Coverage Policy Manual
Policy #: 2008010
Category: Medicine
Initiated: October 2005
Last Review: July 2023
  Certified Nurse Practitioners
Description:
Advanced Practice Registered Nurses (APRNs) are registered nurses who have been educated beyond the requirements for a registered nurse in one of the four roles of advanced practice nurses – Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Midwife (CNM).
 
Certified Nurse Practitioners are registered nurses with the advanced education and clinical competency necessary for the delivery of primary health and medical care.  Certified Nurse Practitioners (CNPs) must possess a certificate of prescriptive authority.  The CNP must work in collaboration with the physician to deliver health care services with medical direction and appropriate supervision.  
Policy/
Coverage:
Effective October 2023
 
CERTIFIED NURSE PRACTITIONERS
 
Certified Nurse Practitioners (CNPs) providing services to ABCBS members must comply with the following policy to qualify for reimbursement:
 
In the absence of a Certificate of Full Independent Practice by the AR State Board of Nursing:
    • The CNP must have a written and signed collaborative agreement with a supervising medical doctor (MD) or doctor of osteopathy (DO). The collaborative agreement must be with a physician whose specialty mirrors the practice of the Certified Nurse Practitioner (e.g., if the CNP is practicing primary care medicine, the collaborative agreement must be with a Family Medicine physician or General Internist). A copy of the agreement must be provided to ABCBS upon request; and
    • The CNP adheres to collaborative responsibilities by participating as a team member in the provision of medical and health care, interacting with physicians to provide comprehensive care according to established and documented protocols.
 
Services provided by CNPs are limited to those patients presenting problems of low to moderate severity and the medical decision making involved does not exceed that same level.
 
Patients with more severe problems must be referred to physicians.
 
Current published guidelines for assigning CPT codes to services and documentation to support the “medical necessity” of all services must be met.
 
Services performed in an inpatient/acute facility are not covered, with the exception of assistant at surgery services provided when the collaborative physician is present.
 
CNPs may order diagnostic plain film x-ray studies that are medically indicated for the level of service in accordance with established and documented protocols, but may not interpret those tests (i.e., may bill technical component only). (Amended February 2015
 
The service provided by the CNP must be concordant with the specialty of the supervising physician.
 
The CNP must present him/herself, so the public and other payers are fully aware of the practitioner’s business operations. This includes items such as signage, letterhead, and other marketing elements.
 
The following billing instructions apply to CNPs licensed in Arkansas:
The line-item or rendering provider is listed in Block 24J on paper claims and in Loop 2310B, segment NM108 (NPI qualifier) and segment NM109 (NPI number) on electronic claims.
 
The billing/pay to provider is listed in Block 33A on paper claims and in Loop 2010AA (Billing) and in loop 2010AB (Pay To) for electronic claims.
 
When the services are provided in the provider's office and the collaborative physician is present in the office suite, services provided may be billed by the CNP or by the collaborative physician. The collaborative physician's NPI or the CNP’s NPI should be used as the line-item provider number on CMS 1500 and 837P.
 
When the services are provided in the provider's office and the collaborative physician is NOT present in the office suite, services should be billed by the CNP that provides the service. The CNP’s NPI should be used as the line-item provider number on CMS 1500 and 837P.
 
When services are provided in the Emergency Room department, the lower-level ER visits may be billed by the CNP. This excludes triage and services for patients transferred to an ER physician. When the CNP meets the requirements for billing these lower-level services, the CNP’s NPI should be used as the line-item provider number on CMS 1500 and 837P.
 
When services are provided to patients designated as "inpatients" in a facility and the collaborative physician is NOT present or does not see the patient at another time during that day, inpatient services in these circumstances provided by the CNP are NOT covered. All services will be denied. The CNP’s NPI should be used as line-item provider on CMS 1500 and 837P.
 
When services are provided to patients designated as "inpatients" in a facility and the collaborative physician sees the patient with the CNP or at another time of day, we will pay the physician, but not the CNP. Only one E&M service is covered during a 24-hour day. The collaborative physician must have a brief note on the chart indicating the patient was seen; this visit should be reported under the collaborating physician’s NPI.
 
When services are provided by a CNP acting as an assistant at surgery in an inpatient or outpatient hospital or ambulatory surgery center, the assistant at surgery service is covered only for those CPT surgical codes for which Arkansas Blue Cross and Blue Shield allows coverage for an Assistant Surgeon. Modifier 'AS' should be used on all line items for the services provided by the CNP. The CNP NPI should be used as the line-item provider number on CMS 1500 and 837P.
 
When services are provided to a patient in a home setting, when the CNP is NOT employed by or contracted to a Home Health agency, lower-level home visits may be billed by the CNP. The CNP’s NPI should be used as the line-item provider number on CMS 1500 and 837P.
 
When services are provided to a patient in a home setting when the CNP is employed by or contracted to a Home Health agency, the reimbursed is based on the Home Health fee schedule at RN level (least costly alternative). The Home Health NPI should be used as the provider number on the UB 04.
 
Reimbursement to CNPs when the CNP’s NPI is submitted as the line-item provider is based on 75% of the corresponding physician reimbursement.
 
CERTIFIED NURSE PRACTITIONER PSYCHIATRIC PROCEDURES
 
CNP applicants who have the following qualifications will be eligible to receive reimbursement for CPT - 90863 [Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure)]:
 
      1. In the absence of a Certificate of Full Independent Practice by the AR State Board of Nursing, CNPs must maintain a collaborative agreement and Quality Assurance Plan with one or more participating psychiatrists.
      2. Hold a current, active unrestricted Arkansas CNP license with prescriptive authority. State licensure from surrounding states may be considered when applying this requirement.
      3. Board Certification by the American Nursing Credentialing Center (ANCC) in at least one of the following specialties:
a. Adult Psychiatric & Mental Health NP
b. Family Psych & Mental Health NP
 
CNPs who are not board certified in one of the required specialties may be considered if they meet the eligibility criteria established by the ANCC for PMHNP-BC designation. The eligibility criteria are:
 
      1. Hold a master’s, post-graduate, or doctorate degree from an adult psychiatric and mental health nurse practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC). A minimum of 500 faculty-supervised clinical hours must be included in your nurse practitioner program.
      2. The APMHNP graduate program must include three separate courses in:
a. Advanced physical/health assessment
b. Advanced pharmacology
c. Advanced pathophysiology
AND content in
d. Health promotion and disease prevention, and
e. Differential diagnosis and disease management
AND
f. Clinical training in at least two psychotherapeutic treatment modalities
 
CNP applicants who have met the qualifications for CPT – 90863 reimbursement and also have two years of post-master’s psychiatric clinical experience* will be eligible to receive reimbursement for the following procedures:
 
*Note: Clinical psychiatric nursing experience prior to obtaining a master’s degree may be considered.
 
CPT 90791 - Psychiatric diagnostic evaluation
CPT 90792 – Psychiatric diagnostic evaluation with medical services
CPT 90832 – Psychotherapy, 30 minutes with patient and/or family member
CPT 90833 – Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
CPT 90834 – Psychotherapy, 45 minutes with patient and/or family member
CPT 90836 - Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
CPT 90837 – Psychotherapy, 60 minutes with patient and/or family member
CPT 90838 – Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
CPT 90839 – Psychotherapy for crisis; first 60 minutes
CPT 90853 - Psychotherapy (other than of a multiple-family group)
 
Effective January 2013 through September 2023
 
CERTIFIED NURSE PRACTITIONERS
 
Certified Nurse Practitioners (CNPs) providing services to ABCBS members must comply with the following policy to qualify for reimbursement:
 
The CNP must have a written and signed collaborative agreement with a supervising medical doctor (MD) or doctor of osteopathy (DO). The collaborative agreement must be with a physician whose specialty mirrors the practice of the Certified Nurse Practitioner (e.g., if the CNP is practicing primary care medicine, the collaborative agreement must be with a Family Medicine physician or General Internist).  A copy of the agreement must be provided to ABCBS upon request.
 
The CNP adheres to collaborative responsibilities by participating as a team member in the provision of medical and health care, interacting with physicians to provide comprehensive care according to established and documented protocols.
 
Services provided by CNP’s are limited to those patients presenting problems of low to moderate severity and the medical decision making involved does not exceed that same level.
 
Patients with more severe problems must be referred to physicians.
 
Current published guidelines for assigning CPT codes to services and documentation to support the “medical necessity” of all services must be met.
 
Services performed in an inpatient/acute facility are not covered, with the exception of assistant at surgery services provided when the collaborative physician is present.
 
CNP’s may order diagnostic plain film x-ray studies that are medically indicated for the level of service in accordance with established and documented ;protocols, but may not interpret those tests (i.e., may bill technical component only). (Amended February 2015)
  
The service provided by the CNP must be concordant with the specialty of the supervising physician.
 
The CNP must present him/herself so the public and other payers are fully aware of the  practitioner’s business operations. This includes items such as signage, letterhead and other marketing elements.
  
The following billing instructions apply to CNPs licensed in Arkansas:
 
The line item or rendering provider is listed in Block 24J on paper claims and in Loop 2310B, segment NM108 (NPI qualifier) and segment NM109 (NPI number) on electronic claims.
 
The billing/pay to provider is listed in Block 33A on paper claims and in Loop 2010AA (Billing) and in loop 2010AB (Pay To) for electronic claims.
  
When the services are provided in the provider's office and the collaborative physician is present in the office suite, services provided may be billed by the CNP or by the collaborative physician.  The collaborative physician's NPI or the CNPs NPI should be used as the line item provider number on CMS 1500 and 837P.
  
When the services are provided in the provider's office and the collaborative physician is NOT present in the office suite, services should be billed by the CNP that provides the service.  The CNP NPI should be used as the line item provider number on CMS 1500 and 837P.
  
When services are provided in the Emergency Room department, the lower level ER visits may be billed by the CNP.  This excludes triage and services for patients transferred to an ER physician.  When the CNP meets the requirements for billing these lower level services, the CNP NPI should be used as the line item provider number on CMS 1500 and 837P.
  
When services are provided to patients designated as "inpatients" in a facility and the collaborative physician is NOT present or does not see the patient at another time during that day, inpatient services in these circumstances provided by the CNP are NOT covered.  All services will be denied.  The CNP NPI should be used as line item provider on CMS 1500 and 837P.  
  
When services are provided to patients designated as "inpatients" in a facility and the collaborative physician sees the patient with the CNP or at another time of day, we will pay the physician, but not the CNP.  Only one E&M service is covered during a 24 hour day.  The collaborative physician must have a brief note on the chart indicating the patient was seen; this visit should be reported under the collaborating physician’s NPI.
  
When services are provided by a CNP acting as an assistant at surgery in an inpatient or outpatient hospital or ambulatory surgery center, the assistant at surgery service is covered only for those CPT surgical codes for which Arkansas Blue Cross and Blue Shield allows coverage for an Assistant Surgeon.  Modifier 'AS' should be used on all line items for the services provided by the CNP.  The CNP NPI should be used as the line item provider number on CMS 1500 and 837P.  
  
When services are provided to a patient in a home setting, when the CNP is NOT employed by or contracted to a Home Health agency, lower level home visits may be billed by the CNP.  The CNP NPI should be used as the line item provider number on CMS 1500 and 837P.   
 
When services are provided to a patient in a home setting when the CNP is employed by or contracted to a Home Health agency, the reimbursed is based on the Home Health fee schedule at RN level (least costly alternative).  The Home Health NPI should be used as the provider number on the UB 04.
  
Reimbursement to CNPs when the CNP NPI is submitted as the line item provider is based on 75% of the corresponding physician reimbursement.
  
CERTIFIED NURSE PRACTITIONER PSYCHIATRIC PROCEDURES
  
CNP applicants who have the following qualifications will be eligible to receive reimbursement for CPT - 90863 (Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure)
  
1.  Maintain a collaborative agreement and Quality Assurance Plan with one or more participating  psychiatrists.
  
2.  Hold a current, active unrestricted Arkansas CNP license with prescriptive authority. State licensure from surrounding states may be considered when applying this requirement.
  
3.  Board Certification by the American Nursing Credentialing Center (ANCC) in at least one of the following specialties:
    A.  Adult Psychiatric & Mental Health NP
    B.  Family Psych & Mental Health NP
  
CNPs who are not board certified in one of the required specialties may be considered if they meet the eligibility criteria established by the ANCC for PMHNP-BC designation.  The eligibility criteria is:
  
1.  Hold a master’s, post-graduate, or doctorate degree from an adult psychiatric and mental health nurse practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC). A minimum of 500 faculty-supervised clinical hours must be included in your nurse practitioner program.
 
2.  The APMHNP graduate program must include three separate courses in:
    A.  Advanced physical/health assessment
    B.  Advanced pharmacology
    C.  Advanced pathophysiology
  
         AND content in
  
    D.  Health promotion and disease prevention, and
    E.  Differential diagnosis and disease management
  
        AND
 
    F.  Clinical training in at least two psychotherapeutic treatment modalities
  
CNP applicants who have met the qualifications for CPT – 90863
reimbursement and also have two years of post-master’s psychiatric clinical experience* will be eligible to receive reimbursement for the following procedures:
  
*Note: Clinical psychiatric nursing experience prior to obtaining a Master’s degree may be considered.
  
CPT 90791 - Psychiatric diagnostic evaluation
CPT 90792 – Psychiatric diagnostic evaluation with medical services
CPT 90832 – Psychotherapy, 30 minutes with patient and/or family member
CPT 90833 – Psychotherapy, 30 minutes with patient and/or family member  when performed with an evaluation and management service (List separately in  addition to the code for primary procedure)
CPT 90834 – Psychotherapy, 45 minutes with patient and/or family member
CPT 90836 - Psychotherapy, 45 minutes with patient and/or family member  when performed with an evaluation and management service (List separately in  addition to the code for primary procedure)
CPT 90837 – Psychotherapy, 60 minutes with patient and/or family member
CPT 90838 – Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
CPT 90839 – Psychotherapy for crisis; first 60 minutes
CPT 90853 - Psychotherapy (other than of a multiple-family group)   
 
Effective Prior to January 2013
 
ANP’s providing services to ABCBS members must comply with the following  policy to qualify for reimbursement:
 
The ANP must have a written and signed collaborative agreement with a  supervising medical doctor (MD) or doctor of osteopathy (DO).
 
The  collaborative agreement must be with a physician whose specialty mirrors the  practice of the Advanced Nurse Practitioner (e.g., if the ANP is practicing  primary care medicine, the collaborative agreement must be with a Family Medicine physician or General Internist).  A copy of the agreement must be  provided to ABCBS upon request.
 
The ANP adheres to collaborative responsibilities by participating as a team member in the provision of medical and health care, interacting with physicians to provide comprehensive care according to established and documented  protocols.
 
Services provided by ANP are limited to those patients presenting problems  of low to moderate severity and the medical decision making involved does not exceed that same level. Patients with more severe problems must be referred to physicians.
 
Current published guidelines for assigning CPT codes to services and documentation to support the “medical necessity” of all services must be met.
 
Services performed in an inpatient/acute facility are not covered, with the exception of assistant at surgery services provided when the collaborative physician is present.
 
ANP may order diagnostic laboratory and x-ray studies that are medically indicated for the level of service as indicated above in accordance with established and documented protocols, but may not interpret those tests.
 
The service provided by the ANP must be concordant with the specialty of the supervising physician.
 
The ANP must present him/herself so the public and other payers are fully aware of the  practitioner’s business operations. This includes items such as signage, letterhead and other marketing elements.
  
The following billing instructions apply to ANPs licensed in Arkansas:
The line item or rendering provider is listed in Block 24J on paper claims and in Loop 2310B, segment NM108 (NPI qualifier) and segment NM109 (NPI number) on electronic claims.
 
The billing/pay to provider is listed in Block 33A on paper claims and in Loop 2010AA (Billing) and in loop 2010AB (Pay To) for electronic claims.
  
Services provided in the provider's office and the collaborative physician is present in the office suite:  
 
Services provided may be billed by the ANP or by the collaborative physician (similar to Medicare's "incident to" guidelines).
 
The collaborative physician's NPI should be used as the line item provider number on CMS 1500 and 837P.
  
Services provided in the provider's office and the collaborative physician is NOT present in the office suite:
 
Services should be billed by the provider of service.  
The APN NPI should be used as the line item provider number on CMS 1500 and 837P.
  
Services provided in the Emergency Room department:
Lower level ER visits may be billed by the provider of service.  
 
This excludes triage and services for patients transferred to an ER physician.  
 
The APN NPI should be used as the line item provider number on CMS 1500 and 837P.
  
Services provided to patients designated as "inpatients" in a facility and the collaborative physician is NOT present or does not see the patient at another time during that day:  
 
Inpatient services are not covered.  All services will be denied.
 
The ANP NPI used as line item provider on CMS 1500 and 837P.  
  
Services provided to patients designated as "inpatients" in a facility and the collaborative physician sees the patient with the ANP or at another time of day:
 
Only one E&M service is covered during a 24 hour day.  The collaborative physician must have a brief note on the chart indicating the patient was seen; this visit should be reported under the collaborating physician’s NPI.
  
Services provided when acting as an assistant at surgery in an inpatient or outpatient hospital or ambulatory surgery center:
 
Assistant at surgery is covered only for those CPT surgical codes for which Arkansas Blue Cross and Blue Shield allows coverage for Assistant Surgeon. Modifier 'AS' should be used on all line items.
 
The APN NPI should be used as the line item provider number on CMS 1500 and 837P.  
 
Services provided to a patient in a home setting, when the APN is NOT
employed by or contracted to a Home Health agency.
 
