Clinical Diagnostic Laboratory Fee Schedule CPT codes ...
[Pages:34]Clinical Diagnostic Laboratory Fee Schedule
CPT codes, descriptions and other data only are copyright American Medical Association.
2015 Codes are in Red
NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
HCPCS Modifier SHORT DESCRIPTION
2015 Fee Schedule
(60% of Medicare)
36415
Routine venipuncture
$3.00
78267
Breath tst attain/anal c-14
$10.70
78268
Breath test analysis c-14
$91.66
80047
Metabolic panel ionized ca
$9.12
80047 QW
Metabolic panel ionized ca
$9.12
80048
Metabolic panel total ca
$9.12
80048 QW
Metabolic panel total ca
$9.12
80051
Electrolyte panel
$7.60
80051 QW
Electrolyte panel
$7.60
80053
Comprehen metabolic panel
$11.44
80053 QW
Comprehen metabolic panel
$11.44
80061
Lipid panel
$15.49
80061 QW
Lipid panel
$15.49
80069
Renal function panel
$9.12
80069 QW
Renal function panel
$9.12
80074
Acute hepatitis panel
$64.83
80076
Hepatic function panel
$9.12
80150
Assay of amikacin
$20.51
80155
Drug screen quant caffeine
$19.25
80156
Assay carbamazepine total
$19.82
80157
Assay carbamazepine free
$18.04
80158
Assay of cyclosporine
$24.57
80159
Drug screen quant clozapine
$25.17
80162
Assay of digoxin
$18.07
80163
Assay of digoxin free
$18.07
80164
Assay dipropylacetic acid
$18.44
80165
Dipropylacetic acid free
$18.44
80168
Assay of ethosuximide
$22.24
80169
Drug screen quant everolimus
$18.69
80170
Assay of gentamicin
$22.30
80171
Drug screen quant gabapentin
$18.04
80173
Assay of haloperidol
$19.82
80175
Drug screen quan lamotrigine
$18.04
80176
Assay of lidocaine
$19.99
80177
Drug scrn quan levetiracetam
$18.04
80178
Assay of lithium
$9.00
80178 QW
Assay of lithium
$9.00
80180
Drug scrn quan mycophenolate
$24.57
80183
Drug scrn quant oxcarbazepin
$18.04
Rev. Jan. 2015
Page 1
Clinical Diagnostic Laboratory Fee Schedule
CPT codes, descriptions and other data only are copyright American Medical Association.
2015 Codes are in Red
NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
HCPCS Modifier SHORT DESCRIPTION
2015 Fee Schedule
(60% of Medicare)
80184
Assay of phenobarbital
$15.58
80185
Assay of phenytoin total
$18.04
80186
Assay of phenytoin free
$18.73
80188
Assay of primidone
$22.58
80190
Assay of procainamide
$22.80
80192
Assay of procainamide
$22.80
80194
Assay of quinidine
$19.87
80195
Assay of sirolimus
$18.69
80197
Assay of tacrolimus
$18.69
80198
Assay of theophylline
$19.25
80199
Drug screen quant tiagabine
$24.58
80200
Assay of tobramycin
$21.94
80201
Assay of topiramate
$16.23
80202
Assay of vancomycin
$18.44
80203
Drug screen quant zonisamide
$18.04
80299
Quantitative assay drug
$18.64
80400
Acth stimulation panel
$44.39
80402
Acth stimulation panel
$118.33
80406
Acth stimulation panel
$106.49
80408
Aldosterone suppression eval
$170.78
80410
Calcitonin stimul panel
$109.33
80412
CRH stimulation panel
$402.44
80414
Testosterone response
$70.27
80415
Estradiol response panel
$76.05
80416
Renin stimulation panel
$179.58
80417
Renin stimulation panel
$59.86
80418
Pituitary evaluation panel
$758.01
80420
Dexamethasone panel
$97.58
80422
Glucagon tolerance panel
$62.70
80424
Glucagon tolerance panel
$68.72
80426
Gonadotropin hormone panel
$201.96
80428
Growth hormone panel
$90.77
80430
Growth hormone panel
$106.80
80432
Insulin suppression panel
$172.89
80434
Insulin tolerance panel
$137.68
80435
Insulin tolerance panel
$140.19
80436
Metyrapone panel
$124.06
80438
TRH stimulation panel
$68.60
80439
TRH stimulation panel
$91.47
Rev. Jan. 2015
Page 2
Clinical Diagnostic Laboratory Fee Schedule
CPT codes, descriptions and other data only are copyright American Medical Association.
