2019 CPT-4 and HCPCS codes subject to CLIA edits

2019 CPT-4 and HCPCS Codes Subject to CLIA Edits

Includes non-waived and non-PPMP tests Laboratory certification codes are for informational purposes only.

CPT only copyright 2018 American Medical Association. All rights reserved CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

HCPCS

G0103 G0123 G0124 G0141 G0143 G0144 G0145 G0147 G0148 G0306 G0307 G0328 G0416 G0416 G0416 G0432 G0433 G0435 G0472

G0475 G0476 G0480 G0481 G0482 G0483 G0499 G0659 G9143 P3000 P3001 P7001 0111T

0001U

0002U

0003U

0005U

0006U

0007U

MOD DESCRIPTION

Psa, screening Screen cerv/vag thin layer Screen c/v thin layer by MD Scr c/v cyto,autosys and md Scr c/v cyto,thinlayer,rescr Scr c/v cyto,thinlayer,rescr Scr c/v cyto,thinlayer,rescr Scr c/v cyto, automated sys Scr c/v cyto, autosys, rescr CBC/diffwbc w/o platelet CBC without platelet Fecal blood scrn immunoassay Prostate biopsy, any mthd TC Prostate biopsy, any mthd 26 Prostate biopsy, any mthd EIA HIV-1/HIV-2 screen ELISA HIV-1/HIV-2 screen Oral HIV-1/HIV-2 screen Hepatitis c antibody screening, for individual at high risk and other covered indication(s) Hiv combination assay Hpv combo assay ca screen Drug test def 1-7 classes Drug test def 8-14 classes Drug test def 15-21 classes Drug test def 22+ classes Hepb screen high risk indiv Drug test def simple all cl Warfarin respon genetic test Screen pap by tech w md supv Screening pap smear by phys Culture bacterial urine Long-chain omega-3 fatty acids in red blood cell membranes

Rbc dna hea 35 ag 11 bld grp

Onc clrct 3 ur metab alg plp

Onc ovar 5 prtn ser alg scor

Onco prst8 3 gene ur alg

Detc ia meds 120+ analytes

Rx test prsmv ur w/def conf

LABORATORY CERTIFICATION (LC) CODE

310 630 630 630 630 630 630 630 630 400 400 310, 400 610 610 610 140, 220 140, 220 140, 220 220

140, 220 140 340 340 340 340 220 340

220, 310 630 630 110

310

510

220, 310

220, 310

220, 310

340

340

HCPCS

0008U 0009U 0010U 0011U 0012U 0013U 0014U 0016U 0017U 0018U

0019U 0020U 0021U 0022U 0023U 0024U 0025U 0026U 0027U 0028U 0029U 0030U 0031U 0032U 0033U 0034U 0035U 0036U 0037U 0038U 0039U 0040U

0041U 0042U 0043U 0044U 0045U 0046U 0047U 0048U 0049U

MOD DESCRIPTION

Hpylori detcj abx rstnc dna Onc brst ca erbb2 amp/nonamp Nfct ds strn typ whl gen seq Rx mntr lc-ms/ms oral fluid Germln do gene reargmt detcj Onc sld org neo gene reargmt Hem hmtlmf neo gene reargmt Onc hmtlmf neo rna bcr/abl1 Onc hmtlmf neo jak2 mut dna MicroRNA gene analysis of thyroid nodule tissue - Effective 10/1/2017 RNA gene analysis of tumor tissue - Effective 10/1/2017 Rx test prsmv ur w/def conf - Discontinued 9/30/2018 Onc prst8 detcj 8 autoantb - Effective 10/1/2017 Trgt gen seq dna&rna 23 gene - Effective 10/1/2017 Onc aml dna detcj/nondetcj - Effective 10/1/2017 Glyca nuc mr spectrsc quan - Effective 1/1/2019 Tenofovir liq chrom ur quan - Effective 1/1/2019 Onc thyr dna&mrna 112 genes - Effective 1/1/2019 Jak2 gene trgt seq alys - Effective 1/1/2019 Cyp2d6 gene cpy nmr cmn vrnt - Discontinued 9/30/2018 Rx metab advrs trgt seq alys - Effective 1/1/2019 Rx metab warf trgt seq alys - Effective 1/1/2019 Cyp1a2 gene - Effective 1/1/2019 Comt gene - Effective 1/1/2019 Htr2a htr2c genes - Effective 1/1/2019 Tpmt nudt15 genes - Effective 1/1/2019 Neuro csf prion prtn qual - Effective 4/1/2018 Xome tum & nml spec seq alys - Effective 4/1/2018 Trgt gen seq dna 324 genes - Effective 4/1/2018 Vitamin d srm microsamp quan - Effective 4/1/2018 Dna antb 2strand hi avidity - Effective 4/1/2018 Gene analysis (t(9;22)) for translocation analysis - Effective 4/1/2018 B brgdrferi antb 5 prtn igm - Effective 4/1/2018 B brgdrferi antb 12 prtn igg - Effective 4/1/2018 Tbrf b grp antb 4 prtn igm - Effective 4/1/2018 Tbrf b grp antb 4 prtn igg - Effective 4/1/2018 Onc brst dux carc is 12 gene - Effective 7/1/2018 Flt3 gene itd variants quan - Effective 7/1/2018 Onc prst8 mrna 17 gene alg - Effective 7/1/2018 Onc sld org neo dna 468 gene - Effective 7/1/2018 Npm1 gene analysis quan - Effective 7/1/2018