Lower level home visits may be billed by the provider of service.  
The APN NPI should be used as the line item provider number on CMS 1500 and 837P.
  
Services provided to a patient in a home setting when the APN is employed by or contracted to a Home Health agency:  
 
Reimbursed based on the Home Health fee schedule at RN level (least costly alternative).  
 
The Home Health NPI should be used as the provider number on the UB 04.
  
Reimbursement to ANPs when the APN NPI is submitted as the line item provider is based on 75% of the corresponding physician reimbursement.
  
Advanced Nurse Practitioner Psychiatric Procedures
  
ANP applicants who have the following qualifications will be eligible to receive reimbursement for CPT - 90862 (Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy).
   
Maintain a collaborative agreement and Quality Assurance Plan with one or more participating  psychiatrists.
  
Hold a current, active unrestricted Arkansas ANP license with prescriptive authority. State licensure from surrounding states may be considered when applying this requirement.
  
Board Certification by the American Nursing Credentialing Center (ANCC) in at least one of the following specialties:
  
Adult Psychiatric & Mental Health NP
Family Psych & Mental Health NP
  
ANPs who are not board certified in one of the required specialties may be considered if they meet the eligibility criteria established by the ANCC for PMHNP-BC designation.  
 
The eligibility criteria is:
  
Hold a master’s, post-graduate, or doctorate degree from an adult psychiatric and mental health nurse practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing  Accrediting Commission (NLNAC). A minimum of 500 faculty-supervised clinical hours must be included in your nurse practitioner program. The APMHNP graduate program must include three separate courses in:
  
advanced physical/health assessment
advanced pharmacology
advanced pathophysiology
  
AND content in
  
health promotion and disease prevention, and
differential diagnosis and disease management
  
AND clinical training in at least two psychotherapeutic treatment modalities
  
ANP applicants who have met the qualifications for CPT – 90862
reimbursement and also have two years of post-master’s psychiatric clinical experience* will be eligible to receive reimbursement for the following procedures:
  
*Note: Clinical psychiatric nursing experience prior to obtaining a Master’s degree may be considered.
 
CPT - 90801 (Psychiatric diagnostic interview examination)
CPT - 90804 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient)
CPT - 90805 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services)  
CPT - 90806 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient)
CPT - 90807 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, pproximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management  services)  
CPT - 90808 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient)
CPT - 90809 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management  services)
 