2015 Codes are in Red
NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
HCPCS Modifier SHORT DESCRIPTION
2015 Fee Schedule
(60% of Medicare)
81000
Urinalysis nonauto w/scope
$4.31
81001
Urinalysis auto w/scope
$4.31
81002
Urinalysis nonauto w/o scope
$3.28
81003
Urinalysis auto w/o scope
$3.06
81003 QW
Urinalysis auto w/o scope
$3.06
81005
Urinalysis
$2.95
81007
Urine screen for bacteria
$3.49
81007 QW
Urine screen for bacteria
$3.49
81015
Microscopic exam of urine
$4.14
81020
Urinalysis glass test
$5.02
81025
Urine pregnancy test
$1.64
81050
Urinalysis volume measure
$3.85
81161
Dmd dup/delet analysis
$0.00
81206
Bcr/abl1 gene major bp
$223.13
81207
Bcr/abl1 gene minor bp
$197.10
81208
Bcr/abl1 gene other bp
$218.88
81210
Braf gene
$178.80
81211
Brca1&2 seq & com dup/del
$2,178.04
81212
Brca1&2 185&5385&6174 var
$176.26
81213
Brca1&2 uncom dup/del var
$581.26
81214
Brca1 full seq & com dup/del
$1,434.54
81215
Brca1 gene known fam variant
$93.01
81217
Brca2 gene known fam variant
$93.01
81225
Cyp2c19 gene com variants
$291.07
81226
Cyp2d6 gene com variants
$450.46
81227
Cyp2c9 gene com variants
$174.64
81235
Egfr gene com variants
$329.18
81240
F2 gene
$66.96
81241
F5 gene
$83.16
81245
Flt3 gene
$165.51
81246
Flt3 gene analysis
$0.00
81256
Hfe gene
$88.95
81261
Igh gene rearrange amp meth
$269.43
81262
Igh gene rearrang dir probe
$59.40
81263
Igh vari regional mutation
$400.79
81264
Igk rearrangeabn clonal pop
$203.21
81265
Str markers specimen anal
$292.65
81267
Chimerism anal no cell selec
$282.32
81268
Chimerism anal w/cell select
$354.89
Rev. Jan. 2015
Page 3
Clinical Diagnostic Laboratory Fee Schedule
CPT codes, descriptions and other data only are copyright American Medical Association.
2015 Codes are in Red
NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
HCPCS Modifier SHORT DESCRIPTION
2015 Fee Schedule
(60% of Medicare)
81270
Jak2 gene
$124.75
81275
Kras gene
$196.99
81287
Mgmt gene methylation anal
$0.00
81288
Mlh1 gene
$0.00
81291
Mthfr gene
$59.40
81292
Mlh1 gene full seq
$644.62
81293
Mlh1 gene known variants
$258.41
81294
Mlh1 gene dup/delete variant
$190.20
81295
Msh2 gene full seq
$151.33
81296
Msh2 gene known variants
$129.21
81297
Msh2 gene dup/delete variant
$151.33
81298
Msh6 gene full seq
$287.11
81299
Msh6 gene known variants
$160.84
81300
Msh6 gene dup/delete variant
$161.28
81301
Microsatellite instability
$394.05
81310
Npm1 gene
$246.52
81313
Pca3/klk3 antigen
$0.00
81315
Pml/raralpha com breakpoints
$282.12
81316
Pml/raralpha 1 breakpoint
$430.31
81317
Pms2 gene full seq analysis
$779.34
81318
Pms2 known familial variants
$184.15
81319
Pms2 gene dup/delet variants
$221.11
81321
Pten gene full sequence
$599.20
81322
Pten gene known fam variant
$58.25
81323
Pten gene dup/delet variant
$87.38
81332
Serpina1 gene
$59.40
81340
Trb@ gene rearrange amplify
$284.31
81341
Trb@ gene rearrange dirprobe
$67.48
81342
Trg gene rearrangement anal
$274.21
81370
Hla i & ii typing lr
$547.23
81371
Hla i & ii type verify lr
$327.54
81372
Hla i typing complete lr
$300.61
81373
Hla i typing 1 locus lr
$151.55
81374
Hla i typing 1 antigen lr
$99.00
81375
Hla ii typing ag equiv lr
$300.40
81376
Hla ii typing 1 locus lr
$166.32
81377
Hla ii type 1 ag equiv lr
$124.94
81378
Hla i & ii typing hr
$470.26
81379
Hla i typing complete hr
$456.40
Rev. Jan. 2015
Page 4
Clinical Diagnostic Laboratory Fee Schedule
CPT codes, descriptions and other data only are copyright American Medical Association.