LABORATORY CERTIFICATION (LC) CODE

110 220, 310

110 340 220, 310 220, 310 400 220, 310, 400 220, 310, 400

220, 310 220, 310

340 220, 310 220, 310 220, 310, 400 220, 310 220, 310 220, 310 310, 900 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310

310 220, 310 220, 310

310 220

220, 310, 400 220 220 220 220

220, 310 220, 310, 410

220, 310 220, 310 220, 310, 410

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2

HCPCS

0050U 0051U 0052U 0053U 0054U 0055U 0056U 0057U 0058U 0059U 0060U 0062U 0063U 0064U 0065U 0066U 0067U 0068U 0069U 0070U 0071U 0072U 0073U 0074U 0075U 0076U 0077U 0078U 0080U

0081U

MOD DESCRIPTION

LABORATORY CERTIFICATION (LC) CODE

Trgt gen seq dna 194 genes - Effective 7/1/2018

220, 310, 410

Rx mntr lc-ms/ms ur 31 pnl - Effective 7/1/2018

340

Lpoprtn bld w/5 maj classes - Effective 7/1/2018

310

Onc prst8 ca fish alys 4 gen - Effective 7/1/2018

220, 310

Rx mntr 14+ drugs & sbsts - Effective 7/1/2018

340

Card hrt trnspl 96 dna seq - Effective 7/1/2018

220, 310

Hem aml dna gene reargmt - Effective 7/1/2018

400

Onc sld org neo mrna 51 gene - Effective 7/1/2018

220, 310

Onc merkel cll carc srm quan - Effective 7/1/2018

220, 310

Onc merkel cll carc srm +/- - Effective 7/1/2018

220, 310

Twn zyg gen seq alys chrms2 - Effective 7/1/2018

900

Ai sle igg&igm alys 80 bmrk - Effective 10/1/2018

220, 310

Neuro autism 32 amines alg - Effective 10/1/2018

220, 310, 900

Antb tp total&rpr ia qual - Effective 10/1/2018

210

Syfls tst nontreponemal antb - Effective 10/1/2018

210

Pamg-1 ia cervico-vag fluid - Effective 10/1/2018

310

Onc brst imhchem prfl 4 bmrk - Effective 10/1/2018

220, 310

Candida species pnl amp prb - Effective 10/1/2018

120

Onc clrct microrna mir-31-3p - Effective 10/1/2018

220, 310

Cyp2d6 gen com&slct rar vrnt - Effective 10/1/2018

220, 310

Cyp2d6 full gene sequence - Effective 10/1/2018

220, 310

Cyp2d6 gen cyp2d6-2d7 hybrid - Effective 10/1/2018

220, 310

Cyp2d6 gen cyp2d7-2d6 hybrid - Effective 10/1/2018

220, 310

Cyp2d6 nonduplicated gene - Effective 10/1/2018

220, 310

Cyp2d6 5' gene dup/mlt - Effective 10/1/2018

220, 310

Cyp2d6 3' gene dup/mlt - Effective 10/1/2018

220, 310

Ig paraprotein qual bld/ur - Effective 10/1/2018

310

Pain mgt opi use gnotyp pnl - Effective 10/1/2018

220, 310

Oncology (lung), mass spectrometric analysis of galectin-3-

220, 310

binding protein and scavenger receptor cysteine-rich type 1 protein M130, with five clinical risk factors (age, smoking status,

nodule diameter, nodule-spiculation status and nodule location),

utilizing plasma, algorithm reported as a categorical probability

of malignancy - Effective 1/1/2019

Oncology (uveal melanoma), mRNA, gene-expression profiling

220, 310

by real-time RT-PCR of 15 genes (12 content and 3

housekeeping genes), utilizing fine needle aspirate or formalin-

fixed paraffin-embedded tissue, algorithm reported as risk of

metastasis - Effective 1/1/2019

CPT only copyright 2018 American Medical Association. All rights reserved.