CPT/HCPCS:
0003AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; third dose
0013AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose
0031AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, single dose (Report 0031A, 0034A for the administration of vaccine 91303)
0071AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose
0072AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose
0121AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; single dose
0124AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, additional dose
0141AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 25 mcg/0.25 mL dosage, tris-sucrose formulation; first dose
0142AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 25 mcg/0.25 mL dosage, tris-sucrose formulation; second dose
0144AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRN-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, additional dose
0151AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, tris-sucrose formulation; single dose
0154AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, additional dose
0171AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, tris-sucrose formulation; first dose
0172AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, tris-sucrose formulation; first dose
0173AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, third dose
0174AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV 2) (coronavirus disease [COVID 19]) vaccine, mRNALNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris sucrose formulation; additional dose
0207TEvacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral
0240UInfectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected
0241UInfectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected
0256UTrimethylamine/trimethylamine N-oxide (TMA/TMAO) profile, tandem mass spectrometry (MS/MS), urine, with algorithmic analysis and interpretive report
0272TInterrogation device evaluation (in person), carotid sinus baroreflex activation system, including telemetric iterative communication with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst mode, therapy start/stop times each day);
0273TInterrogation device evaluation (in person), carotid sinus baroreflex activation system, including telemetric iterative communication with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst mode, therapy start/stop times each day); with programming
10021Fine needle aspiration biopsy, without imaging guidance; first lesion
10040Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)
10060Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single
10080Incision and drainage of pilonidal cyst; simple
10120Incision and removal of foreign body, subcutaneous tissues; simple
10140Incision and drainage of hematoma, seroma or fluid collection
10160Puncture aspiration of abscess, hematoma, bulla, or cyst
11042Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
11043Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
11055Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
11056Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions
11057Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than 4 lesions
11102Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion
11103Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to code for primary procedure)
11104Punch biopsy of skin (including simple closure, when performed); single lesion
11105Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure)
11106Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion
11107Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure)
11200Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
11201Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure)
11300Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less
11301Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm
11302Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm
11303Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm
11305Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
11306Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm
11307Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm
11308Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm
11310Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less
11311Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm
11400Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less
11401Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm
11420Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
11421Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
11719Trimming of nondystrophic nails, any number
11720Debridement of nail(s) by any method(s); 1 to 5
11721Debridement of nail(s) by any method(s); 6 or more
11730Avulsion of nail plate, partial or complete, simple; single
11732Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)
11740Evacuation of subungual hematoma
11750Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal
11765Wedge excision of skin of nail fold (eg, for ingrown toenail)
11900Injection, intralesional; up to and including 7 lesions
11901Injection, intralesional; more than 7 lesions
11981Insertion, drug delivery implant (i.e., bioresorbable, biodegradable, non-biodegradable)
11982Removal, non biodegradable drug delivery implant
11983Removal with reinsertion, non biodegradable drug delivery implant
12001Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less
12002Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm
12004Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm
12005Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm
12006Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm
15271Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area
15272Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)
15792Chemical peel, nonfacial; epidermal
15793Chemical peel, nonfacial; dermal
16000Initial treatment, first degree burn, when no more than local treatment is required
17000Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion
17003Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion)
17004Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions
17110Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions
17111Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions
17250Chemical cauterization of granulation tissue (ie, proud flesh)
17340Cryotherapy (CO2 slush, liquid N2) for acne
20552Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
20553Injection(s); single or multiple trigger point(s), 3 or more muscles
21310Closed treatment of nasal bone fracture without manipulation
21315Closed treatment of nasal bone fracture; with manipulation; without stabilization
23500Closed treatment of clavicular fracture; without manipulation
23570Closed treatment of scapular fracture; without manipulation
24650Closed treatment of radial head or neck fracture; without manipulation
25500Closed treatment of radial shaft fracture; without manipulation
25530Closed treatment of ulnar shaft fracture; without manipulation
25600Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation
25630Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone
25650Closed treatment of ulnar styloid fracture
26010Drainage of finger abscess; simple
26341Manipulation, palmar fascial cord (ie, Dupuytren's cord), post enzyme injection (eg, collagenase), single cord
26720Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each
26750Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each
27200Closed treatment of coccygeal fracture
28400Closed treatment of calcaneal fracture; without manipulation
28470Closed treatment of metatarsal fracture; without manipulation, each
28490Closed treatment of fracture great toe, phalanx or phalanges; without manipulation
28510Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each
28530Closed treatment of sesamoid fracture
29065Application, cast; shoulder to hand (long arm)
29075Application, cast; elbow to finger (short arm)
29085Application, cast; hand and lower forearm (gauntlet)
29086Application, cast; finger (eg, contracture)
29105Application of long arm splint (shoulder to hand)
29125Application of short arm splint (forearm to hand); static
29126Application of short arm splint (forearm to hand); dynamic
29130Application of finger splint; static
29131Application of finger splint; dynamic
29200Strapping; thorax
29240Strapping; shoulder (eg, Velpeau)
29260Strapping; elbow or wrist
29280Strapping; hand or finger
29405Application of short leg cast (below knee to toes);
29425Application of short leg cast (below knee to toes); walking or ambulatory type
29440Adding walker to previously applied cast
29515Application of short leg splint (calf to foot)
29520Strapping; hip
29530Strapping; knee
29540Strapping; ankle and/or foot
29550Strapping; toes
29580Strapping; Unna boot
29581Application of multi layer compression system; leg (below knee), including ankle and foot
29584Application of multi layer compression system; upper arm, forearm, hand, and fingers
29730Windowing of cast
30300Removal foreign body, intranasal; office type procedure
30901Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method
32552Removal of indwelling tunneled pleural catheter with cuff
32561Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); initial day
32562Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); subsequent day
36415Collection of venous blood by venipuncture
36416Collection of capillary blood specimen (eg, finger, heel, ear stick)
36568Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age
36569Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older
36584Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement
36589Removal of tunneled central venous catheter, without subcutaneous port or pump
36600Arterial puncture, withdrawal of blood for diagnosis
38220Diagnostic bone marrow; aspiration(s)
46083Incision of thrombosed hemorrhoid, external
46505Chemodenervation of internal anal sphincter
46600Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
51701Insertion of non indwelling bladder catheter (eg, straight catheterization for residual urine)
57061Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
57156Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy
57160Fitting and insertion of pessary or other intravaginal support device
57170Diaphragm or cervical cap fitting with instructions
58300Insertion of intrauterine device (IUD)
58301Removal of intrauterine device (IUD)
59025Fetal non stress test
59425Antepartum care only; 4 6 visits
59426Antepartum care only; 7 or more visits
59430Postpartum care only (separate procedure)
62270Spinal puncture, lumbar, diagnostic;
62369Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill
62370Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill of a physician or other qualified health care professional)
69200Removal foreign body from external auditory canal; without general anesthesia
69210Removal impacted cerumen requiring instrumentation, unilateral
70030Radiologic examination, eye, for detection of foreign body
70100Radiologic examination, mandible; partial, less than 4 views
70110Radiologic examination, mandible; complete, minimum of 4 views
70120Radiologic examination, mastoids; less than 3 views per side
70130Radiologic examination, mastoids; complete, minimum of 3 views per side
70134Radiologic examination, internal auditory meati, complete
70140Radiologic examination, facial bones; less than 3 views
70150Radiologic examination, facial bones; complete, minimum of 3 views
70160Radiologic examination, nasal bones, complete, minimum of 3 views
70190Radiologic examination; optic foramina
70200Radiologic examination; orbits, complete, minimum of 4 views
70210Radiologic examination, sinuses, paranasal, less than 3 views
70220Radiologic examination, sinuses, paranasal, complete, minimum of 3 views
70240Radiologic examination, sella turcica
70250Radiologic examination, skull; less than 4 views
70260Radiologic examination, skull; complete, minimum of 4 views
70300Radiologic examination, teeth; single view
70310Radiologic examination, teeth; partial examination, less than full mouth
70320Radiologic examination, teeth; complete, full mouth
70328Radiologic examination, temporomandibular joint, open and closed mouth; unilateral
70330Radiologic examination, temporomandibular joint, open and closed mouth; bilateral
70360Radiologic examination; neck, soft tissue
70380Radiologic examination, salivary gland for calculus
71045Radiologic examination, chest; single view
71046Radiologic examination, chest; 2 views
71047Radiologic examination, chest; 3 views
71048Radiologic examination, chest; 4 or more views
71100Radiologic examination, ribs, unilateral; 2 views
71101Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views
71110Radiologic examination, ribs, bilateral; 3 views
71111Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views
71120Radiologic examination; sternum, minimum of 2 views
71130Radiologic examination; sternoclavicular joint or joints, minimum of 3 views
71271Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
72020Radiologic examination, spine, single view, specify level
72040Radiologic examination, spine, cervical; 2 or 3 views
72050Radiologic examination, spine, cervical; 4 or 5 views
72052Radiologic examination, spine, cervical; 6 or more views
72070Radiologic examination, spine; thoracic, 2 views
72072Radiologic examination, spine; thoracic, 3 views
72074Radiologic examination, spine; thoracic, minimum of 4 views
72080Radiologic examination, spine; thoracolumbar junction, minimum of 2 views
72081Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view
72082Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views
72083Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 4 or 5 views
72084Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); minimum of 6 views
72100Radiologic examination, spine, lumbosacral; 2 or 3 views
72110Radiologic examination, spine, lumbosacral; minimum of 4 views
72114Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views
72120Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views
72170Radiologic examination, pelvis; 1 or 2 views
72190Radiologic examination, pelvis; complete, minimum of 3 views
72200Radiologic examination, sacroiliac joints; less than 3 views
72202Radiologic examination, sacroiliac joints; 3 or more views
72220Radiologic examination, sacrum and coccyx, minimum of 2 views
73000Radiologic examination; clavicle, complete
73010Radiologic examination; scapula, complete
73020Radiologic examination, shoulder; 1 view
73030Radiologic examination, shoulder; complete, minimum of 2 views
73060Radiologic examination; humerus, minimum of 2 views
73070Radiologic examination, elbow; 2 views
73080Radiologic examination, elbow; complete, minimum of 3 views
73090Radiologic examination; forearm, 2 views
73092Radiologic examination; upper extremity, infant, minimum of 2 views
73100Radiologic examination, wrist; 2 views
73110Radiologic examination, wrist; complete, minimum of 3 views
73120Radiologic examination, hand; 2 views
73130Radiologic examination, hand; minimum of 3 views
73140Radiologic examination, finger(s), minimum of 2 views
73501Radiologic examination, hip, unilateral, with pelvis when performed; 1 view
73502Radiologic examination, hip, unilateral, with pelvis when performed; 2 3 views
73503Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views
73521Radiologic examination, hips, bilateral, with pelvis when performed; 2 views
73522Radiologic examination, hips, bilateral, with pelvis when performed; 3 4 views
73523Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views
73551Radiologic examination, femur; 1 view
73552Radiologic examination, femur; minimum 2 views
73560Radiologic examination, knee; 1 or 2 views
73562Radiologic examination, knee; 3 views
73564Radiologic examination, knee; complete, 4 or more views
73565Radiologic examination, knee; both knees, standing, anteroposterior
73590Radiologic examination; tibia and fibula, 2 views
73592Radiologic examination; lower extremity, infant, minimum of 2 views
73600Radiologic examination, ankle; 2 views
73610Radiologic examination, ankle; complete, minimum of 3 views
73620Radiologic examination, foot; 2 views
73630Radiologic examination, foot; complete, minimum of 3 views
73650Radiologic examination; calcaneus, minimum of 2 views
73660Radiologic examination; toe(s), minimum of 2 views
74018Radiologic examination, abdomen; 1 view
74019Radiologic examination, abdomen; 2 views
74021Radiologic examination, abdomen; 3 or more views
74022Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest
76010Radiologic examination from nose to rectum for foreign body, single view, child
76499Unlisted diagnostic radiographic procedure
76818Fetal biophysical profile; with non stress testing
76819Fetal biophysical profile; without non stress testing
78267Urea breath test, C 14 (isotopic); acquisition for analysis
78268Urea breath test, C 14 (isotopic); analysis
80047Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520)
80048Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520)
80050General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443)
80051Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295)
80053Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN) (84520)
80055Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis test, non treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901)
80061Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)
80069Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520)
80074Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803)
80076Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450)
80081Obstetric panel (includes HIV testing) This panel must include the following: Blood count, complete (CBC), and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) HIV 1 antigen(s), with HIV 1 and HIV 2 antibodies, single result (87389) Antibody, rubella (86762) Syphilis test, non treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901)
80150Amikacin
80156Carbamazepine; total
80157Carbamazepine; free
80158Cyclosporine
80162Digoxin; total
80164Valproic acid (dipropylacetic acid); total
80168Ethosuximide
80170Gentamicin
80173Haloperidol
80176Lidocaine
80178Lithium
80184Phenobarbital
80185Phenytoin; total
80186Phenytoin; free
80188Primidone
80190Procainamide;
80192Procainamide; with metabolites (eg, n acetyl procainamide)
80194Quinidine
80195Sirolimus
80197Tacrolimus
80198Theophylline
80200Tobramycin
80201Topiramate
80202Vancomycin
80299Quantitation of therapeutic drug, not elsewhere specified
80305Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service
80306Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; read by instrument assisted direct optical observation (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service
80400ACTH stimulation panel; for adrenal insufficiency This panel must include the following: Cortisol (82533 x 2)
80402ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2)
80406ACTH stimulation panel; for 3 beta hydroxydehydrogenase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2)
80408Aldosterone suppression evaluation panel (eg, saline infusion) This panel must include the following: Aldosterone (82088 x 2) Renin (84244 x 2)
80410Calcitonin stimulation panel (eg, calcium, pentagastrin) This panel must include the following: Calcitonin (82308 x 3)
80412Corticotropic releasing hormone (CRH) stimulation panel This panel must include the following: Cortisol (82533 x 6) Adrenocorticotropic hormone (ACTH) (82024 x 6)
80414Chorionic gonadotropin stimulation panel; testosterone response This panel must include the following: Testosterone (84403 x 2 on 3 pooled blood samples)
80415Chorionic gonadotropin stimulation panel; estradiol response This panel must include the following: Estradiol, total (82670 x 2 on 3 pooled blood samples)
80416Renal vein renin stimulation panel (eg, captopril) This panel must include the following: Renin (84244 x 6)
80417Peripheral vein renin stimulation panel (eg, captopril) This panel must include the following: Renin (84244 x 2)
80418Combined rapid anterior pituitary evaluation panel This panel must include the following: Adrenocorticotropic hormone (ACTH) (82024 x 4) Luteinizing hormone (LH) (83002 x 4) Follicle stimulating hormone (FSH) (83001 x 4) Prolactin (84146 x 4) Human growth hormone (HGH) (83003 x 4) Cortisol (82533 x 4) Thyroid stimulating hormone (TSH) (84443 x 4)
80420Dexamethasone suppression panel, 48 hour This panel must include the following: Free cortisol, urine (82530 x 2) Cortisol (82533 x 2) Volume measurement for timed collection (81050 x 2)
80422Glucagon tolerance panel; for insulinoma This panel must include the following: Glucose (82947 x 3) Insulin (83525 x 3)
80424Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2)
80426Gonadotropin releasing hormone stimulation panel This panel must include the following: Follicle stimulating hormone (FSH) (83001 x 4) Luteinizing hormone (LH) (83002 x 4)
80428Growth hormone stimulation panel (eg, arginine infusion, l dopa administration) This panel must include the following: Human growth hormone (HGH) (83003 x 4)
80430Growth hormone suppression panel (glucose administration) This panel must include the following: Glucose (82947 x 3) Human growth hormone (HGH) (83003 x 4)
80432Insulin induced C peptide suppression panel This panel must include the following: Insulin (83525) C peptide (84681 x 5) Glucose (82947 x 5)
80434Insulin tolerance panel; for ACTH insufficiency This panel must include the following: Cortisol (82533 x 5) Glucose (82947 x 5)
80435Insulin tolerance panel; for growth hormone deficiency This panel must include the following: Glucose (82947 x 5) Human growth hormone (HGH) (83003 x 5)
80436Metyrapone panel This panel must include the following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2)
80438Thyrotropin releasing hormone (TRH) stimulation panel; 1 hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 3)
80439Thyrotropin releasing hormone (TRH) stimulation panel; 2 hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 4)
81000Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non automated, with microscopy
81001Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy
81002Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non automated, without microscopy
81003Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy
81005Urinalysis; qualitative or semiquantitative, except immunoassays
81007Urinalysis; bacteriuria screen, except by culture or dipstick
81015Urinalysis; microscopic only
81020Urinalysis; 2 or 3 glass test
81025Urine pregnancy test, by visual color comparison methods
81050Volume measurement for timed collection, each
81099Unlisted urinalysis procedure
81105Human Platelet Antigen 1 genotyping (HPA 1), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post transfusion purpura), gene analysis, common variant, HPA 1a/b (L33P)
81106Human Platelet Antigen 2 genotyping (HPA 2), GP1BA (glycoprotein Ib [platelet], alpha polypeptide [GPIba]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post transfusion purpura), gene analysis, common variant, HPA 2a/b (T145M)
81107Human Platelet Antigen 3 genotyping (HPA 3), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex], antigen CD41 [GPIIb]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post transfusion purpura), gene analysis, common variant, HPA 3a/b (I843S)
81108Human Platelet Antigen 4 genotyping (HPA 4), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post transfusion purpura), gene analysis, common variant, HPA 4a/b (R143Q)
81109Human Platelet Antigen 5 genotyping (HPA 5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA 2 receptor] [GPIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post transfusion purpura), gene analysis, common variant (eg, HPA 5a/b [K505E])
81110Human Platelet Antigen 6 genotyping (HPA 6w), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61] [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post transfusion purpura), gene analysis, common variant, HPA 6a/b (R489Q)
81111Human Platelet Antigen 9 genotyping (HPA 9w), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex, antigen CD41] [GPIIb]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post transfusion purpura), gene analysis, common variant, HPA 9a/b (V837M)
81112Human Platelet Antigen 15 genotyping (HPA 15), CD109 (CD109 molecule) (eg, neonatal alloimmune thrombocytopenia [NAIT], post transfusion purpura), gene analysis, common variant, HPA 15a/b (S682Y)
81120IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg, glioma), common variants (eg, R132H, R132C)
81121IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (eg, glioma), common variants (eg, R140W, R172M)
81162BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements)
81163BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81164BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)
81165BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81166BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)
81167BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)
81168CCND1/IGH (t(11;14)) (eg, mantle cell lymphoma) translocation analysis, major breakpoint, qualitative and quantitative, if performed
81171AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental retardation 2 [FRAXE]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles
81172AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental retardation 2 [FRAXE]) gene analysis; characterization of alleles (eg, expanded size and methylation status)
81173AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; full gene sequence
81174AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; known familial variant