2015 Codes are in Red
NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
HCPCS Modifier SHORT DESCRIPTION
2015 Fee Schedule
(60% of Medicare)
81380
Hla i typing 1 locus hr
$241.21
81381
Hla i typing 1 allele hr
$128.71
81382
Hla ii typing 1 loc hr
$168.31
81383
Hla ii typing 1 allele hr
$148.51
81410
Aortic dysfunction/dilation
$0.00
81411
Aortic dysfunction/dilation
$0.00
81415
Exome sequence analysis
$0.00
81416
Exome sequence analysis
$0.00
81417
Exome re-evaluation
$0.00
81420
Fetal chrmoml aneuploidy
$0.00
81425
Genome sequence analysis
$0.00
81426
Genome sequence analysis
$0.00
81427
Genome re-evaluation
$0.00
81430
Hearing loss sequence analys
$0.00
81431
Hearing loss dup/del analys
$0.00
81435
Hereditary colon cancer
$0.00
81436
Hereditary colon ca synd
$0.00
81440
Mitochondrial gene
$0.00
81445
Targeted genomic seq analys
$0.00
81450
Targeted genomic seq analys
$0.00
81455
Targeted genomic seq analys
$0.00
81460
Whole mitochondrial genome
$0.00
81465
Whole mitochondrial genome
$0.00
81470
X-linked intellectual dblt
$0.00
81471
X-linked intellectual dblt
$0.00
82009
Test for acetone/ketones
$6.15
82010
Acetone assay
$11.12
82010 QW
Acetone assay
$11.12
82013
Acetylcholinesterase assay
$15.20
82016
Acylcarnitines qual
$18.87
82017
Acylcarnitines quant
$2.77
82024
Assay of acth
$44.88
82030
Assay of adp & amp
$35.11
82040
Assay of serum albumin
$6.72
82040 QW
Assay of serum albumin
$6.72
82042
Assay of urine albumin
$7.04
82042 QW
Assay of urine albumin
$7.04
82043
Microalbumin quantitative
$7.87
82043 QW
Microalbumin quantitative
$7.87
Rev. Jan. 2015
Page 5
Clinical Diagnostic Laboratory Fee Schedule
CPT codes, descriptions and other data only are copyright American Medical Association.
2015 Codes are in Red
NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
HCPCS Modifier SHORT DESCRIPTION
2015 Fee Schedule
(60% of Medicare)
82044
Microalbumin semiquant
$6.22
82044 QW
Microalbumin semiquant
$6.22
82045
Albumin ischemia modified
$46.19
82075
Assay of breath ethanol
$15.82
82085
Assay of aldolase
$13.21
82088
Assay of aldosterone
$55.46
82103
Alpha-1-antitrypsin total
$18.29
82104
Alpha-1-antitrypsin pheno
$19.68
82105
Alpha-fetoprotein serum
$22.83
82106
Alpha-fetoprotein amniotic
$22.83
82107
Alpha-fetoprotein l3
$87.65
82108
Assay of aluminum
$34.67
82120
Amines vaginal fluid qual
$5.12
82120 QW
Amines vaginal fluid qual
$5.12
82127
Amino acid single qual
$18.87
82128
Amino acids mult qual
$18.87
82131
Amino acids single quant
$22.95
82135
Assay aminolevulinic acid
$22.39
82136
Amino acids quant 2-5
$2.77
82139
Amino acids quan 6 or more
$2.77
82140
Assay of ammonia
$19.83
82143
Amniotic fluid scan
$9.35
82150
Assay of amylase
$8.82
82150 QW
Assay of amylase
$8.82
82154
Androstanediol glucuronide
$39.24
82157
Assay of androstenedione
$39.84
82160
Assay of androsterone
$34.03
82163
Assay of angiotensin II
$23.74
82164
Angiotensin I enzyme test
$19.87
82172
Assay of apolipoprotein
$19.28
82175
Assay of arsenic
$25.82
82180
Assay of ascorbic acid
$7.91
82190
Atomic absorption
$20.28
82232
Assay of beta-2 protein
$22.02
82239
Bile acids total
$23.31
82240
Bile acids cholylglycine
$29.80
82247
Bilirubin total
$6.83
82247 QW
Bilirubin total
$6.83
82248
Bilirubin direct
$6.83
Rev. Jan. 2015
Page 6
Clinical Diagnostic Laboratory Fee Schedule
CPT codes, descriptions and other data only are copyright American Medical Association.