3

HCPCS

0082U

0083U

17311 17312 17313 17314 17315 78110 78110 78110 78111 78111 78111 78120 78120 78120 78121 78121 78121 78122 78122 78122 78130 78130 78130 78191 78191 78191 78270 78270 78270 78271 78271 78271 78272 78272 78272 80047 80048 80050

MOD

TC 26 TC 26 TC 26 TC 26 TC 26 TC 26 TC 26 TC 26 TC 26 TC 26

DESCRIPTION

Drug test(s), definitive, 90 or more drugs or substances, definitive chromatography with mass spectrometry, and presumptive, any number of drug classes, by instrument chemistry analyzer (utilizing immunoassay), urine, report of presence or absence of each drug, drug metabolite or substance with description and severity of significant interactions per date of service - Effective 1/1/2019

Oncology, response to chemotherapy drugs using motility contrast tomography, fresh or frozen tissue, reported as likelihood of sensitivity or resistance to drugs or drug combinations - Effective 1/1/2019

Mohs, 1 stage, h/n/hf/g Mohs addl stage Mohs, 1 stage, t/a/l Mohs, addl stage, t/a/l Mohs surg, addl block Plasma volume, single Plasma volume, single Plasma volume single Plasma volume, multiple Plasma volume, multiple Plasma volume multiple Red cell mass, single Red cell mass, single Red cell mass single Red cell mass, multiple Red cell mass, multiple Red cell mass multiple Blood volume Blood volume Blood volume Red cell survival study Red cell survival study Red cell survival study Platelet survival Platelet survival Platelet survival Vit B-12 absorption exam - Discontinued 12/31/2018 Vit B-12 absorption exam - Discontinued 12/31/2018 Vit B-12 absorption exam - Discontinued 12/31/2018 Vit B-12 absorp exam, int fac - Discontinued 12/31/2018 Vit B-12 absorp exam, int fac - Discontinued 12/31/2018 Vit b-12 absrp exam int fac - Discontinued 12/31/2018 Vit B-12 absorp, combined - Discontinued 12/31/2018 Vit B-12 absorp, combined - Discontinued 12/31/2018 Vit b-12 absorp combined - Discontinued 12/31/2018 Metabolic panel ionized ca Metabolic panel total ca General health panel - Not payable by Medicare

LABORATORY CERTIFICATION (LC) CODE

340

220, 310

610 610 610 610 610 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 800 310 310 310, 330, 400

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4

HCPCS

80051 80053 80055 80061 80069 80074 80076 80081 80150 80155 80156 80157 80158 80159 80162 80163 80164 80165 80168 80169 80170 80171 80173 80175 80176 80177 80178 80180 80183 80184 80185 80186 80188 80190 80192 80194 80195 80197 80198 80199 80200 80201 80202 80203 80299 80305 80306 80307 80320 80321

MOD DESCRIPTION

Electrolyte panel Comprehen metabolic panel Obstetric panel - Not valid for Medicare Lipid panel Renal function panel Acute hepatitis panel Hepatic function panel Obstetric panel Assay of amikacin Drug assay caffeine Assay, carbamazepine, total Assay, carbamazepine, free Drug assay cyclosporine Drug assay clozapine Assay of digoxin total Assay of digoxin free Assay dipropylacetic acd tot Dipropylacetic acid free Assay of ethosuximide Drug screen quant everolimus Assay of gentamicin Drug screen quant gabapentin Assay of haloperidol Drug screen quan lamotrigine Assay of lidocaine Drug scrn quan levetiracetam Assay of lithium Drug scrn quan mycophenolate Drug scrn quant oxcarbazepin Assay of phenobarbital Assay of phenytoin, total Assay of phenytoin, free Assay of primidone Assay of procainamide Assay of procainamide Assay of quinidine Assay of sirolimus Assay of tacrolimus Assay of theophylline Drug screen quant tiagabine Assay of tobramycin Assay of topiramate Assay of vancomycin Drug screen quant zonisamide Quantitative assay, drug Drug test prsmv dir opt obs Drug test prsmv instrmnt Drug test prsmv chem anlyzr Drug screen quantalcohols - Not payable by Medicare Alcohols biomarkers 1or 2 - Not payable by Medicare

LABORATORY CERTIFICATION (LC) CODE

310 310 210, 220, 400, 530 310 310 220 310 210, 220, 400, 510, 520 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340

CPT only copyright 2018 American Medical Association. All rights reserved.