81175ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; full gene sequence
81176ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; targeted sequence analysis (eg, exon 12)
81177ATN1 (atrophin 1) (eg, dentatorubral pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81178ATXN1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81179ATXN2 (ataxin 2) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81180ATXN3 (ataxin 3) (eg, spinocerebellar ataxia, Machado Joseph disease) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81181ATXN7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81182ATXN8OS (ATXN8 opposite strand [non protein coding]) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81183ATXN10 (ataxin 10) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81184CACNA1A (calcium voltage gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; evaluation to detect abnormal (eg, expanded) alleles
81185CACNA1A (calcium voltage gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; full gene sequence
81186CACNA1A (calcium voltage gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; known familial variant
81187CNBP (CCHC type zinc finger nucleic acid binding protein) (eg, myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81188CSTB (cystatin B) (eg, Unverricht Lundborg disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles
81189CSTB (cystatin B) (eg, Unverricht Lundborg disease) gene analysis; full gene sequence
81190CSTB (cystatin B) (eg, Unverricht Lundborg disease) gene analysis; known familial variant(s)
81200ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg, E285A, Y231X)
81201APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence
81202APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants
81203APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants
81204AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; characterization of alleles (eg, expanded size or methylation status)
81205BCKDHB (branched chain keto acid dehydrogenase E1, beta polypeptide) (eg, maple syrup urine disease) gene analysis, common variants (eg, R183P, G278S, E422X)
81206BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative
81207BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative
81208BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; other breakpoint, qualitative or quantitative
81209BLM (Bloom syndrome, RecQ helicase like) (eg, Bloom syndrome) gene analysis, 2281del6ins7 variant
81210BRAF (B Raf proto oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600 variant(s)
81212BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; 185delAG, 5385insC, 6174delT variants
81215BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant
81216BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81217BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant
81220CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; common variants (eg, ACMG/ACOG guidelines)
81221CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; known familial variants
81222CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; duplication/deletion variants
81223CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; full gene sequence
81224CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; intron 8 poly T analysis (eg, male infertility)
81225CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17)
81226CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN)
81227CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *5, *6)
81228Cytogenomic (genome wide) analysis; interrogation of genomic regions for copy number variants comparative genomic hybridization [CGH] microarray analysis)
81229Cytogenomic constitutional (genome wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants, comparative genomic hybridization (CGH) microarray analysis.
81230CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug metabolism), gene analysis, common variant(s) (eg, *2, *22)
81231CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7)
81232DPYD (dihydropyrimidine dehydrogenase) (eg, 5 fluorouracil/5 FU and capecitabine drug metabolism), gene analysis, common variant(s) (eg, *2A, *4, *5, *6)
81233BTK (Bruton's tyrosine kinase) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, C481S, C481R, C481F)
81234DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal (expanded) alleles
81235EGFR (epidermal growth factor receptor) (eg, non small cell lung cancer) gene analysis, common variants (eg, exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q)
81236EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, myelodysplastic syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence
81237EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, diffuse large B cell lymphoma) gene analysis, common variant(s) (eg, codon 646)
81238F9 (coagulation factor IX) (eg, hemophilia B), full gene sequence
81239DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; characterization of alleles (eg, expanded size)
81240F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene analysis, 20210G>A variant
81241F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene analysis, Leiden variant
81242FANCC (Fanconi anemia, complementation group C) (eg, Fanconi anemia, type C) gene analysis, common variant (eg, IVS4+4A>T)
81243FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles
81244FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status)
81245FLT3 (fms related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; internal tandem duplication (ITD) variants (ie, exons 14, 15)
81247G6PD (glucose 6 phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; common variant(s) (eg, A, A )
81248G6PD (glucose 6 phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; known familial variant(s)
81249G6PD (glucose 6 phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; full gene sequence
81250G6PC (glucose 6 phosphatase, catalytic subunit) (eg, Glycogen storage disease, type 1a, von Gierke disease) gene analysis, common variants (eg, R83C, Q347X)
81251GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene analysis, common variants (eg, N370S, 84GG, L444P, IVS2+1G>A)
81252GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; full gene sequence
81253GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; known familial variants
81254GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (eg, nonsyndromic hearing loss) gene analysis, common variants (eg, 309kb [del(GJB6 D13S1830)] and 232kb [del(GJB6 D13S1854)])
81255HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay Sachs disease) gene analysis, common variants (eg, 1278insTATC, 1421+1G>C, G269S)
81256HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis, common variants (eg, C282Y, H63D)
81257HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring)
81258HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; known familial variant
81259HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence
81260IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B cells, kinase complex associated protein) (eg, familial dysautonomia) gene analysis, common variants (eg, 2507+6T>C, R696P)
81261IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (eg, polymerase chain reaction)
81262IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B cell), gene rearrangement analysis to detect abnormal clonal population(s); direct probe methodology (eg, Southern blot)
81263IGH@ (Immunoglobulin heavy chain locus) (eg, leukemia and lymphoma, B cell), variable region somatic mutation analysis
81264IGK@ (Immunoglobulin kappa light chain locus) (eg, leukemia and lymphoma, B cell), gene rearrangement analysis, evaluation to detect abnormal clonal population(s)
81265Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (eg, pre transplant recipient and donor germline testing, post transplant non hematopoietic recipient germline [eg, buccal swab or other germline tissue sample] and donor testing, twin zygosity testing, or maternal cell contamination of fetal cells)
81266Comparative analysis using Short Tandem Repeat (STR) markers; each additional specimen (eg, additional cord blood donor, additional fetal samples from different cultures, or additional zygosity in multiple birth pregnancies) (List separately in addition to code for primary procedure)
81267Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; without cell selection
81268Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; with cell selection (eg, CD3, CD33), each cell type
81269HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; duplication/deletion variants
81270JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.Val617Phe (V617F) variant
81271HTT (huntingtin) (eg, Huntington disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles
81274HTT (huntingtin) (eg, Huntington disease) gene analysis; characterization of alleles (eg, expanded size)
81275KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and 13)
81276KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146)
81277Cytogenomic neoplasia (genome wide) microarray analysis, interrogation of genomic regions for copy number and loss of heterozygosity variants for chromosomal abnormalities
81279JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) targeted sequence analysis (eg, exons 12 and 13)
81283IFNL3 (interferon, lambda 3) (eg, drug response), gene analysis, rs12979860 variant
81284FXN (frataxin) (eg, Friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles
81285FXN (frataxin) (eg, Friedreich ataxia) gene analysis; characterization of alleles (eg, expanded size)
81286FXN (frataxin) (eg, Friedreich ataxia) gene analysis; full gene sequence
81289FXN (frataxin) (eg, Friedreich ataxia) gene analysis; known familial variant(s)
81290MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene analysis, common variants (eg, IVS3 2A>G, del6.4kb)
81291MTHFR (5,10 methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C)
81292MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis
81293MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants
81294MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants
81295MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis
81296MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants
81297MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants
81298MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis
81299MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants
81300MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants
81301Microsatellite instability analysis (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) of markers for mismatch repair deficiency (eg, BAT25, BAT26), includes comparison of neoplastic and normal tissue, if performed
81302MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; full sequence analysis
81303MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; known familial variant
81304MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; duplication/deletion variants
81305MYD88 (myeloid differentiation primary response 88) (eg, Waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant
81306NUDT15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common variant(s) (eg, *2, *3, *4, *5, *6)
81307PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; full gene sequence
81308PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; known familial variant
81310NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, exon 12 variants
81312PABPN1 (poly[A] binding protein nuclear 1) (eg, oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81315PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; common breakpoints (eg, intron 3 and intron 6), qualitative or quantitative
81316PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; single breakpoint (eg, intron 3, intron 6 or exon 6), qualitative or quantitative
81317PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis
81318PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants
81319PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants
81320PLCG2 (phospholipase C gamma 2) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, R665W, S707F, L845F)
81321PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; full sequence analysis
81322PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; known familial variant
81323PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; duplication/deletion variant
81324PMP22 (peripheral myelin protein 22) (eg, Charcot Marie Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; duplication/deletion analysis
81325PMP22 (peripheral myelin protein 22) (eg, Charcot Marie Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; full sequence analysis
81326PMP22 (peripheral myelin protein 22) (eg, Charcot Marie Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; known familial variant
81328SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5)
81329SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; dosage/deletion analysis (eg, carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed
81330SMPD1(sphingomyelin phosphodiesterase 1, acid lysosomal) (eg, Niemann Pick disease, Type A) gene analysis, common variants (eg, R496L, L302P, fsP330)
81331SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A) (eg, Prader Willi syndrome and/or Angelman syndrome), methylation analysis
81332SERPINA1 (serpin peptidase inhibitor, clade A, alpha 1 antiproteinase, antitrypsin, member 1) (eg, alpha 1 antitrypsin deficiency), gene analysis, common variants (eg, *S and *Z)
81333TGFBI (transforming growth factor beta induced) (eg, corneal dystrophy) gene analysis, common variants (eg, R124H, R124C, R124L, R555W, R555Q)
81334RUNX1 (runt related transcription factor 1) (eg, acute myeloid leukemia, familial platelet disorder with associated myeloid malignancy) gene analysis, targeted sequence analysis (eg, exons 3 8)
81335TPMT (thiopurine S methyltransferase) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3)
81336SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; full gene sequence
81337SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; known familial sequence variant(s)
81339MPL (MPL proto oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; sequence analysis, exon 10
81340TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using amplification methodology (eg, polymerase chain reaction)
81341TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using direct probe methodology (eg, Southern blot)
81342TRG@ (T cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population(s)
81343PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81344TBP (TATA box binding protein) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles
81345TERT (telomerase reverse transcriptase) (eg, thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (eg, promoter region)
81346TYMS (thymidylate synthetase) (eg, 5 fluorouracil/5 FU drug metabolism), gene analysis, common variant(s) (eg, tandem repeat variant)
81350UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, drug metabolism, hereditary unconjugated hyperbilirubinemia [Gilbert syndrome]) gene analysis, common variants (eg, *28, *36, *37)
81355VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, 1639G>A, c.173+1000C>T)
81361HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE)
81362HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); known familial variant(s)
81363HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); duplication/deletion variant(s)
81364HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); full gene sequence
81370HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA A, B, C, DRB1/3/4/5, and DQB1
81371HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA A, B, and DRB1 (eg, verification typing)
81372HLA Class I typing, low resolution (eg, antigen equivalents); complete (ie, HLA A, B, and C)
81373HLA Class I typing, low resolution (eg, antigen equivalents); one locus (eg, HLA A, B, or C), each
81374HLA Class I typing, low resolution (eg, antigen equivalents); one antigen equivalent (eg, B*27), each
81375HLA Class II typing, low resolution (eg, antigen equivalents); HLA DRB1/3/4/5 and DQB1
81376HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA DRB1, DRB3/4/5, DQB1, DQA1, DPB1, or DPA1), each
81377HLA Class II typing, low resolution (eg, antigen equivalents); one antigen equivalent, each
81378HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA A, B, C, and DRB1
81379HLA Class I typing, high resolution (ie, alleles or allele groups); complete (ie, HLA A, B, and C)
81380HLA Class I typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA A, B, or C), each
81381HLA Class I typing, high resolution (ie, alleles or allele groups); one allele or allele group (eg, B*57:01P), each
81382HLA Class II typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA DRB1, DRB3/4/5, DQB1, DQA1, DPB1, or DPA1), each
81383HLA Class II typing, high resolution (ie, alleles or allele groups); one allele or allele group (eg, HLA DQB1*06:02P), each
81400Molecular pathology procedure, Level 1 (eg, identification of single germline variant [eg, SNP] by techniques such as restriction enzyme digestion or melt curve analysis)
81401Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or 1 somatic variant [typically using nonsequencing target variant analysis], or detection of a dynamic mutation disorder/triplet repeat) ABCC8 (ATP-binding cassette, sub-family C [CFTR/MRP], member 8) (eg, familial hyperinsulinism), common variants (eg, c.3898-9G>A [c.3992-9G>A], F1388del) ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib resistance), T315I variant ACADM (acyl-CoA dehydrogenase, C-4 to C-12 straight chain, MCAD) (eg, medium chain acyl dehydrogenase deficiency), commons variants (eg, K304E, Y42H) ADRB2 (adrenergic beta-2 receptor surface) (eg, drug metabolism), common variants (eg, G16R, Q27E) APOB (apolipoprotein B) (eg, familial hypercholesterolemia type B), common variants (eg, R3500Q, R3500W) APOE (apolipoprotein E) (eg, hyperlipoproteinemia type III, cardiovascular disease, Alzheimer disease), common variants (eg, *2, *3, *4) CBFB/MYH11 (inv(16)) (eg, acute myeloid leukemia), qualitative, and quantitative, if performed CBS (cystathionine-beta-synthase) (eg, homocystinuria, cystathionine beta-synthase deficiency), common variants (eg, I278T, G307S) CFH/ARMS2 (complement factor H/age-related maculopathy susceptibility 2) (eg, macular degeneration), common variants (eg, Y402H [CFH], A69S [ARMS2]) DEK/NUP214 (t(6;9)) (eg, acute myeloid leukemia), translocation analysis, qualitative, and quantitative, if performed E2A/PBX1 (t(1;19)) (eg, acute lymphocytic leukemia), translocation analysis, qualitative, and quantitative, if performed EML4/ALK (inv(2)) (eg, non-small cell lung cancer), translocation or inversion analysis ETV6/RUNX1 (t(12;21)) (eg, acute lymphocytic leukemia), translocation analysis, qualitative, and quantitative, if performed EWSR1/ATF1 (t(12;22)) (eg, clear cell sarcoma), translocation analysis, qualitative, and quantitative, if performed EWSR1/ERG (t(21;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed EWSR1/FLI1 (t(11;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed EWSR1/WT1 (t(11;22)) (eg, desmoplastic small round cell tumor), translocation analysis, qualitative, and quantitative, if performed F11 (coagulation factor XI) (eg, coagulation disorder), common variants (eg, E117X [Type II], F283L [Type III], IVS14del14, and IVS14+1G>A [Type I]) FGFR3 (fibroblast growth factor receptor 3) (eg, achondroplasia, hypochondroplasia), common variants (eg, 1138G>A, 1138G>C, 1620C>A, 1620C>G) FIP1L1/PDGFRA (del[4q12]) (eg, imatinib-sensitive chronic eosinophilic leukemia), qualitative, and quantitative, if performed FLG (filaggrin) (eg, ichthyosis vulgaris), common variants (eg, R501X, 2282del4, R2447X, S3247X, 3702delG) FOXO1/PAX3 (t(2;13)) (eg, alveolar rhabdomyosarcoma), translocation analysis, qualitative, and quantitative, if performed FOXO1/PAX7 (t(1;13)) (eg, alveolar rhabdomyosarcoma), translocation analysis, qualitative, and quantitative, if performed FUS/DDIT3 (t(12;16)) (eg, myxoid liposarcoma), translocation analysis, qualitative, and quantitative, if performed GALC (galactosylceramidase) (eg, Krabbe disease), common variants (eg, c.857G>A, 30-kb deletion) GALT (galactose-1-phosphate uridylyltransferase) (eg, galactosemia), common variants (eg, Q188R, S135L, K285N, T138M, L195P, Y209C, IVS2-2A>G, P171S, del5kb, N314D, L218L/N314D) H19 (imprinted maternally expressed transcript [non-protein coding]) (eg, Beckwith-Wiedemann syndrome), methylation analysis IGH@/BCL2 (t(14;18)) (eg, follicular lymphoma), translocation analysis; single breakpoint (eg, major breakpoint region [MBR] or minor cluster region [mcr]), qualitative or quantitative (When both MBR and mcr breakpoints are performed, use 81278) KCNQ1OT1 (KCNQ1 overlapping transcript 1 [non-protein coding]) (eg, Beckwith-Wiedemann syndrome), methylation analysis LINC00518 (long intergenic non-protein coding RNA 518) (eg, melanoma), expression analysis LRRK2 (leucine-rich repeat kinase 2) (eg, Parkinson disease), common variants (eg, R1441G, G2019S, I2020T) MED12 (mediator complex subunit 12) (eg, FG syndrome type 1, Lujan syndrome), common variants (eg, R961W, N1007S) MEG3/DLK1 (maternally expressed 3 [non-protein coding]/delta-like 1 homolog [Drosophila]) (eg, intrauterine growth retardation), methylation analysis MLL/AFF1 (t(4;11)) (eg, acute lymphoblastic leukemia), translocation analysis, qualitative, and quantitative, if performed MLL/MLLT3 (t(9;11)) (eg, acute myeloid leukemia), translocation analysis, qualitative, and quantitative, if performed MT-ATP6 (mitochondrially encoded ATP synthase 6) (eg, neuropathy with ataxia and retinitis pigmentosa [NARP], Leigh syndrome), common variants (eg, m.8993T>G, m.8993T>C) MT-ND4, MT-ND6 (mitochondrially encoded NADH dehydrogenase 4, mitochondrially encoded NADH dehydrogenase 6) (eg, Leber hereditary optic neuropathy [LHON]), common variants (eg, m.11778G>A, m.3460G>A, m.14484T>C) MT-ND5 (mitochondrially encoded tRNA leucine 1 [UUA/G], mitochondrially encoded NADH dehydrogenase 5) (eg, mitochondrial encephalopathy with lactic acidosis and stroke-like episodes [MELAS]), common variants (eg, m.3243A>G, m.3271T>C, m.3252A>G, m.13513G>A) MT-RNR1 (mitochondrially encoded 12S RNA) (eg, nonsyndromic hearing loss), common variants (eg, m.1555A>G, m.1494C>T) MT-TK (mitochondrially encoded tRNA lysine) (eg, myoclonic epilepsy with ragged-red fibers [MERRF]), common variants (eg, m.8344A>G, m.8356T>C) MT-TL1 (mitochondrially encoded tRNA leucine 1 [UUA/G]) (eg, diabetes and hearing loss), common variants (eg, m.3243A>G, m.14709 T>C) MT-TL1 MT-TS1, MT-RNR1 (mitochondrially encoded tRNA serine 1 [UCN], mitochondrially encoded 12S RNA) (eg, nonsyndromic sensorineural deafness [including aminoglycoside-induced nonsyndromic deafness]), common variants (eg, m.7445A>G, m.1555A>G) MUTYH (mutY homolog [E. coli]) (eg, MYH-associated polyposis), common variants (eg, Y165C, G382D) NOD2 (nucleotide-binding oligomerization domain containing 2) (eg, Crohn's disease, Blau syndrome), common variants (eg, SNP 8, SNP 12, SNP 13) NPM1/ALK (t(2;5)) (eg, anaplastic large cell lymphoma), translocation analysis PAX8/PPARG (t(2;3) (q13;p25)) (eg, follicular thyroid carcinoma), translocation analysis PRAME (preferentially expressed antigen in melanoma) (eg, melanoma), expression analysis PRSS1 (protease, serine, 1 [trypsin 1]) (eg, hereditary pancreatitis), common variants (eg, N29I, A16V, R122H) PYGM (phosphorylase, glycogen, muscle) (eg, glycogen storage disease type V, McArdle disease), common variants (eg, R50X, G205S) RUNX1/RUNX1T1 (t(8;21)) (eg, acute myeloid leukemia) translocation analysis, qualitative, and quantitative, if performed SS18/SSX1 (t(X;18)) (eg, synovial sarcoma), translocation analysis, qualitative, and quantitative, if performed SS18/SSX2 (t(X;18)) (eg, synovial sarcoma), translocation analysis, qualitative, and quantitative, if performed VWF (von Willebrand factor) (eg, von Willebrand disease type 2N), common variants (eg, T791M, R816W, R854Q)
81402Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10 methylated variants, or 2-10 somatic variants [typically using non-sequencing target variant analysis], immunoglobulin and T-cell receptor gene rearrangements, duplication/deletion variants of 1 exon, loss of heterozygosity [LOH], uniparental disomy [UPD]) Chromosome 1p-/19q- (eg, glial tumors), deletion analysis Chromosome 18q- (eg, D18S55, D18S58, D18S61, D18S64, and D18S69) (eg, colon cancer), allelic imbalance assessment (ie, loss of heterozygosity) COL1A1/PDGFB (t(17;22)) (eg, dermatofibrosarcoma protuberans), translocation analysis, multiple breakpoints, qualitative, and quantitative, if performed CYP21A2 (cytochrome P450, family 21, subfamily A, polypeptide 2) (eg, congenital adrenal hyperplasia, 21-hydroxylase deficiency), common variants (eg, IVS2-13G, P30L, I172N, exon 6 mutation cluster [I235N, V236E, M238K], V281L, L307FfsX6, Q318X, R356W, P453S, G110VfsX21, 30-kb deletion variant) ESR1/PGR (receptor 1/progesterone receptor) ratio (eg, breast cancer) MEFV (Mediterranean fever) (eg, familial Mediterranean fever), common variants (eg, E148Q, P369S, F479L, M680I, I692del, M694V, M694I, K695R, V726A, A744S, R761H) TRD@ (T cell antigen receptor, delta) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population Uniparental disomy (UPD) (eg, Russell-Silver syndrome, Prader-Willi/Angelman syndrome), short tandem repeat (STR) analysis