2015 Codes are in Red
NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
HCPCS Modifier SHORT DESCRIPTION
2015 Fee Schedule
(60% of Medicare)
82252
Fecal bilirubin test
$6.19
82261
Assay of biotinidase
$2.77
82270
Occult blood feces
$4.43
82271
Occult blood other sources
$4.43
82271 QW
Occult blood other sources
$4.43
82272
Occult bld feces 1-3 tests
$4.43
82272 QW
Occult bld feces 1-3 tests
$4.43
82274
Assay test for blood fecal
$21.65
82274 QW
Assay test for blood fecal
$21.65
82286
Assay of bradykinin
$9.38
82300
Assay of cadmium
$31.49
82306
Vitamin d 25 hydroxy
$37.19
82308
Assay of calcitonin
$36.45
82310
Assay of calcium
$7.02
82310 QW
Assay of calcium
$7.02
82330
Assay of calcium
$18.60
82330 QW
Assay of calcium
$18.60
82331
Calcium infusion test
$7.04
82340
Assay of calcium in urine
$5.36
82355
Calculus analysis qual
$15.75
82360
Calculus assay quant
$17.52
82365
Calculus spectroscopy
$17.55
82370
X-ray assay calculus
$17.05
82373
Assay c-d transfer measure
$24.58
82374
Assay blood carbon dioxide
$6.65
82374 QW
Assay blood carbon dioxide
$6.65
82375
Assay carboxyhb quant
$16.77
82376
Assay carboxyhb qual
$8.15
82378
Carcinoembryonic antigen
$25.81
82379
Assay of carnitine
$2.77
82380
Assay of carotene
$12.55
82382
Assay urine catecholamines
$23.40
82383
Assay blood catecholamines
$34.10
82384
Assay three catecholamines
$34.36
82387
Assay of cathepsin-d
$28.32
82390
Assay of ceruloplasmin
$14.62
82397
Chemiluminescent assay
$19.22
82415
Assay of chloramphenicol
$17.24
82435
Assay of blood chloride
$6.26
Rev. Jan. 2015
Page 7
Clinical Diagnostic Laboratory Fee Schedule
CPT codes, descriptions and other data only are copyright American Medical Association.
2015 Codes are in Red
NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
HCPCS Modifier SHORT DESCRIPTION
2015 Fee Schedule
(60% of Medicare)
82435 QW
Assay of blood chloride
$6.26
82436
Assay of urine chloride
$6.85
82438
Assay other fluid chlorides
$6.65
82441
Test for chlorohydrocarbons
$7.12
82465
Assay bld/serum cholesterol
$5.92
82465 QW
Assay bld/serum cholesterol
$5.92
82480
Assay serum cholinesterase
$10.72
82482
Assay rbc cholinesterase
$10.45
82485
Assay chondroitin sulfate
$28.10
82486
Gas/liquid chromatography
$24.58
82487
Paper chromatography
$21.73
82488
Paper chromatography
$29.07
82489
Thin layer chromatography
$25.17
82491
Chromotography quant sing
$24.58
82492
Chromotography quant mult
$24.58
82495
Assay of chromium
$27.60
82507
Assay of citrate
$37.84
82523
Collagen crosslinks
$25.43
82523 QW
Collagen crosslinks
$25.43
82525
Assay of copper
$16.89
82528
Assay of corticosterone
$30.64
82530
Cortisol free
$22.74
82533
Total cortisol
$22.19
82540
Assay of creatine
$6.31
82541
Column chromotography qual
$24.58
82542
Column chromotography quant
$24.58
82543
Column chromotograph/isotope
$24.58
82544
Column chromotograph/isotope
$24.58
82550
Assay of ck (cpk)
$8.50
82550 QW
Assay of ck (cpk)
$8.50
82552
Assay of cpk in blood
$18.23
82553
Creatine mb fraction
$8.96
82554
Creatine isoforms
$16.15
82565
Assay of creatinine
$6.97
82565 QW
Assay of creatinine
$6.97
82570
Assay of urine creatinine
$7.04
82570 QW
Assay of urine creatinine
$7.04
82575
Creatinine clearance test
$11.63
82585
Assay of cryofibrinogen
$11.68
Rev. Jan. 2015
Page 8
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