5

HCPCS

80322 80323 80324 80325 80326 80327 80328 80329 80330 80331 80332 80333 80334 80335 80336 80337 80338 80339 80340 80341 80342 80343 80344 80345 80346 80347 80348 80349 80350 80351 80352 80353 80354 80355 80356 80357 80358 80359 80360 80361 80362 80363 80364 80365 80366 80367 80368 80369 80370 80371

MOD DESCRIPTION

Alcohols biomarkers 3/more - Not payable by Medicare Alkaloids nos - Not payable by Medicare Drug screen amphetamines 1/2 - Not payable by Medicare Amphetamines 3or 4 - Not payable by Medicare Amphetamines 5 or more - Not payable by Medicare Anabolic steroid 1 or 2 - Not payable by Medicare Anabolic steroid 3 or more - Not payable by Medicare Analgesics non-opioid 1 or 2 - Not payable by Medicare Analgesics non-opioid 3-5 - Not payable by Medicare Analgesics non-opioid 6/more - Not payable by Medicare Antidepressants class 1 or 2 - Not payable by Medicare Antidepressants class 3-5 - Not payable by Medicare Antidepressants class 6/more - Not payable by Medicare Antidepressant tricyclic 1/2 - Not payable by Medicare Antidepressant tricyclic 3-5 - Not payable by Medicare Tricyclic & cyclicals 6/more - Not payable by Medicare Antidepressant not specified - Not payable by Medicare Antiepileptics nos 1-3 - Not payable by Medicare Antiepileptics nos 4-6 - Not payable by Medicare Antiepileptics nos 7/more - Not payable by Medicare Antipsychotics nos 1-3 - Not payable by Medicare Antipsychotics nos 4-6 - Not payable by Medicare Antipsychotics nos 7/more - Not payable by Medicare Drug screening barbiturates - Not payable by Medicare Benzodiazepines1-12 - Not payable by Medicare Benzodiazepines 13 or more - Not payable by Medicare Drug screening buprenorphine - Not payable by Medicare Cannabinoids natural - Not payable by Medicare Cannabinoids synthetic 1-3 - Not payable by Medicare Cannabinoids synthetic 4-6 - Not payable by Medicare Cannabinoid synthetic 7/more - Not payable by Medicare Drug screening cocaine - Not payable by Medicare Drug screening fentanyl - Not payable by Medicare Gabapentin non-blood - Not payable by Medicare Heroin metabolite - Not payable by Medicare Ketamine and norketamine - Not payable by Medicare Drug screening methadone - Not payable by Medicare Methylenedioxyamphetamines - Not payable by Medicare Methylphenidate - Not payable by Medicare Opiates 1 or more - Not payable by Medicare Opioids & opiate analogs 1/2 - Not payable by Medicare Opioids & opiate analogs 3/4 - Not payable by Medicare Opioid &opiate analog 5/more - Not payable by Medicare Drug screening oxycodone - Not payable by Medicare Drug screening pregabalin - Not payable by Medicare Drug screening propoxyphene - Not payable by Medicare Sedative hypnotics - Not payable by Medicare Skeletal muscle relaxant 1/2 - Not payable by Medicare Skel musc relaxant 3 or more - Not payable by Medicare Stimulants synthetic - Not payable by Medicare

LABORATORY CERTIFICATION (LC) CODE

340 340 340 340 340 330 330 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340 340

CPT only copyright 2018 American Medical Association. All rights reserved.

6

HCPCS

80372 80373 80374 80375 80376 80377 80400 80402 80406 80408 80410 80412 80414 80415 80416 80417 80418 80420 80422 80424 80426 80428 80430 80432 80434 80435 80436 80438 80439 81003 81005 81007 81099 81105 81106 81107 81108 81109 81110 81111 81112 81120 81121 81161 81162 81163 81164 81165 81166 81167