81403Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons) ANG (angiogenin, ribonuclease, RNase A family, 5) (eg, amyotrophic lateral sclerosis), full gene sequence ARX (aristaless-related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked mental retardation), duplication/deletion analysis CEL (carboxyl ester lipase [bile salt-stimulated lipase]) (eg, maturity-onset diabetes of the young [MODY]), targeted sequence analysis of exon 11 (eg, c.1785delC, c.1686delT) CTNNB1 (catenin [cadherin-associated protein], beta 1, 88kDa) (eg, desmoid tumors), targeted sequence analysis (eg, exon 3) DAZ/SRY (deleted in azoospermia and sex determining region Y) (eg, male infertility), common deletions (eg, AZFa, AZFb, AZFc, AZFd) DNMT3A (DNA [cytosine-5-]-methyltransferase 3 alpha) (eg, acute myeloid leukemia), targeted sequence analysis (eg, exon 23) EPCAM (epithelial cell adhesion molecule) (eg, Lynch syndrome), duplication/deletion analysis F8 (coagulation factor VIII) (eg, hemophilia A), inversion analysis, intron 1 and intron 22A F12 (coagulation factor XII [Hageman factor]) (eg, angioedema, hereditary, type III; factor XII deficiency), targeted sequence analysis of exon 9 FGFR3 (fibroblast growth factor receptor 3) (eg, isolated craniosynostosis), targeted sequence analysis (eg, exon 7) (For targeted sequence analysis of multiple FGFR3 exons, use 81404) GJB1 (gap junction protein, beta 1) (eg, Charcot-Marie-Tooth X-linked), full gene sequence GNAQ (guanine nucleotide-binding protein G[q] subunit alpha) (eg, uveal melanoma), common variants (eg, R183, Q209) Human erythrocyte antigen gene analyses (eg, SLC14A1 [Kidd blood group], BCAM [Lutheran blood group], ICAM4 [Landsteiner-Wiener blood group], SLC4A1 [Diego blood group], AQP1 [Colton blood group], ERMAP [Scianna blood group], RHCE [Rh blood group, CcEe antigens], KEL [Kell blood group], DARC [Duffy blood group], GYPA, GYPB, GYPE [MNS blood group], ART4 [Dombrock blood group]) (eg, sickle-cell disease, thalassemia, hemolytic transfusion reactions, hemolytic disease of the fetus or newborn), common variants HRAS (v-Ha-ras Harvey rat sarcoma viral oncogene homolog) (eg, Costello syndrome), exon 2 sequence KCNC3 (potassium voltage-gated channel, Shaw-related subfamily, member 3) (eg, spinocerebellar ataxia), targeted sequence analysis (eg, exon 2) KCNJ2 (potassium inwardly-rectifying channel, subfamily J, member 2) (eg, Andersen-Tawil syndrome), full gene sequence KCNJ11 (potassium inwardly-rectifying channel, subfamily J, member 11) (eg, familial hyperinsulinism), full gene sequence Killer cell immunoglobulin-like receptor (KIR) gene family (eg, hematopoietic stem cell transplantation), genotyping of KIR family genes Known familial variant not otherwise specified, for gene listed in Tier 1 or Tier 2, or identified during a genomic sequencing procedure, DNA sequence analysis, each variant exon (For a known familial variant that is considered a common variant, use specific common variant Tier 1 or Tier 2 code) MC4R (melanocortin 4 receptor) (eg, obesity), full gene sequence MICA (MHC class I polypeptide-related sequence A) (eg, solid organ transplantation), common variants (eg, *001, *002) MT-RNR1 (mitochondrially encoded 12S RNA) (eg, nonsyndromic hearing loss), full gene sequence MT-TS1 (mitochondrially encoded tRNA serine 1) (eg, nonsyndromic hearing loss), full gene sequence NDP (Norrie disease [pseudoglioma]) (eg, Norrie disease), duplication/deletion analysis NHLRC1 (NHL repeat containing 1) (eg, progressive myoclonus epilepsy), full gene sequence PHOX2B (paired-like homeobox 2b) (eg, congenital central hypoventilation syndrome), duplication/deletion analysis PLN (phospholamban) (eg, dilated cardiomyopathy, hypertrophic cardiomyopathy), full gene sequence RHD (Rh blood group, D antigen) (eg, hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene) RHD (Rh blood group, D antigen) (eg, hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene), performed on cell-free fetal DNA in maternal blood (For human erythrocyte gene analysis of RHD, use a separate unit of 81403) SH2D1A (SH2 domain containing 1A) (eg, X-linked lymphoproliferative syndrome), duplication/deletion analysis TWIST1 (twist homolog 1 [Drosophila]) (eg, Saethre-Chotzen syndrome), duplication/deletion analysis UBA1 (ubiquitin-like modifier activating enzyme 1) (eg, spinal muscular atrophy, X-linked), targeted sequence analysis (eg, exon 15) VHL (von Hippel-Lindau tumor suppressor) (eg, von Hippel-Lindau familial cancer syndrome), deletion/duplication analysis VWF (von Willebrand factor) (eg, von Willebrand disease types 2A, 2B, 2M), targeted sequence analysis (eg, exon 28)
81404Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis) ACADS (acyl-CoA dehydrogenase, C-2 to C-3 short chain) (eg, short chain acyl-CoA dehydrogenase deficiency), targeted sequence analysis (eg, exons 5 and 6) AQP2 (aquaporin 2 [collecting duct]) (eg, nephrogenic diabetes insipidus), full gene sequence ARX (aristaless related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked mental retardation), full gene sequence AVPR2 (arginine vasopressin receptor 2) (eg, nephrogenic diabetes insipidus), full gene sequence BBS10 (Bardet-Biedl syndrome 10) (eg, Bardet-Biedl syndrome), full gene sequence BTD (biotinidase) (eg, biotinidase deficiency), full gene sequence C10orf2 (chromosome 10 open reading frame 2) (eg, mitochondrial DNA depletion syndrome), full gene sequence CAV3 (caveolin 3) (eg, CAV3-related distal myopathy, limb-girdle muscular dystrophy type 1C), full gene sequence CD40LG (CD40 ligand) (eg, X-linked hyper IgM syndrome), full gene sequence CDKN2A (cyclin-dependent kinase inhibitor 2A) (eg, CDKN2A-related cutaneous malignant melanoma, familial atypical mole-malignant melanoma syndrome), full gene sequence CLRN1 (clarin 1) (eg, Usher syndrome, type 3), full gene sequence COX6B1 (cytochrome c oxidase subunit VIb polypeptide 1) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence CPT2 (carnitine palmitoyltransferase 2) (eg, carnitine palmitoyltransferase II deficiency), full gene sequence CRX (cone-rod homeobox) (eg, cone-rod dystrophy 2, Leber congenital amaurosis), full gene sequence CYP1B1 (cytochrome P450, family 1, subfamily B, polypeptide 1) (eg, primary congenital glaucoma), full gene sequence EGR2 (early growth response 2) (eg, Charcot-Marie-Tooth), full gene sequence EMD (emerin) (eg, Emery-Dreifuss muscular dystrophy), duplication/deletion analysis EPM2A (epilepsy, progressive myoclonus type 2A, Lafora disease [laforin]) (eg, progressive myoclonus epilepsy), full gene sequence FGF23 (fibroblast growth factor 23) (eg, hypophosphatemic rickets), full gene sequence FGFR2 (fibroblast growth factor receptor 2) (eg, craniosynostosis, Apert syndrome, Crouzon syndrome), targeted sequence analysis (eg, exons 8, 10) FGFR3 (fibroblast growth factor receptor 3) (eg, achondroplasia, hypochondroplasia), targeted sequence analysis (eg, exons 8, 11, 12, 13) FHL1 (four and a half LIM domains 1) (eg, Emery-Dreifuss muscular dystrophy), full gene sequence FKRP (fukutin related protein) (eg, congenital muscular dystrophy type 1C [MDC1C], limb-girdle muscular dystrophy [LGMD] type 2I), full gene sequence FOXG1 (forkhead box G1) (eg, Rett syndrome), full gene sequence FSHMD1A (facioscapulohumeral muscular dystrophy 1A) (eg, facioscapulohumeral muscular dystrophy), evaluation to detect abnormal (eg, deleted) alleles FSHMD1A (facioscapulohumeral muscular dystrophy 1A) (eg, facioscapulohumeral muscular dystrophy), characterization of haplotype(s) (ie, chromosome 4A and 4B haplotypes) GH1 (growth hormone 1) (eg, growth hormone deficiency), full gene sequence GP1BB (glycoprotein Ib [platelet], beta polypeptide) (eg, Bernard-Soulier syndrome type B), full gene sequence (For common deletion variants of alpha globin 1 and alpha globin 2 genes, use 81257) HNF1B (HNF1 homeobox B) (eg, maturity-onset diabetes of the young [MODY]), duplication/deletion analysis HRAS (v-Ha-ras Harvey rat sarcoma viral oncogene homolog) (eg, Costello syndrome), full gene sequence HSD3B2 (hydroxy-delta-5-steroid dehydrogenase, 3 beta- and steroid delta-isomerase 2) (eg, 3-beta-hydroxysteroid dehydrogenase type II deficiency), full gene sequence HSD11B2 (hydroxysteroid [11-beta] dehydrogenase 2) (eg, mineralocorticoid excess syndrome), full gene sequence HSPB1 (heat shock 27kDa protein 1) (eg, Charcot-Marie-Tooth disease), full gene sequence INS (insulin) (eg, diabetes mellitus), full gene sequence KCNJ1 (potassium inwardly-rectifying channel, subfamily J, member 1) (eg, Bartter syndrome), full gene sequence KCNJ10 (potassium inwardly-rectifying channel, subfamily J, member 10) (eg, SeSAME syndrome, EAST syndrome, sensorineural hearing loss), full gene sequence LITAF (lipopolysaccharide-induced TNF factor) (eg, Charcot-Marie-Tooth), full gene sequence MEFV (Mediterranean fever) (eg, familial Mediterranean fever), full gene sequence MEN1 (multiple endocrine neoplasia I) (eg, multiple endocrine neoplasia type 1, Wermer syndrome), duplication/deletion analysis MMACHC (methylmalonic aciduria [cobalamin deficiency] cblC type, with homocystinuria) (eg, methylmalonic acidemia and homocystinuria), full gene sequence MPV17 (MpV17 mitochondrial inner membrane protein) (eg, mitochondrial DNA depletion syndrome), duplication/deletion analysis NDP (Norrie disease [pseudoglioma]) (eg, Norrie disease), full gene sequence NDUFA1 (NADH dehydrogenase [ubiquinone] 1 alpha subcomplex, 1, 7.5kDa) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NDUFAF2 (NADH dehydrogenase [ubiquinone] 1 alpha subcomplex, assembly factor 2) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NDUFS4 (NADH dehydrogenase [ubiquinone] Fe-S protein 4, 18kDa [NADH-coenzyme Q reductase]) (eg, Leigh syndrome, mitochondrial complex I deficiency), full gene sequence NIPA1 (non-imprinted in Prader-Willi/Angelman syndrome 1) (eg, spastic paraplegia), full gene sequence NLGN4X (neuroligin 4, X-linked) (eg, autism spectrum disorders), duplication/deletion analysis NPC2 (Niemann-Pick disease, type C2 [epididymal secretory protein E1]) (eg, Niemann-Pick disease type C2), full gene sequence NR0B1 (nuclear receptor subfamily 0, group B, member 1) (eg, congenital adrenal hypoplasia), full gene sequence PDX1 (pancreatic and duodenal homeobox 1) (eg, maturity-onset diabetes of the young [MODY]), full gene sequence PHOX2B (paired-like homeobox 2b) (eg, congenital central hypoventilation syndrome), full gene sequence PLP1 (proteolipid protein 1) (eg, Pelizaeus-Merzbacher disease, spastic paraplegia), duplication/deletion analysis PQBP1 (polyglutamine binding protein 1) (eg, Renpenning syndrome), duplication/deletion analysis PRNP (prion protein) (eg, genetic prion disease), full gene sequence PROP1 (PROP paired-like homeobox 1) (eg, combined pituitary hormone deficiency), full gene sequence PRPH2 (peripherin 2 [retinal degeneration, slow]) (eg, retinitis pigmentosa), full gene sequence PRSS1 (protease, serine, 1 [trypsin 1]) (eg, hereditary pancreatitis), full gene sequence RAF1 (v-raf-1 murine leukemia viral oncogene homolog 1) (eg, LEOPARD syndrome), targeted sequence analysis (eg, exons 7, 12, 14, 17) RET (ret proto-oncogene) (eg, multiple endocrine neoplasia, type 2B and familial medullary thyroid carcinoma), common variants (eg, M918T, 2647_2648delinsTT, A883F) RHO (rhodopsin) (eg, retinitis pigmentosa), full gene sequence RP1 (retinitis pigmentosa 1) (eg, retinitis pigmentosa), full gene sequence SCN1B (sodium channel, voltage-gated, type I, beta) (eg, Brugada syndrome), full gene sequence SCO2 (SCO cytochrome oxidase deficient homolog 2 [SCO1L]) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence SDHC (succinate dehydrogenase complex, subunit C, integral membrane protein, 15kDa) (eg, hereditary paraganglioma-pheochromocytoma syndrome), duplication/deletion analysis SDHD (succinate dehydrogenase complex, subunit D, integral membrane protein) (eg, hereditary paraganglioma), full gene sequence SGCG (sarcoglycan, gamma [35kDa dystrophin-associated glycoprotein]) (eg, limb-girdle muscular dystrophy), duplication/deletion analysis SH2D1A (SH2 domain containing 1A) (eg, X-linked lymphoproliferative syndrome), full gene sequence SLC16A2 (solute carrier family 16, member 2 [thyroid hormone transporter]) (eg, specific thyroid hormone
81405Molecular pathology procedure, Level 6 (eg, analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally targeted cytogenomic array analysis) Cytogenomic constitutional targeted microarray analysis of chromosome 22q13 by interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities (When performing cytogenomic [genome-wide] analysis, for constitutional chromosomal abnormalities. See 81228, 81229, 81349)
81406Molecular pathology procedure, Level 7 (eg, analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons) ACADVL (acyl-CoA dehydrogenase, very long chain) (eg, very long chain acyl-coenzyme A dehydrogenase deficiency), full gene sequence ACTN4 (actinin, alpha 4) (eg, focal segmental glomerulosclerosis), full gene sequence AFG3L2 (AFG3 ATPase family gene 3-like 2 [S. cerevisiae]) (eg, spinocerebellar ataxia), full gene sequence AIRE (autoimmune regulator) (eg, autoimmune polyendocrinopathy syndrome type 1), full gene sequence ALDH7A1 (aldehyde dehydrogenase 7 family, member A1) (eg, pyridoxine-dependent epilepsy), full gene sequence ANO5 (anoctamin 5) (eg, limb-girdle muscular dystrophy), full gene sequence ANOS1 (anosmin-1) (eg, Kallmann syndrome 1), full gene sequence APP (amyloid beta [A4] precursor protein) (eg, Alzheimer disease), full gene sequence ASS1 (argininosuccinate synthase 1) (eg, citrullinemia type I), full gene sequence ATL1 (atlastin GTPase 1) (eg, spastic paraplegia), full gene sequence ATP1A2 (ATPase, Na+/K+ transporting, alpha 2 polypeptide) (eg, familial hemiplegic migraine), full gene sequence ATP7B (ATPase, Cu++ transporting, beta polypeptide) (eg, Wilson disease), full gene sequence BBS1 (Bardet-Biedl syndrome 1) (eg, Bardet-Biedl syndrome), full gene sequence BBS2 (Bardet-Biedl syndrome 2) (eg, Bardet-Biedl syndrome), full gene sequence BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, maple syrup urine disease, type 1B), full gene sequence BEST1 (bestrophin 1) (eg, vitelliform macular dystrophy), full gene sequence BMPR2 (bone morphogenetic protein receptor, type II [serine/threonine kinase]) (eg, heritable pulmonary arterial hypertension), full gene sequence BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg, Noonan syndrome), full gene sequence BSCL2 (Berardinelli-Seip congenital lipodystrophy 2 [seipin]) (eg, Berardinelli-Seip congenital lipodystrophy), full gene sequence BTK (Bruton agammaglobulinemia tyrosine kinase) (eg, X-linked agammaglobulinemia), full gene sequence CACNB2 (calcium channel, voltage-dependent, beta 2 subunit) (eg, Brugada syndrome), full gene sequence CAPN3 (calpain 3) (eg, limb-girdle muscular dystrophy [LGMD] type 2A, calpainopathy), full gene sequence CBS (cystathionine-beta-synthase) (eg, homocystinuria, cystathionine beta-synthase deficiency), full gene sequence CDH1 (cadherin 1, type 1, E-cadherin [epithelial]) (eg, hereditary diffuse gastric cancer), full gene sequence CDKL5 (cyclin-dependent kinase-like 5) (eg, early infantile epileptic encephalopathy), full gene sequence CLCN1 (chloride channel 1, skeletal muscle) (eg, myotonia congenita), full gene sequence CLCNKB (chloride channel, voltage-sensitive Kb) (eg, Bartter syndrome 3 and 4b), full gene sequence CNTNAP2 (contactin-associated protein-like 2) (eg, Pitt-Hopkins-like syndrome 1), full gene sequence COL6A2 (collagen, type VI, alpha 2) (eg, collagen type VI-related disorders), duplication/deletion analysis CPT1A (carnitine palmitoyltransferase 1A [liver]) (eg, carnitine palmitoyltransferase 1A [CPT1A] deficiency), full gene sequence CRB1 (crumbs homolog 1 [Drosophila]) (eg, Leber congenital amaurosis), full gene sequence CREBBP (CREB binding protein) (eg, Rubinstein-Taybi syndrome), duplication/deletion analysis DBT (dihydrolipoamide branched chain transacylase E2) (eg, maple syrup urine disease, type 2), full gene sequence DLAT (dihydrolipoamide S-acetyltransferase) (eg, pyruvate dehydrogenase E2 deficiency), full gene sequence DLD (dihydrolipoamide dehydrogenase) (eg, maple syrup urine disease, type III), full gene sequence DSC2 (desmocollin) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 11), full gene sequence DSG2 (desmoglein 2) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 10), full gene sequence DSP (desmoplakin) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 8), full gene sequence EFHC1 (EF-hand domain [C-terminal] containing 1) (eg, juvenile myoclonic epilepsy), full gene sequence EIF2B3 (eukaryotic translation initiation factor 2B, subunit 3 gamma, 58kDa) (eg, leukoencephalopathy with vanishing white matter), full gene sequence EIF2B4 (eukaryotic translation initiation factor 2B, subunit 4 delta, 67kDa) (eg, leukoencephalopathy with vanishing white matter), full gene sequence EIF2B5 (eukaryotic translation initiation factor 2B, subunit 5 epsilon, 82kDa) (eg, childhood ataxia with central nervous system hypomyelination/vanishing white matter), full gene sequence ENG (endoglin) (eg, hereditary hemorrhagic telangiectasia, type 1), full gene sequence EYA1 (eyes absent homolog 1 [Drosophila]) (eg, branchio-oto-renal [BOR] spectrum disorders), full gene sequence F8 (coagulation factor VIII) (eg, hemophilia A), duplication/deletion analysis FAH (fumarylacetoacetate hydrolase [fumarylacetoacetase]) (eg, tyrosinemia, type 1), full gene sequence FASTKD2 (FAST kinase domains 2) (eg, mitochondrial respiratory chain complex IV deficiency), full gene sequence FIG4 (FIG4 homolog, SAC1 lipid phosphatase domain containing [S. cerevisiae]) (eg, Charcot-Marie-Tooth disease), full gene sequence FTSJ1 (FtsJ RNA methyltransferase homolog 1 [E. coli]) (eg, X-linked mental retardation 9), full gene sequence FUS (fused in sarcoma) (eg, amyotrophic lateral sclerosis), full gene sequence GAA (glucosidase, alpha; acid) (eg, glycogen storage disease type II [Pompe disease]), full gene sequence GALC (galactosylceramidase) (eg, Krabbe disease), full gene sequence GALT (galactose-1-phosphate uridylyltransferase) (eg, galactosemia), full gene sequence GARS (glycyl-tRNA synthetase) (eg, Charcot-Marie-Tooth disease), full gene sequence GCDH (glutaryl-CoA dehydrogenase) (eg, glutaricacidemia type 1), full gene sequence GCK (glucokinase [hexokinase 4]) (eg, maturity-onset diabetes of the young [MODY]), full gene sequence GLUD1 (glutamate dehydrogenase 1) (eg, familial hyperinsulinism), full gene sequence GNE (glucosamine [UDP-N-acetyl]-2-epimerase/N-acetylmannosamine kinase) (eg, inclusion body myopathy 2 [IBM2], Nonaka myopathy), full gene sequence GRN (granulin) (eg, frontotemporal dementia), full gene sequence HADHA (hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase [trifunctional protein] alpha subunit) (eg, long chain acyl-coenzyme A dehydrogenase deficiency), full gene sequence HADHB (hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase [trifunctional protein], beta subunit) (eg, trifunctional protein deficiency), full gene sequence HEXA (hexosaminidase A, alpha polypeptide) (eg, Tay-Sachs disease), full gene sequence HLCS (HLCS holocarboxylase synthetase) (eg, holocarboxylase synthetase deficiency), full gene sequence HMBS (hydroxymethylbilane synthase) (eg, acute intermittent porphyria), full gene sequence HNF4A (hepatocyte nuclear factor 4, alpha) (eg, maturity-onset diabetes of the young [MODY]), full gene sequence IDUA (iduronidase, alpha-L-) (eg, mucopolysaccharidosis type I), full gene sequence INF2 (inverted formin, FH2 and WH2 domain containing) (eg, focal segmental glomerulosclerosis), full gene sequence IVD (isovaleryl-CoA dehydrogenase) (eg, isovaleric acidemia), full gene sequence JAG1 (jagged 1) (eg, Alagille syndrome), duplication/deletion analysis JUP (junction plakoglobin) (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy 11), full gene sequence KCNH2 (potassium voltage-gated channel, subfamily H [eag-related], member 2) (eg, short QT syndrome, long QT syndrome), full gene sequence KCNQ1 (potassium voltage-gated channel, KQT-like subfamily, member 1) (eg, short QT syndrome, long QT syndrome), full gene sequence KCNQ2 (potassium voltage-gated channel, KQT-like subfamily, member 2) (eg, epileptic encephalopathy), full gene sequence LDB3 (LIM domain binding 3) (eg, familial dilated cardiomyopathy, myofibrillar myopathy), full gene sequence LDLR (low den
81407Molecular pathology procedure, Level 8 (eg, analysis of 26 50 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of >50 exons, sequence analysis of multiple genes on one platform)
81408Molecular pathology procedure, Level 9 (eg, analysis of >50 exons in a single gene by DNA sequence analysis)
81443Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH)
81448Hereditary peripheral neuropathies (eg, Charcot Marie Tooth, spastic paraplegia), genomic sequence analysis panel, must include sequencing of at least 5 peripheral neuropathy related genes (eg, BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST, SPG11, SPTLC1)
81479Unlisted molecular pathology procedure
81513Infectious disease, bacterial vaginosis, quantitative real time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species, utilizing vaginal fluid specimens, algorithm reported as a positive or negative result for bacterial vaginosis
81514Infectious disease, bacterial vaginosis and vaginitis, quantitative real time amplification of DNA markers for Gardnerella vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial Vaginosis Associated Bacteria 2 (BVAB 2), and Lactobacillus species (L. crispatus and L. jensenii), utilizing vaginal fluid specimens, algorithm reported as a positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and/or Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata, Candida krusei, when reported
81518Oncology (breast), mRNA, gene expression profiling by real time RT PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin fixed paraffin embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy
81519Oncology (breast), mRNA, gene expression profiling by real time RT PCR of 21 genes, utilizing formalin fixed paraffin embedded tissue, algorithm reported as recurrence score
81520Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing formalin fixed paraffin embedded tissue, algorithm reported as a recurrence risk score
81521Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes and 465 housekeeping genes, utilizing fresh frozen or formalin fixed paraffin embedded tissue, algorithm reported as index related to risk of distant metastasis
81522Oncology (breast), mRNA, gene expression profiling by RT PCR of 12 genes (8 content and 4 housekeeping), utilizing formalin fixed paraffin embedded tissue, algorithm reported as recurrence risk score
81541Oncology (prostate), mRNA gene expression profiling by real time RT PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin fixed paraffin embedded tissue, algorithm reported as a disease specific mortality risk score
81542Oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes, utilizing formalin fixed paraffin embedded tissue, algorithm reported as metastasis risk score
81551Oncology (prostate), promoter methylation profiling by real time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin fixed paraffin embedded tissue, algorithm reported as a likelihood of prostate cancer detection on repeat biopsy
81552Oncology (uveal melanoma), mRNA, gene expression profiling by real time RT PCR of 15 genes (12 content and 3 housekeeping), utilizing fine needle aspirate or formalin fixed paraffin embedded tissue, algorithm reported as risk of metastasis
81596Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2 macroglobulin, apolipoprotein A 1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver
82009Ketone body(s) (eg, acetone, acetoacetic acid, beta hydroxybutyrate); qualitative
82010Ketone body(s) (eg, acetone, acetoacetic acid, beta hydroxybutyrate); quantitative
82013Acetylcholinesterase
82016Acylcarnitines; qualitative, each specimen
82017Acylcarnitines; quantitative, each specimen
82024Adrenocorticotropic hormone (ACTH)
82030Adenosine, 5 monophosphate, cyclic (cyclic AMP)
82040Albumin; serum, plasma or whole blood
82042Albumin; other source, quantitative, each specimen
82043Albumin; urine (eg, microalbumin), quantitative
82044Albumin; urine (eg, microalbumin), semiquantitative (eg, reagent strip assay)
82045Albumin; ischemia modified
82075Alcohol (ethanol); breath
82077Alcohol (ethanol); any specimen except urine and breath, immunoassay (eg, IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)
82085Aldolase
82088Aldosterone
82103Alpha 1 antitrypsin; total
82104Alpha 1 antitrypsin; phenotype
82105Alpha fetoprotein (AFP); serum
82106Alpha fetoprotein (AFP); amniotic fluid
82107Alpha fetoprotein (AFP); AFP L3 fraction isoform and total AFP (including ratio)
82108Aluminum
82120Amines, vaginal fluid, qualitative
82127Amino acids; single, qualitative, each specimen
82128Amino acids; multiple, qualitative, each specimen
82131Amino acids; single, quantitative, each specimen
82135Aminolevulinic acid, delta (ALA)
82136Amino acids, 2 to 5 amino acids, quantitative, each specimen
82139Amino acids, 6 or more amino acids, quantitative, each specimen
82140Ammonia
82143Amniotic fluid scan (spectrophotometric)
82150Amylase
82154Androstanediol glucuronide
82157Androstenedione
82160Androsterone
82163Angiotensin II
82164Angiotensin I converting enzyme (ACE)
82172Apolipoprotein, each
82175Arsenic
82180Ascorbic acid (Vitamin C), blood
82190Atomic absorption spectroscopy, each analyte
82232Beta 2 microglobulin
82239Bile acids; total
82240Bile acids; cholylglycine
82247Bilirubin; total
82248Bilirubin; direct
82252Bilirubin; feces, qualitative
82261Biotinidase, each specimen
82270Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)
