
76091 Mammogram, both breasts
76092 Mammogram, screening
76093 Magnetic image, breast
76094 Magnetic image, both breasts
76095 Stereotactic breast biopsy
76096 X-ray of needle wire, breast
76355 Ct scan for localization
76360 Ct scan for needle biopsy
76362 Ct guide for tissue ablation
76370 Ct scan for therapy guide
76393 Mr guidance for needle place
76394 Mri for tissue ablation
76400 Magnetic image, bone marrow
76778 Us exam kidney transplant
76986 Ultrasound guide intraoper
78704 Imaging renogram
78715 Renal vascular flow exam
78760 Testicular imaging
G0265 Cryopresevation Freeze+stora
G0266 Thawing + expansion froz cel
S3618 Blood Chemistry For Free Beta Human Chorionic Gonadotropin (Hcg)
0010T Tb test, gamma interferon
0023T Phenotype drug test, hiv 1
0038T Rad endovasc taa rpr w/cover
0039T Rad s/i, endovasc taa repair
0040T Rad s/i, endovasc taa prosth
0152T Computer chest add-on
76375 3d/holograph reconstr add-on
78160 Plasma iron turnover
78162 Radioiron absorption exam
78170 Red cell iron utilization
78172 Total body iron estimation
Page 53 of 55
78455 Venous thrombosis study
78810 Tumor imaging (PET)
78990 Provide diag radionuclide(s)
79000 Init hyperthyroid therapy
79001 Repeat hyperthyroid therapy
79020 Thyroid ablation
79030 Thyroid ablation, carcinoma
79035 Thyroid metastatic therapy
79100 Hematopoetic nuclear therapy
79400 Nonhemato nuclear therapy
79420 Intravascular nuclear ther
79900 Provide ther radiopharm(s)
82273 Test for blood, other source
83715 Assay of blood lipoproteins
83716 Assay of blood lipoproteins
86064 B cells, total count
86379 Nk cells, total count
86585 TB tine test
86587 Stem cells, total count
88180 Cell marker study
G0001 Drawing blood for specimen
G0030 PET imaging prev PET single
G0031 PET imaging prev PET multple
G0032 PET follow SPECT 78464 singl
G0033 PET follow SPECT 78464 mult
G0034 PET follow SPECT 76865 singl
G0035 PET follow SPECT 78465 mult
G0036 PET follow cornry angio sing
G0037 PET follow cornry angio mult
G0038 PET follow myocard perf sing
G0039 PET follow myocard perf mult
G0040 PET follow stress echo singl
G0041 PET follow stress echo mult
G0042 PET follow ventriculogm sing
G0043 PET follow ventriculogm mult
G0044 PET following rest ECG singl
G0045 PET following rest ECG mult
G0046 PET follow stress ECG singl
G0047 PET follow stress ECG mult
G0107 CA screen; fecal blood test
G0125 PET img WhBD sgl pulm ring
G0210 PET img wholebody dxlung
G0211 PET img wholbody init lung
G0212 PET img wholebod restag lung
G0213 PET img wholbody dx
G0214 PET img wholebod init
G0215 PETimg wholebod restag
G0216 PET img wholebod dx melanoma
G0217 PET img wholebod init melan
G0218 PET img wholebod restag mela
G0242 Multisource photon ster plan
G0243 Multisour photon stero treat
G0253 PET image brst dection recur
G0220 PET img wholebod dx lymphoma
G0221 PET imag wholbod init lympho
Page 54 of 55
G0222 PET imag wholbod resta lymph
G0223 PET imag wholbod reg dx head
G0224 PET imag wholbod reg ini hea
G0225 PET whol restag headneckonly
G0226 PET img wholbody dx esophagl
G0227 PET img wholbod ini esophage
G0228 PET img wholbod restg esopha
G0229 PET img metaboloc brain pres
G0230 PET myocard viability post
G0231 PET WhBD colorec; gamma cam
G0232 PET whbd lymphoma; gamma cam
G0233 PET whbd melanoma; gamma cam
G0234 PET WhBD pulm nod; gamma cam
G0254 PET image brst eval to tx
G0330 PET image initial dx cervcal
G0331 PET image restage ovarian ca
G0336 PET imaging brain alzheimers
S3701 NMP-22 assay
S8004 Wholebody radiopharm trgcell
S8075 CAD of digital mammogr
S8093 CT angiography coronary
S9022 Digital subtraction angiogra
De tener alguna pregunta puede comunicarse con nuestro Centro de Llamadas de Servicios
para Proveedores, sin cargo, al (888) 558-5501. Nuestras horas de servicio son de lunes a
viernes, de 7:00 a.m. a 7:00 p.m.
Gracias por su respaldo y por hacer posible que servicios de excelencia continúen llegando a
nuestros asegurados.
Cordialmente,
Molina Healthcare de Puerto Rico
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