MOD DESCRIPTION

Drug screening tapentadol - Not payable by Medicare Drug screening tramadol - Not payable by Medicare Stereoisomer analysis - Not payable by Medicare Drug/substance nos 1-3 - Not payable by Medicare Drug/substance nos 4-6 - Not payable by Medicare Drug/substance nos 7/more - Not payable by Medicare Acth stimulation panel Acth stimulation panel Acth stimulation panel Aldosterone suppression eval Calcitonin stimul panel CRH stimulation panel Testosterone response Estradiol response panel Renin stimulation panel Renin stimulation panel Pituitary evaluation panel Dexamethasone panel Glucagon tolerance panel Glucagon tolerance panel Gonadotropin hormone panel Growth hormone panel Growth hormone panel Insulin suppression panel Insulin tolerance panel Insulin tolerance panel Metyrapone panel TRH stimulation panel TRH stimulation panel Urinalysis, auto, w/o scope Urinalysis Urine screen for bacteria Urinalysis test procedure Hpa-1 genotyping Hpa-2 genotyping Hpa-3 genotyping Hpa-4 genotyping Hpa-5 genotyping Hpa-6 genotyping Hpa-9 genotyping Hpa-15 genotyping Idh1 common variants Idh2 common variants Dmd dup/delet analysis Brca1&2 seq & full dup/del Brca1&2 gene full seq alys - Effective 1/1/2019 Brca1&2 gen ful dup/del alys - Effective 1/1/2019 Brca1 gene full seq alys - Effective 1/1/2019 Brca1 gene full dup/del alys - Effective 1/1/2019 Brca2 gene full dup/del alys - Effective 1/1/2019

LABORATORY CERTIFICATION (LC) CODE

340 340 340 340 340 340 330 330 330 330 330 330 330 330 330 330 330 330 310, 330 310, 330 330 330 310, 330 310, 330 310, 330 310, 330 330 330 330 320 320 110 320 400 400 400 400 400 400 400 400 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310

CPT only copyright 2018 American Medical Association. All rights reserved.

7

HCPCS

81170 81171 81172 81173 81174 81175 81176 81177 81178 81179 81180 81181 81182 81183 81184 81185 81186 81187 81188 81189 81190 81200 81201 81202 81203 81204 81205 81206 81207 81208 81209 81210 81211 81212 81213 81214 81215 81216 81217 81218 81219 81220 81221 81222 81223 81224 81225 81226 81227 81228

MOD DESCRIPTION

Abl1 gene Aff2 gene detc abnor alleles - Effective 1/1/2019 Aff2 gene charac alleles - Effective 1/1/2019 Ar gene full gene sequence - Effective 1/1/2019 Ar gene known famil variant - Effective 1/1/2019 Asxl1 full gene sequence Asxl1 gene target seq alys Atn1 gene detc abnor alleles - Effective 1/1/2019 Atxn1 gene detc abnor allele - Effective 1/1/2019 Atxn2 gene detc abnor allele - Effective 1/1/2019 Atxn3 gene detc abnor allele - Effective 1/1/2019 Atxn7 gene detc abnor allele - Effective 1/1/2019 Atxn8os gen detc abnor allel - Effective 1/1/2019 Atxn10 gene detc abnor allel - Effective 1/1/2019 Cacna1a gen detc abnor allel - Effective 1/1/2019 Cacna1a gene full gene seq - Effective 1/1/2019 Cacna1a gen known famil vrnt - Effective 1/1/2019 Cnbp gene detc abnor allele - Effective 1/1/2019 Cstb gene detc abnor allele - Effective 1/1/2019 Cstb gene full gene sequence - Effective 1/1/2019 Cstb gene known famil vrnt - Effective 1/1/2019 Aspa gene Apc gene full sequence Apc gene known fam variants Apc gene dup/delet variants Ar gene charac alleles - Effective 1/1/2019 Bckdhb gene Bcr/abl1 gene major bp Bcr/abl1 gene minor bp Bcr/abl1 gene other bp Blm gene Braf gene Brca1&2 seq & com dup/del - Discontinued 12/31/2018 Brca1&2 185&5385&6174 var Brca1&2 uncom dup/del var - Discontinued 12/31/2018 Brca1 full seq & com dup/del - Discontinued 12/31/2018 Brca1 gene known fam variant Brca2 gene full sequence Brca2 gene known fam variant Cebpa gene full sequence Calr gene com variants Cftr gene com variants Cftr gene known fam variants Cftr gene dup/delet variants Cftr gene full sequence Cftr gene intron poly t Cyp2c19 gene com variants Cyp2d6 gene com variants Cyp2c9 gene com variants Cytogen micrarray copy nmbr

LABORATORY CERTIFICATION (LC) CODE

220, 310, 900 220, 310 220, 310 310, 330 310, 330 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 310, 330 220, 310

220, 310, 900 220, 310, 900 220, 310, 900

220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310, 900 220, 310, 900 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310 220, 310, 900

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