82271Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources
82272Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1 3 simultaneous determinations, performed for other than colorectal neoplasm screening
82274Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1 3 simultaneous determinations
82286Bradykinin
82300Cadmium
82306Vitamin D; 25 hydroxy, includes fraction(s), if performed
82308Calcitonin
82310Calcium; total
82330Calcium; ionized
82331Calcium; after calcium infusion test
82340Calcium; urine quantitative, timed specimen
82355Calculus; qualitative analysis
82360Calculus; quantitative analysis, chemical
82365Calculus; infrared spectroscopy
82370Calculus; X ray diffraction
82373Carbohydrate deficient transferrin
82374Carbon dioxide (bicarbonate)
82375Carboxyhemoglobin; quantitative
82376Carboxyhemoglobin; qualitative
82378Carcinoembryonic antigen (CEA)
82379Carnitine (total and free), quantitative, each specimen
82380Carotene
82382Catecholamines; total urine
82383Catecholamines; blood
82384Catecholamines; fractionated
82387Cathepsin D
82390Ceruloplasmin
82397Chemiluminescent assay
82415Chloramphenicol
82435Chloride; blood
82436Chloride; urine
82438Chloride; other source
82441Chlorinated hydrocarbons, screen
82465Cholesterol, serum or whole blood, total
82480Cholinesterase; serum
82482Cholinesterase; RBC
82485Chondroitin B sulfate, quantitative
82495Chromium
82507Citrate
82523Collagen cross links, any method
82525Copper
82528Corticosterone
82530Cortisol; free
82533Cortisol; total
82540Creatine
82542Column chromatography, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS MS, GC, GC/MS MS, GC/MS, HPLC/MS), non drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen
82550Creatine kinase (CK), (CPK); total
82552Creatine kinase (CK), (CPK); isoenzymes
82553Creatine kinase (CK), (CPK); MB fraction only
82554Creatine kinase (CK), (CPK); isoforms
82565Creatinine; blood
82570Creatinine; other source
82575Creatinine; clearance
82585Cryofibrinogen
82595Cryoglobulin, qualitative or semi quantitative (eg, cryocrit)
82600Cyanide
82607Cyanocobalamin (Vitamin B 12);
82608Cyanocobalamin (Vitamin B 12); unsaturated binding capacity
82610Cystatin C
82615Cystine and homocystine, urine, qualitative
82626Dehydroepiandrosterone (DHEA)
82627Dehydroepiandrosterone sulfate (DHEA S)
82633Desoxycorticosterone, 11
82634Deoxycortisol, 11
82638Dibucaine number
82642Dihydrotestosterone (DHT)
82652Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed
82656Elastase, pancreatic (EL 1), fecal, qualitative or semi-quantitative
82657Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen
82658Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; radioactive substrate, each specimen
82664Electrophoretic technique, not elsewhere specified
82668Erythropoietin
82670Estradiol; total
82671Estrogens; fractionated
82672Estrogens; total
82677Estriol
82679Estrone
82681Estradiol; free, direct measurement (eg, equilibrium dialysis)
82693Ethylene glycol
82696Etiocholanolone
82705Fat or lipids, feces; qualitative
82710Fat or lipids, feces; quantitative
82715Fat differential, feces, quantitative
82725Fatty acids, nonesterified
82726Very long chain fatty acids
82728Ferritin
82731Fetal fibronectin, cervicovaginal secretions, semi quantitative
82735Fluoride
82746Folic acid; serum
82747Folic acid; RBC
82757Fructose, semen
82759Galactokinase, RBC
82760Galactose
82775Galactose 1 phosphate uridyl transferase; quantitative
82776Galactose 1 phosphate uridyl transferase; screen
82784Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
82785Gammaglobulin (immunoglobulin); IgE
82787Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each
82800Gases, blood, pH only
82803Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);
82805Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry
82810Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry
82820Hemoglobin oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen)
82930Gastric acid analysis, includes pH if performed, each specimen
82938Gastrin after secretin stimulation
82941Gastrin
82943Glucagon
82945Glucose, body fluid, other than blood
82946Glucagon tolerance test
82947Glucose; quantitative, blood (except reagent strip)
82948Glucose; blood, reagent strip
82950Glucose; post glucose dose (includes glucose)
82951Glucose; tolerance test (GTT), 3 specimens (includes glucose)
82952Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure)
82955Glucose 6 phosphate dehydrogenase (G6PD); quantitative
82960Glucose 6 phosphate dehydrogenase (G6PD); screen
82962Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use
82963Glucosidase, beta
82965Glutamate dehydrogenase
82977Glutamyltransferase, gamma (GGT)
82978Glutathione
82979Glutathione reductase, RBC
82985Glycated protein
83001Gonadotropin; follicle stimulating hormone (FSH)
83002Gonadotropin; luteinizing hormone (LH)
83003Growth hormone, human (HGH) (somatotropin)
83009Helicobacter pylori, blood test analysis for urease activity, non radioactive isotope (eg, C 13)
83010Haptoglobin; quantitative
83012Haptoglobin; phenotypes
83013Helicobacter pylori; breath test analysis for urease activity, non radioactive isotope (eg, C 13)
83014Helicobacter pylori; drug administration
83015Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); qualitative, any number of analytes
83018Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); quantitative, each, not elsewhere specified
83020Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)
83021Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F)
83026Hemoglobin; by copper sulfate method, non automated
83030Hemoglobin; F (fetal), chemical
83033Hemoglobin; F (fetal), qualitative
83036Hemoglobin; glycosylated (A1C)
83037Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use
83045Hemoglobin; methemoglobin, qualitative
83050Hemoglobin; methemoglobin, quantitative
83051Hemoglobin; plasma
83060Hemoglobin; sulfhemoglobin, quantitative
83065Hemoglobin; thermolabile
83068Hemoglobin; unstable, screen
83069Hemoglobin; urine
83070Hemosiderin, qualitative
83080b Hexosaminidase, each assay
83088Histamine
83090Homocysteine
83150Homovanillic acid (HVA)
83491Hydroxycorticosteroids, 17 (17 OHCS)
83497Hydroxyindolacetic acid, 5 (HIAA)
83498Hydroxyprogesterone, 17 d
83500Hydroxyproline; free
83505Hydroxyproline; total
83516Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method
83518Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, single step method (eg, reagent strip)
83519Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA)
83520Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified
83525Insulin; total
83527Insulin; free
83528Intrinsic factor
83540Iron
83550Iron binding capacity
83570Isocitric dehydrogenase (IDH)
83582Ketogenic steroids, fractionation
83586Ketosteroids, 17 (17 KS); total
83593Ketosteroids, 17 (17 KS); fractionation
83605Lactate (lactic acid)
83615Lactate dehydrogenase (LD), (LDH);
83625Lactate dehydrogenase (LD), (LDH); isoenzymes, separation and quantitation
83630Lactoferrin, fecal; qualitative
83631Lactoferrin, fecal; quantitative
83632Lactogen, human placental (HPL) human chorionic somatomammotropin
83633Lactose, urine, qualitative
83655Lead
83661Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio
83662Fetal lung maturity assessment; foam stability test
83663Fetal lung maturity assessment; fluorescence polarization
83664Fetal lung maturity assessment; lamellar body density
83670Leucine aminopeptidase (LAP)
83690Lipase
83695Lipoprotein (a)
83698Lipoprotein associated phospholipase A2 (Lp PLA2)
83700Lipoprotein, blood; electrophoretic separation and quantitation
83701Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation)
83704Lipoprotein, blood; quantitation of lipoprotein particle number(s) (eg, by nuclear magnetic resonance spectroscopy), includes lipoprotein particle subclass(es), when performed
83718Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
83719Lipoprotein, direct measurement; VLDL cholesterol
83721Lipoprotein, direct measurement; LDL cholesterol
83722Lipoprotein, direct measurement; small dense LDL cholesterol
83727Luteinizing releasing factor (LRH)
83735Magnesium
83775Malate dehydrogenase
83785Manganese
83789Mass spectrometry and tandem mass spectrometry (eg, MS, MS/MS, MALDI, MS TOF, QTOF), non drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen
83825Mercury, quantitative
83835Metanephrines
83857Methemalbumin
83861Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity
83864Mucopolysaccharides, acid, quantitative
83872Mucin, synovial fluid (Ropes test)
83873Myelin basic protein, cerebrospinal fluid
83874Myoglobin
83876Myeloperoxidase (MPO)
83880Natriuretic peptide
83883Nephelometry, each analyte not elsewhere specified
83885Nickel
83915Nucleotidase 5'
83916Oligoclonal immune (oligoclonal bands)
83918Organic acids; total, quantitative, each specimen
83919Organic acids; qualitative, each specimen
83921Organic acid, single, quantitative
83930Osmolality; blood
83935Osmolality; urine
83937Osteocalcin (bone g1a protein)
83945Oxalate
83950Oncoprotein; HER 2/neu
83951Oncoprotein; des gamma carboxy prothrombin (DCP)
83970Parathormone (parathyroid hormone)
83986pH; body fluid, not otherwise specified
83987pH; exhaled breath condensate
83992Phencyclidine (PCP)
83993Calprotectin, fecal
84030Phenylalanine (PKU), blood
84035Phenylketones, qualitative
84060Phosphatase, acid; total
84066Phosphatase, acid; prostatic
84075Phosphatase, alkaline;
84078Phosphatase, alkaline; heat stable (total not included)
84080Phosphatase, alkaline; isoenzymes
84081Phosphatidylglycerol
84085Phosphogluconate, 6 , dehydrogenase, RBC
84087Phosphohexose isomerase
84100Phosphorus inorganic (phosphate);
84105Phosphorus inorganic (phosphate); urine
84106Porphobilinogen, urine; qualitative
84110Porphobilinogen, urine; quantitative
84112Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (eg, placental alpha microglobulin 1 [PAMG 1], placental protein 12 [PP12], alpha fetoprotein), qualitative, each specimen
84119Porphyrins, urine; qualitative
84120Porphyrins, urine; quantitation and fractionation
84126Porphyrins, feces, quantitative
84132Potassium; serum, plasma or whole blood
84133Potassium; urine
84134Prealbumin
84135Pregnanediol
84138Pregnanetriol
84140Pregnenolone
8414317 hydroxypregnenolone
84144Progesterone
84145Procalcitonin (PCT)
84146Prolactin
84150Prostaglandin, each
84152Prostate specific antigen (PSA); complexed (direct measurement)
84153Prostate specific antigen (PSA); total
84154Prostate specific antigen (PSA); free
84155Protein, total, except by refractometry; serum, plasma or whole blood
84156Protein, total, except by refractometry; urine
84157Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)
84160Protein, total, by refractometry, any source
84163Pregnancy associated plasma protein A (PAPP A)
84165Protein; electrophoretic fractionation and quantitation, serum
84166Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF)
84181Protein; Western Blot, with interpretation and report, blood or other body fluid
84182Protein; Western Blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each
84202Protoporphyrin, RBC; quantitative
84203Protoporphyrin, RBC; screen
84206Proinsulin
84207Pyridoxal phosphate (Vitamin B 6)
84210Pyruvate
84220Pyruvate kinase
84228Quinine
84233Receptor assay; estrogen
84234Receptor assay; progesterone
84235Receptor assay; endocrine, other than estrogen or progesterone (specify hormone)
84238Receptor assay; non endocrine (specify receptor)
84244Renin
84252Riboflavin (Vitamin B 2)
84255Selenium
84260Serotonin
84270Sex hormone binding globulin (SHBG)
84275Sialic acid
84285Silica
84295Sodium; serum, plasma or whole blood
84300Sodium; urine
84302Sodium; other source
84305Somatomedin
84307Somatostatin
84311Spectrophotometry, analyte not elsewhere specified
84315Specific gravity (except urine)
84375Sugars, chromatographic, TLC or paper chromatography
84376Sugars (mono , di , and oligosaccharides); single qualitative, each specimen
84377Sugars (mono , di , and oligosaccharides); multiple qualitative, each specimen
84378Sugars (mono , di , and oligosaccharides); single quantitative, each specimen
84379Sugars (mono , di , and oligosaccharides); multiple quantitative, each specimen
84392Sulfate, urine
84402Testosterone; free
84403Testosterone; total
84425Thiamine (Vitamin B 1)
84430Thiocyanate
84431Thromboxane metabolite(s), including thromboxane if performed, urine
84432Thyroglobulin
84436Thyroxine; total
84437Thyroxine; requiring elution (eg, neonatal)
84439Thyroxine; free
84442Thyroxine binding globulin (TBG)
84443Thyroid stimulating hormone (TSH)
84445Thyroid stimulating immune globulins (TSI)
84446Tocopherol alpha (Vitamin E)
84449Transcortin (cortisol binding globulin)
84450Transferase; aspartate amino (AST) (SGOT)
84460Transferase; alanine amino (ALT) (SGPT)
84466Transferrin
84478Triglycerides
84479Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)
84480Triiodothyronine T3; total (TT 3)
84481Triiodothyronine T3; free
84482Triiodothyronine T3; reverse
84484Troponin, quantitative
84485Trypsin; duodenal fluid
84488Trypsin; feces, qualitative
84490Trypsin; feces, quantitative, 24 hour collection
84510Tyrosine
84512Troponin, qualitative
84520Urea nitrogen; quantitative
84525Urea nitrogen; semiquantitative (eg, reagent strip test)
84540Urea nitrogen, urine
84545Urea nitrogen, clearance
84550Uric acid; blood
84560Uric acid; other source
84577Urobilinogen, feces, quantitative
84578Urobilinogen, urine; qualitative
84580Urobilinogen, urine; quantitative, timed specimen
84583Urobilinogen, urine; semiquantitative
84585Vanillylmandelic acid (VMA), urine
84586Vasoactive intestinal peptide (VIP)
84588Vasopressin (antidiuretic hormone, ADH)
84590Vitamin A
84591Vitamin, not otherwise specified
84597Vitamin K
84600Volatiles (eg, acetic anhydride, diethylether)
84620Xylose absorption test, blood and/or urine
84630Zinc
84681C peptide
84702Gonadotropin, chorionic (hCG); quantitative
84703Gonadotropin, chorionic (hCG); qualitative
84704Gonadotropin, chorionic (hCG); free beta chain
84830Ovulation tests, by visual color comparison methods for human luteinizing hormone
84999Unlisted chemistry procedure
85002Bleeding time
85004Blood count; automated differential WBC count
85007Blood count; blood smear, microscopic examination with manual differential WBC count
85008Blood count; blood smear, microscopic examination without manual differential WBC count
85009Blood count; manual differential WBC count, buffy coat
85013Blood count; spun microhematocrit
85014Blood count; hematocrit (Hct)
85018Blood count; hemoglobin (Hgb)
85025Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
85027Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)
85032Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each
85041Blood count; red blood cell (RBC), automated
85044Blood count; reticulocyte, manual
85045Blood count; reticulocyte, automated
85046Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content [CHr], immature reticulocyte fraction [IRF], reticulocyte volume [MRV], RNA content), direct measurement
85048Blood count; leukocyte (WBC), automated
85049Blood count; platelet, automated
85055Reticulated platelet assay
85130Chromogenic substrate assay
85170Clot retraction
85175Clot lysis time, whole blood dilution
85210Clotting; factor II, prothrombin, specific
85220Clotting; factor V (AcG or proaccelerin), labile factor
85230Clotting; factor VII (proconvertin, stable factor)
85240Clotting; factor VIII (AHG), 1 stage
85244Clotting; factor VIII related antigen
85245Clotting; factor VIII, VW factor, ristocetin cofactor
85246Clotting; factor VIII, VW factor antigen
85247Clotting; factor VIII, von Willebrand factor, multimetric analysis
85250Clotting; factor IX (PTC or Christmas)
85260Clotting; factor X (Stuart Prower)
85270Clotting; factor XI (PTA)
85280Clotting; factor XII (Hageman)
85290Clotting; factor XIII (fibrin stabilizing)
85291Clotting; factor XIII (fibrin stabilizing), screen solubility
85292Clotting; prekallikrein assay (Fletcher factor assay)
85293Clotting; high molecular weight kininogen assay (Fitzgerald factor assay)
85300Clotting inhibitors or anticoagulants; antithrombin III, activity
85301Clotting inhibitors or anticoagulants; antithrombin III, antigen assay
85302Clotting inhibitors or anticoagulants; protein C, antigen
85303Clotting inhibitors or anticoagulants; protein C, activity
85305Clotting inhibitors or anticoagulants; protein S, total
85306Clotting inhibitors or anticoagulants; protein S, free
85307Activated Protein C (APC) resistance assay
85335Factor inhibitor test
85337Thrombomodulin
85345Coagulation time; Lee and White
85347Coagulation time; activated
85348Coagulation time; other methods
85360Euglobulin lysis
85362Fibrin(ogen) degradation (split) products (FDP) (FSP); agglutination slide, semiquantitative
85366Fibrin(ogen) degradation (split) products (FDP) (FSP); paracoagulation
85370Fibrin(ogen) degradation (split) products (FDP) (FSP); quantitative
85378Fibrin degradation products, D dimer; qualitative or semiquantitative
85379Fibrin degradation products, D dimer; quantitative
85380Fibrin degradation products, D dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative
85384Fibrinogen; activity
85385Fibrinogen; antigen
85390Fibrinolysins or coagulopathy screen, interpretation and report
85396Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day
85397Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS 13), each analyte
85400Fibrinolytic factors and inhibitors; plasmin
85410Fibrinolytic factors and inhibitors; alpha 2 antiplasmin
85415Fibrinolytic factors and inhibitors; plasminogen activator
85420Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay
85421Fibrinolytic factors and inhibitors; plasminogen, antigenic assay
85441Heinz bodies; direct
85445Heinz bodies; induced, acetyl phenylhydrazine
85460Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis (Kleihauer Betke)
85461Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; rosette
85475Hemolysin, acid
85520Heparin assay
85525Heparin neutralization
85530Heparin protamine tolerance test
85536Iron stain, peripheral blood
85540Leukocyte alkaline phosphatase with count
85547Mechanical fragility, RBC
85549Muramidase
85555Osmotic fragility, RBC; unincubated
85557Osmotic fragility, RBC; incubated
85576Platelet, aggregation (in vitro), each agent
85597Phospholipid neutralization; platelet
85598Phospholipid neutralization; hexagonal phospholipid
85610Prothrombin time;
85611Prothrombin time; substitution, plasma fractions, each
85612Russell viper venom time (includes venom); undiluted
85613Russell viper venom time (includes venom); diluted
85635Reptilase test
85651Sedimentation rate, erythrocyte; non automated
85652Sedimentation rate, erythrocyte; automated
85660Sickling of RBC, reduction
85670Thrombin time; plasma
85675Thrombin time; titer
85705Thromboplastin inhibition, tissue
85730Thromboplastin time, partial (PTT); plasma or whole blood
85732Thromboplastin time, partial (PTT); substitution, plasma fractions, each
85810Viscosity
85999Unlisted hematology and coagulation procedure
86000Agglutinins, febrile (eg, Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus), each antigen
86001Allergen specific IgG quantitative or semiquantitative, each allergen
86003Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each
86005Allergen specific IgE; qualitative, multiallergen screen (eg, disk, sponge, card)
86008Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each
86021Antibody identification; leukocyte antibodies
86022Antibody identification; platelet antibodies
86023Antibody identification; platelet associated immunoglobulin assay
86038Antinuclear antibodies (ANA);
86039Antinuclear antibodies (ANA); titer
86041Acetylcholine receptor (AChR); binding antibody
86042Acetylcholine receptor (AChR); blocking antibody
86043Acetylcholine receptor (AChR); modulating antibody
86060Antistreptolysin 0; titer
86063Antistreptolysin 0; screen
86140C reactive protein;
86141C reactive protein; high sensitivity (hsCRP)
86146Beta 2 Glycoprotein I antibody, each
86147Cardiolipin (phospholipid) antibody, each Ig class
86148Anti phosphatidylserine (phospholipid) antibody
86155Chemotaxis assay, specify method
86156Cold agglutinin; screen
86157Cold agglutinin; titer
86160Complement; antigen, each component
86161Complement; functional activity, each component
86162Complement; total hemolytic (CH50)
86171Complement fixation tests, each antigen
86200Cyclic citrullinated peptide (CCP), antibody
86215Deoxyribonuclease, antibody
86225Deoxyribonucleic acid (DNA) antibody; native or double stranded
86226Deoxyribonucleic acid (DNA) antibody; single stranded
86235Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS A, SS B, Sm, RNP, Sc170, J01), each antibody
86255Fluorescent noninfectious agent antibody; screen, each antibody
86256Fluorescent noninfectious agent antibody; titer, each antibody
86277Growth hormone, human (HGH), antibody
86280Hemagglutination inhibition test (HAI)
86294Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen)
86300Immunoassay for tumor antigen, quantitative; CA 15 3 (27.29)
86301Immunoassay for tumor antigen, quantitative; CA 19 9
86304Immunoassay for tumor antigen, quantitative; CA 125
86305Human epididymis protein 4 (HE4)
86308Heterophile antibodies; screening
86309Heterophile antibodies; titer
86310Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney
86316Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72 4, 549), each
86317Immunoassay for infectious agent antibody, quantitative, not otherwise specified
86318Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);
86320Immunoelectrophoresis; serum
86325Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration
86327Immunoelectrophoresis; crossed (2 dimensional assay)
86329Immunodiffusion; not elsewhere specified
86331Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody
86332Immune complex assay
86334Immunofixation electrophoresis; serum
86335Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF)
86336Inhibin A
86337Insulin antibodies
86340Intrinsic factor antibodies
86341Islet cell antibody
86343Leukocyte histamine release test (LHR)
86344Leukocyte phagocytosis
86352Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP)
86353Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis
86355B cells, total count
86356Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen
86357Natural killer (NK) cells, total count
86359T cells; total count
86360T cells; absolute CD4 and CD8 count, including ratio
86361T cells; absolute CD4 count
86366Muscle specific kinase (MuSK) antibody
86367Stem cells (ie, CD34), total count
86376Microsomal antibodies (eg, thyroid or liver kidney), each
86382Neutralization test, viral
86384Nitroblue tetrazolium dye test (NTD)
86386Nuclear Matrix Protein 22 (NMP22), qualitative
86403Particle agglutination; screen, each antibody
86406Particle agglutination; titer, each antibody
86430Rheumatoid factor; qualitative
86431Rheumatoid factor; quantitative
86480Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon
86481Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon producing T cells in cell suspension
86485Skin test; candida
86490Skin test; coccidioidomycosis
86510Skin test; histoplasmosis
86580Skin test; tuberculosis, intradermal
86590Streptokinase, antibody
86592Syphilis test, non treponemal antibody; qualitative (eg, VDRL, RPR, ART)
86593Syphilis test, non treponemal antibody; quantitative
86602Antibody; actinomyces
86603Antibody; adenovirus
86606Antibody; Aspergillus
86609Antibody; bacterium, not elsewhere specified
86611Antibody; Bartonella
86612Antibody; Blastomyces
86615Antibody; Bordetella
86617Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot)
86618Antibody; Borrelia burgdorferi (Lyme disease)
86619Antibody; Borrelia (relapsing fever)
86622Antibody; Brucella
86625Antibody; Campylobacter
86628Antibody; Candida
86631Antibody; Chlamydia
86632Antibody; Chlamydia, IgM
86635Antibody; Coccidioides
86638Antibody; Coxiella burnetii (Q fever)
86641Antibody; Cryptococcus
86644Antibody; cytomegalovirus (CMV)
86645Antibody; cytomegalovirus (CMV), IgM
86648Antibody; Diphtheria
86651Antibody; encephalitis, California (La Crosse)
86652Antibody; encephalitis, Eastern equine
86653Antibody; encephalitis, St. Louis
86654Antibody; encephalitis, Western equine
86658Antibody; enterovirus (eg, coxsackie, echo, polio)
86663Antibody; Epstein Barr (EB) virus, early antigen (EA)
86664Antibody; Epstein Barr (EB) virus, nuclear antigen (EBNA)
86665Antibody; Epstein Barr (EB) virus, viral capsid (VCA)
86666Antibody; Ehrlichia
86668Antibody; Francisella tularensis
86671Antibody; fungus, not elsewhere specified
86674Antibody; Giardia lamblia
86677Antibody; Helicobacter pylori
86682Antibody; helminth, not elsewhere specified
86684Antibody; Haemophilus influenza
86687Antibody; HTLV I
86688Antibody; HTLV II
86689Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot)
86692Antibody; hepatitis, delta agent
86694Antibody; herpes simplex, non specific type test
86695Antibody; herpes simplex, type 1
86696Antibody; herpes simplex, type 2
86698Antibody; histoplasma
86701Antibody; HIV 1
86702Antibody; HIV 2
86703Antibody; HIV 1 and HIV 2, single result
86704Hepatitis B core antibody (HBcAb); total
86705Hepatitis B core antibody (HBcAb); IgM antibody
86706Hepatitis B surface antibody (HBsAb)
86707Hepatitis Be antibody (HBeAb)
86708Hepatitis A antibody (HAAb)
86709Hepatitis A antibody (HAAb), IgM antibody
86710Antibody; influenza virus
86713Antibody; Legionella
86717Antibody; Leishmania
86720Antibody; Leptospira
86723Antibody; Listeria monocytogenes
86727Antibody; lymphocytic choriomeningitis
86732Antibody; mucormycosis
86735Antibody; mumps
86738Antibody; mycoplasma
86741Antibody; Neisseria meningitidis
86744Antibody; Nocardia
86747Antibody; parvovirus
86750Antibody; Plasmodium (malaria)
86753Antibody; protozoa, not elsewhere specified
86756Antibody; respiratory syncytial virus
86757Antibody; Rickettsia
86759Antibody; rotavirus
86762Antibody; rubella
86765Antibody; rubeola
86768Antibody; Salmonella
86769Antibody; severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) (Coronavirus disease [COVID 19])
86771Antibody; Shigella
86774Antibody; tetanus
86777Antibody; Toxoplasma
86778Antibody; Toxoplasma, IgM
86780Antibody; Treponema pallidum
86784Antibody; Trichinella
86787Antibody; varicella zoster
86788Antibody; West Nile virus, IgM
86789Antibody; West Nile virus
86790Antibody; virus, not elsewhere specified
86793Antibody; Yersinia
86794Antibody; Zika virus, IgM
86800Thyroglobulin antibody
86803Hepatitis C antibody;
86804Hepatitis C antibody; confirmatory test (eg, immunoblot)
86805Lymphocytotoxicity assay, visual crossmatch; with titration
86806Lymphocytotoxicity assay, visual crossmatch; without titration
86807Serum screening for cytotoxic percent reactive antibody (PRA); standard method
86808Serum screening for cytotoxic percent reactive antibody (PRA); quick method
86812HLA typing; A, B, or C (eg, A10, B7, B27), single antigen
86813HLA typing; A, B, or C, multiple antigens
86816HLA typing; DR/DQ, single antigen
86817HLA typing; DR/DQ, multiple antigens
86821HLA typing; lymphocyte culture, mixed (MLC)
86825Human leukocyte antigen (HLA) crossmatch, non cytotoxic (eg, using flow cytometry); first serum sample or dilution
86826Human leukocyte antigen (HLA) crossmatch, non cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure)
86849Unlisted immunology procedure
86850Antibody screen, RBC, each serum technique
86860Antibody elution (RBC), each elution
86870Antibody identification, RBC antibodies, each panel for each serum technique
86880Antihuman globulin test (Coombs test); direct, each antiserum
86885Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell
86886Antihuman globulin test (Coombs test); indirect, each antibody titer
86890Autologous blood or component, collection processing and storage; predeposited
86891Autologous blood or component, collection processing and storage; intra or postoperative salvage
86900Blood typing, serologic; ABO
86901Blood typing, serologic; Rh (D)
86902Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test
86904Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened
86905Blood typing, serologic; RBC antigens, other than ABO or Rh (D), each
86906Blood typing, serologic; Rh phenotyping, complete
86910Blood typing, for paternity testing, per individual; ABO, Rh and MN
86911Blood typing, for paternity testing, per individual; each additional antigen system
86920Compatibility test each unit; immediate spin technique
86921Compatibility test each unit; incubation technique
86922Compatibility test each unit; antiglobulin technique
86923Compatibility test each unit; electronic
86927Fresh frozen plasma, thawing, each unit
86930Frozen blood, each unit; freezing (includes preparation)
86931Frozen blood, each unit; thawing
86932Frozen blood, each unit; freezing (includes preparation) and thawing
86940Hemolysins and agglutinins; auto, screen, each
86941Hemolysins and agglutinins; incubated
86945Irradiation of blood product, each unit
86950Leukocyte transfusion
86960Volume reduction of blood or blood product (eg, red blood cells or platelets), each unit
86965Pooling of platelets or other blood products
86970Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with chemical agents or drugs, each
86971Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with enzymes, each
86972Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; by density gradient separation
86975Pretreatment of serum for use in RBC antibody identification; incubation with drugs, each
86976Pretreatment of serum for use in RBC antibody identification; by dilution
86977Pretreatment of serum for use in RBC antibody identification; incubation with inhibitors, each
86978Pretreatment of serum for use in RBC antibody identification; by differential red cell absorption using patient RBCs or RBCs of known phenotype, each absorption
86985Splitting of blood or blood products, each unit
86999Unlisted transfusion medicine procedure
87015Concentration (any type), for infectious agents
87040Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)
87045Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species
87046Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate
87070Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates
87071Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool
87073Culture, bacterial; quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool
87075Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates
87076Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate
87077Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate
87081Culture, presumptive, pathogenic organisms, screening only;
87084Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart
87086Culture, bacterial; quantitative colony count, urine
87088Culture, bacterial; with isolation and presumptive identification of each isolate, urine
87101Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail
87102Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)
87103Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood
87106Culture, fungi, definitive identification, each organism; yeast
87107Culture, fungi, definitive identification, each organism; mold
87109Culture, mycoplasma, any source
87110Culture, chlamydia, any source
87116Culture, tubercle or other acid fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates
87118Culture, mycobacterial, definitive identification, each isolate
87140Culture, typing; immunofluorescent method, each antiserum
87143Culture, typing; gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method
87147Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum
87149Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed
87150Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed
87152Culture, typing; identification by pulse field gel typing
87153Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene)
87158Culture, typing; other methods
87164Dark field examination, any source (eg, penile, vaginal, oral, skin); includes specimen collection
87166Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection
87168Macroscopic examination; arthropod
87169Macroscopic examination; parasite
87172Pinworm exam (eg, cellophane tape prep)
87176Homogenization, tissue, for culture
87177Ova and parasites, direct smears, concentration and identification
87181Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)
87184Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)
87185Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme
87186Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi antimicrobial, per plate
87187Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure)
87188Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent
87190Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent
87197Serum bactericidal titer (Schlichter test)
87205Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types
87206Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types
87207Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses)
87209Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites
87210Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)
87220Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)
87230Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile toxin)
87250Virus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection
87252Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect
87253Virus isolation; tissue culture, additional studies or definitive identification (eg, hemabsorption, neutralization, immunofluorescence stain), each isolate
87254Virus isolation; centrifuge enhanced (shell vial) technique, includes identification with immunofluorescence stain, each virus
87255Virus isolation; including identification by non immunologic method, other than by cytopathic effect (eg, virus specific enzymatic activity)
87260Infectious agent antigen detection by immunofluorescent technique; adenovirus
87265Infectious agent antigen detection by immunofluorescent technique; Bordetella pertussis/parapertussis
87267Infectious agent antigen detection by immunofluorescent technique; Enterovirus, direct fluorescent antibody (DFA)
87269Infectious agent antigen detection by immunofluorescent technique; giardia
87270Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis
87271Infectious agent antigen detection by immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody (DFA)
87272Infectious agent antigen detection by immunofluorescent technique; cryptosporidium
87273Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 2
87274Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 1
87275Infectious agent antigen detection by immunofluorescent technique; influenza B virus
87276Infectious agent antigen detection by immunofluorescent technique; influenza A virus
87278Infectious agent antigen detection by immunofluorescent technique; Legionella pneumophila
87279Infectious agent antigen detection by immunofluorescent technique; Parainfluenza virus, each type
87280Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus
87281Infectious agent antigen detection by immunofluorescent technique; Pneumocystis carinii
87283Infectious agent antigen detection by immunofluorescent technique; Rubeola
87285Infectious agent antigen detection by immunofluorescent technique; Treponema pallidum
87290Infectious agent antigen detection by immunofluorescent technique; Varicella zoster virus
87299Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism
87300Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum
87301Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; adenovirus enteric types 40/41
87305Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Aspergillus
87320Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Chlamydia trachomatis
87324Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Clostridium difficile toxin(s)
87327Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple step method; Cryptococcus neoformans
87328Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; cryptosporidium
87329Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; giardia
87332Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; cytomegalovirus
87335Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Escherichia coli 0157
87336Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Entamoeba histolytica dispar group
87337Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Entamoeba histolytica group
87338Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Helicobacter pylori, stool
87339Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Helicobacter pylori
87340Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg)
87341Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) neutralization
87350Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis Be antigen (HBeAg)
87380Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis, delta agent
87385Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Histoplasma capsulatum
87389Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result
87390Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1
87391Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-2
87400Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Influenza, A or B, each
87420Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; respiratory syncytial virus
87425Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; rotavirus
87426Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
87427Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Shiga-like toxin
87428Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B
87430Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Streptococcus, group A
87449Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; not otherwise specified, each organism
87451Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; multiple-step method, polyvalent for multiple organisms, each polyvalent antiserum
87471Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique
87472Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, quantification
87475Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, direct probe technique
87476Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique
87480Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique
87481Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique
87482Infectious agent detection by nucleic acid (DNA or RNA); Candida species, quantification
87483Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (eg, Neisseria meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenzae, E. coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster virus, Cryptococcus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12 25 targets
87485Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, direct probe technique
87486Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique
87487Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, quantification
87490Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique
87491Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique
87493Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique
87495Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, direct probe technique
87496Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique
87497Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification
87498Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, amplified probe technique, includes reverse transcription when performed
87500Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique
87501Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype
87502Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub types
87503Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, each additional influenza virus type or sub type beyond 2 (List separately in addition to code for primary procedure)
87510Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, direct probe technique
87511Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique
87512Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, quantification
87516Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, amplified probe technique
87517Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification
87520Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique
87521Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed
87522Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed
87523Infectious agent detection by nucleic acid (DNA or RNA); hepatitis D (delta), quantification, including reverse transcription, when performed
87525Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, direct probe technique
87526Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, amplified probe technique
87527Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, quantification
87528Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, direct probe technique
87529Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique
87530Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, quantification
87531Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus 6, direct probe technique
87532Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus 6, amplified probe technique
87533Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus 6, quantification
87534Infectious agent detection by nucleic acid (DNA or RNA); HIV 1, direct probe technique
87535Infectious agent detection by nucleic acid (DNA or RNA); HIV 1, amplified probe technique, includes reverse transcription when performed
87536Infectious agent detection by nucleic acid (DNA or RNA); HIV 1, quantification, includes reverse transcription when performed
87537Infectious agent detection by nucleic acid (DNA or RNA); HIV 2, direct probe technique
87538Infectious agent detection by nucleic acid (DNA or RNA); HIV 2, amplified probe technique, includes reverse transcription when performed
87539Infectious agent detection by nucleic acid (DNA or RNA); HIV 2, quantification, includes reverse transcription when performed
87540Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, direct probe technique
87541Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique
87542Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, quantification
87550Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, direct probe technique
87551Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, amplified probe technique
87552Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, quantification
87555Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, direct probe technique
87556Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, amplified probe technique
87557Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, quantification
87560Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium intracellulare, direct probe technique
87561Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium intracellulare, amplified probe technique
87562Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium intracellulare, quantification
87563Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma genitalium, amplified probe technique
87580Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, direct probe technique
87581Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique
87582Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, quantification
87590Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique
87591Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique
87592Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, quantification
87634Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe technique
87635Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
87636Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
87637Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique
87640Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique
87641Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique
87650Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, direct probe technique
87651Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique
87652Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, quantification
87653Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique
87660Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, direct probe technique
87662Infectious agent detection by nucleic acid (DNA or RNA); Zika virus, amplified probe technique
87797Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism
87798Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism
87799Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism
87800Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique
87801Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique
87802Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group B
87803Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Clostridium difficile toxin A
87804Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza
87807Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; respiratory syncytial virus
87808Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Trichomonas vaginalis
87809Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; adenovirus
87810Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Chlamydia trachomatis
87811Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
87850Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Neisseria gonorrhoeae
87880Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A
87899Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified
87900Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics
87901Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV 1, reverse transcriptase and protease regions
87902Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus
87903Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested
87904Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure)
87905Infectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid)
87906Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV 1, other region (eg, integrase, fusion)
87999Unlisted microbiology procedure
88000Necropsy (autopsy), gross examination only; without CNS
88005Necropsy (autopsy), gross examination only; with brain
88007Necropsy (autopsy), gross examination only; with brain and spinal cord
88012Necropsy (autopsy), gross examination only; infant with brain
88014Necropsy (autopsy), gross examination only; stillborn or newborn with brain
88016Necropsy (autopsy), gross examination only; macerated stillborn
88020Necropsy (autopsy), gross and microscopic; without CNS
88025Necropsy (autopsy), gross and microscopic; with brain
88027Necropsy (autopsy), gross and microscopic; with brain and spinal cord
88028Necropsy (autopsy), gross and microscopic; infant with brain
88029Necropsy (autopsy), gross and microscopic; stillborn or newborn with brain
88036Necropsy (autopsy), limited, gross and/or microscopic; regional
88037Necropsy (autopsy), limited, gross and/or microscopic; single organ
88040Necropsy (autopsy); forensic examination
88045Necropsy (autopsy); coroner's call
88099Unlisted necropsy (autopsy) procedure
88104Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation
88106Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation
88108Cytopathology, concentration technique, smears and interpretation (eg, Saccomanno technique)
88112Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal
88125Cytopathology, forensic (eg, sperm)
88130Sex chromatin identification; Barr bodies
88140Sex chromatin identification; peripheral blood smear, polymorphonuclear drumsticks
88141Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician
88142Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision
88143Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision
88147Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision
88148Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision
88150Cytopathology, slides, cervical or vaginal; manual screening under physician supervision
88152Cytopathology, slides, cervical or vaginal; with manual screening and computer assisted rescreening under physician supervision
88153Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision
88155Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code[s] for other technical and interpretation services)
88160Cytopathology, smears, any other source; screening and interpretation
88161Cytopathology, smears, any other source; preparation, screening and interpretation
88162Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains
88164Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision
88165Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision
88166Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer assisted rescreening under physician supervision
88167Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer assisted rescreening using cell selection and review under physician supervision
88174Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
88175Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision
88199Unlisted cytopathology procedure
88230Tissue culture for non neoplastic disorders; lymphocyte
88233Tissue culture for non neoplastic disorders; skin or other solid tissue biopsy
88235Tissue culture for non neoplastic disorders; amniotic fluid or chorionic villus cells
88237Tissue culture for neoplastic disorders; bone marrow, blood cells
88239Tissue culture for neoplastic disorders; solid tumor
88240Cryopreservation, freezing and storage of cells, each cell line
88241Thawing and expansion of frozen cells, each aliquot
88371Protein analysis of tissue by Western Blot, with interpretation and report;
88372Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each
88720Bilirubin, total, transcutaneous
88738Hemoglobin (Hgb), quantitative, transcutaneous
88740Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin
88741Hemoglobin, quantitative, transcutaneous, per day; methemoglobin
89050Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood;
89051Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count
89055Leukocyte assessment, fecal, qualitative or semiquantitative
89060Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)
89125Fat stain, feces, urine, or respiratory secretions
89160Meat fibers, feces
89190Nasal smear for eosinophils
89220Sputum, obtaining specimen, aerosol induced technique (separate procedure)
89230Sweat collection by iontophoresis
89250Culture of oocyte(s)/embryo(s), less than 4 days;
89251Culture of oocyte(s)/embryo(s), less than 4 days; with co culture of oocyte(s)/embryos
89253Assisted embryo hatching, microtechniques (any method)
89254Oocyte identification from follicular fluid
89255Preparation of embryo for transfer (any method)
89257Sperm identification from aspiration (other than seminal fluid)
89258Cryopreservation; embryo(s)
89259Cryopreservation; sperm
89260Sperm isolation; simple prep (eg, sperm wash and swim up) for insemination or diagnosis with semen analysis
89261Sperm isolation; complex prep (eg, Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis
89264Sperm identification from testis tissue, fresh or cryopreserved
89268Insemination of oocytes
89272Extended culture of oocyte(s)/embryo(s), 4 7 days
89280Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes
89281Assisted oocyte fertilization, microtechnique; greater than 10 oocytes
89300Semen analysis; presence and/or motility of sperm including Huhner test (post coital)
89310Semen analysis; motility and count (not including Huhner test)
89320Semen analysis; volume, count, motility, and differential
89321Semen analysis; sperm presence and motility of sperm, if performed
89322Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, Kruger)
89325Sperm antibodies
89329Sperm evaluation; hamster penetration test
89330Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test
89331Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated)
89335Cryopreservation, reproductive tissue, testicular
89352Thawing of cryopreserved; embryo(s)
89353Thawing of cryopreserved; sperm/semen, each aliquot
89354Thawing of cryopreserved; reproductive tissue, testicular/ovarian
89356Thawing of cryopreserved; oocytes, each aliquot
90377Rabies immune globulin, heat and solvent/detergent treated (RIg HT S/D), human, for intramuscular and/or subcutaneous use
90399Unlisted immune globulin
90460Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
90461Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)
90471Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90472Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
90473Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
90474Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
90476Adenovirus vaccine, type 4, live, for oral use
90480Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, single dose
90587Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use
90589Chikungunya virus vaccine, live attenuated, for intramuscular use
90619Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY TT), for intramuscular use
90623Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y tetanus toxoid carrier, and Men B FHbp, for intramuscular use
90625Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use
90626Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use
90627Tick-borne encephalitis virus vaccine, inactivated; 0.5 mL dosage, for intramuscular use
90630Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
90632Hepatitis A vaccine (HepA), adult dosage, for intramuscular use
90633Hepatitis A vaccine (HepA), pediatric/adolescent dosage 2 dose schedule, for intramuscular use
90634Hepatitis A vaccine (HepA), pediatric/adolescent dosage 3 dose schedule, for intramuscular use
90636Hepatitis A and hepatitis B vaccine (HepA HepB), adult dosage, for intramuscular use
90644Meningococcal conjugate vaccine, serogroups C & Y and Haemophilus influenzae type b vaccine (Hib MenCY), 4 dose schedule, when administered to children 6 weeks 18 months of age, for intramuscular use
90647Haemophilus influenzae type b vaccine (Hib), PRP OMP conjugate, 3 dose schedule, for intramuscular use
90648Haemophilus influenzae type b vaccine (Hib), PRP T conjugate, 4 dose schedule, for intramuscular use
90649Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use
90650Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use
90654Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for intradermal use
90655Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90656Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90657Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use
90658Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
90660Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use
90661Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90662Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90664Influenza virus vaccine, live (LAIV), pandemic formulation, for intranasal use
90666Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use
90667Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use
90668Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use
90670Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
90671Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use
90672Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90673Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90674Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90677Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use
90679Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use
90680Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use
90681Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use
90682Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90685Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90686Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90687Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
90688Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
90689Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use
90690Typhoid vaccine, live, oral
90691Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use
90694Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use
90696Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP IPV), when administered to children 4 through 6 years of age, for intramuscular use
90697Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP OMP conjugate vaccine, and hepatitis B vaccine (DTaP IPV Hib HepB), for intramuscular use
90698Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP IPV/Hib), for intramuscular use
90700Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use
90702Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use
90707Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
90710Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use
90713Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use
90714Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use
90715Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use
90716Varicella virus vaccine (VAR), live, for subcutaneous use
90717Yellow fever vaccine, live, for subcutaneous use
90723Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP HepB IPV), for intramuscular use
90732Pneumococcal polysaccharide vaccine, 23 valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
90733Meningococcal polysaccharide vaccine, serogroups A, C, Y, W 135, quadrivalent (MPSV4), for subcutaneous use
90734Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY D) or CRM197 carrier (MenACWY CRM), for intramuscular use
90736Zoster (shingles) vaccine (HZV), live, for subcutaneous injection
90738Japanese encephalitis virus vaccine, inactivated, for intramuscular use
90740Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use
90743Hepatitis B vaccine (HepB), adolescent, 2 dose schedule, for intramuscular use
90744Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use
90746Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use
90747Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule, for intramuscular use
90748Hepatitis B and Haemophilus influenzae type b vaccine (Hib HepB), for intramuscular use
90749Unlisted vaccine/toxoid
90750Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use
90756Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
90758Zaire ebolavirus vaccine, live, for intramuscular use
90785Interactive complexity (List separately in addition to the code for primary procedure)
90791Psychiatric diagnostic evaluation
90792Psychiatric diagnostic evaluation with medical services
90832Psychotherapy, 30 minutes with patient
90833Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90834Psychotherapy, 45 minutes with patient
90836Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90837Psychotherapy, 60 minutes with patient
90838Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90839Psychotherapy for crisis; first 60 minutes
90840Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service)
90853Group psychotherapy (other than of a multiple family group)
90863Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure)
91200Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report
91303Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use
91304Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use
91318Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use
91319Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use
91320Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use
91321Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use
91322Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use
92071Fitting of contact lens for treatment of ocular surface disease
92072Fitting of contact lens for management of keratoconus, initial fitting
92132Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
92133Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
92134Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina
92537Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)
92538Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations)
92540Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording
92558Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis
92618Evaluation for prescription of non speech generating augmentative and alternative communication device, face to face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure)
93005Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report
93981Duplex scan of arterial inflow and venous outflow of penile vessels; follow up or limited study
93990Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow)
93998Unlisted noninvasive vascular diagnostic study
94011Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age
94012Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age
94013Measurement of lung volumes (ie, functional residual capacity [FRC], forced vital capacity [FVC], and expiratory reserve volume [ERV]) in an infant or child through 2 years of age
94150Vital capacity, total (separate procedure)
94375Respiratory flow volume loop
94640Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device
94642Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis
94664Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device
94667Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation
94668Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent
94726Plethysmography for determination of lung volumes and, when performed, airway resistance
94727Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes
94728Airway resistance by oscillometry
94729Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure)
94760Noninvasive ear or pulse oximetry for oxygen saturation; single determination
94761Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)
94780Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes
94781Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; each additional full 30 minutes (List separately in addition to code for primary procedure)
95004Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
95024Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
95027Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests
95028Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests
95044Patch or application test(s) (specify number of tests)
95052Photo patch test(s) (specify number of tests)
95056Photo tests
95070Inhalation bronchial challenge testing (not including necessary pulmonary function tests), with histamine, methacholine, or similar compounds
95115Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection
95117Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections
95905Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F wave study when performed, with interpretation and report
95938Short latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs
95939Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs
96127Brief emotional/behavioral assessment (eg, depression inventory, attention deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
96156Health behavior assessment, or re assessment (ie, health focused clinical interview, behavioral observations, clinical decision making)
96158Health behavior intervention, individual, face to face; initial 30 minutes
96159Health behavior intervention, individual, face to face; each additional 15 minutes (List separately in addition to code for primary service)
96360Intravenous infusion, hydration; initial, 31 minutes to 1 hour
96361Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)
96365Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
96367Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)
96368Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)
96369Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set up and establishment of subcutaneous infusion site(s)
96370Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
96371Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure)
96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
96374Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
96375Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)
96376Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)
96379Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra arterial injection or infusion
96401Chemotherapy administration, subcutaneous or intramuscular; non hormonal anti neoplastic
96402Chemotherapy administration, subcutaneous or intramuscular; hormonal anti neoplastic
96405Chemotherapy administration; intralesional, up to and including 7 lesions
96406Chemotherapy administration; intralesional, more than 7 lesions
96409Chemotherapy administration; intravenous, push technique, single or initial substance/drug
96411Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)
96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
96416Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump
96417Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)
96446Chemotherapy administration into the peritoneal cavity via indwelling port or catheter
96521Refilling and maintenance of portable pump
96523Irrigation of implanted venous access device for drug delivery systems
97597Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less
97598Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
97602Removal of devitalized tissue from wound(s), non selective debridement, without anesthesia (eg, wet to moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session
97605Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters
97606Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters
98960Education and training for patient self management by a qualified, nonphysician health care professional using a standardized curriculum, face to face with the patient (could include caregiver/family) each 30 minutes; individual patient
98961Education and training for patient self management by a qualified, nonphysician health care professional using a standardized curriculum, face to face with the patient (could include caregiver/family) each 30 minutes; 2 4 patients
98962Education and training for patient self management by a qualified, nonphysician health care professional using a standardized curriculum, face to face with the patient (could include caregiver/family) each 30 minutes; 5 8 patients
98966Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5 10 minutes of medical discussion
98967Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11 20 minutes of medical discussion
98968Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21 30 minutes of medical discussion
99000Handling and/or conveyance of specimen for transfer from the office to a laboratory
99001Handling and/or conveyance of specimen for transfer from the patient in other than an office to a laboratory (distance may be indicated)
99173Screening test of visual acuity, quantitative, bilateral
99175Ipecac or similar administration for individual emesis and continued observation until stomach adequately emptied of poison
99202Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.
99203Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
99204Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.
99205Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.
99211Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.
99212Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.
99213Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
99214Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.
99215Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.
99224Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit.
99225Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
99281Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
99282Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
99283Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
99304Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
99305Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
99307Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
99308Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
99315Nursing facility discharge management; 30 minutes or less total time on the date of the encounter
99316Nursing facility discharge management; more than 30 minutes total time on the date of the encounter
99334Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver.
99335Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver.
99341Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
99342Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
99343Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face to face with the patient and/or family.
99347Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
99348Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
99349Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
99354Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215])
99355Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; each additional 30 minutes (List separately in addition to code for prolonged service)
99381Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)
99382Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years)
99383Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years)
99384Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years)
99385Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18 39 years
99386Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40 64 years
99387Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
99391Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)
99392Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)
99393Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years)
99394Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)
99395Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18 39 years
99396Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40 64 years
99397Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
99401Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
99402Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
99403Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
99404Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
99406Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
99408Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes
99411Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes
99412Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes
99415Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
99416Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service)
99453Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set up and patient education on use of equipment
99454Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
99457Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
99458Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure)
99459Pelvic examination (List separately in addition to code for primary procedure)
99460Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant
99461Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center
99462Subsequent hospital care, per day, for evaluation and management of normal newborn
99463Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date
99465Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output
99492Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies.
99493Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.
99494Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure)
99495Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge. At least moderate level of medical decision making during the service period. Face-to-face visit, within 14 calendar days of discharge
99496Transitional care management services with the following requiredelements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge. High level of medical decision making during the service period. Face-to-face visit, within 7 calendar days of discharge
99497Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face to face with the patient, family member(s), and/or surrogate
99498Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)
99503Home visit for respiratory therapy care (eg, bronchodilator, oxygen therapy, respiratory assessment, apnea evaluation)
99504Home visit for mechanical ventilation care
99505Home visit for stoma care and maintenance including colostomy and cystostomy
99506Home visit for intramuscular injections
99507Home visit for care and maintenance of catheter(s) (eg, urinary, drainage, and enteral)
99509Home visit for assistance with activities of daily living and personal care
99510Home visit for individual, family, or marriage counseling
99511Home visit for fecal impaction management and enema administration
99512Home visit for hemodialysis
99601Home infusion/specialty drug administration, per visit (up to 2 hours);
99602Home infusion/specialty drug administration, per visit (up to 2 hours); each additional hour (List separately in addition to code for primary procedure)
G0008Administration of influenza virus vaccine
G0009Administration of pneumococcal vaccine
G0010Administration of hepatitis b vaccine
G0017Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes
G0018Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)
G0027Semen analysis; presence and/or motility of sperm excluding huhner
G0068Professional services for the administration of anti infective, pain management, chelation, pulmonary hypertension, and/or inotropic infusion drug(s) for each infusion drug administration calendar day in the individual's home, each 15 minutes
G0069Professional services for the administration of subcutaneous immunotherapy for each infusion drug administration calendar day in the individual's home, each 15 minutes
G0070Professional services for the administration of chemotherapy for each infusion drug administration calendar day in the individual's home, each 15 minutes
G0071Payment for communication technology based services for 5 minutes or more of a virtual (non face to face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only
G0076Brief (20 minutes) care management home visit for a new patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0077Limited (30 minutes) care management home visit for a new patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0078Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0079Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0080Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0081Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0082Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0083Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0084Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0085Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0086Limited (30 minutes) care management home care plan oversight. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0087Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
G0101Cervical or vaginal cancer screening; pelvic and clinical breast examination
G0102Prostate cancer screening; digital rectal examination
G0103Prostate cancer screening; prostate specific antigen test (psa)
G0108Diabetes outpatient self management training services, individual, per 30 minutes
G0109Diabetes outpatient self management training services, group session (2 or more), per 30 minutes
G0123Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
G0127Trimming of dystrophic nails, any number
G0143Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision
G0144Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision
G0145Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision
G0147Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
G0148Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
G0168Wound closure utilizing tissue adhesive(s) only
G0239Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)
G0245Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education
G0246Follow up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education
G0247Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
G0248Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face to face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results
G0250Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests
G0268Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing
G0270Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes
G0271Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
G0296Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)
G0306Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count
G0307Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)
G0328Colorectal cancer screening; fecal occult blood test, immunoassay, 1 3 simultaneous
G0402Initial preventive physical examination; face to face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
G0404Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
G0420Face to face educational services related to the care of chronic kidney disease; individual, per session, per one hour
G0421Face to face educational services related to the care of chronic kidney disease; group, per session, per one hour
G0422Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session
G0423Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session
G0424Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
G0432Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv 1 and/or hiv 2, screening
G0433Infectious agent antibody detection by enzyme linked immunosorbent assay (elisa) technique, hiv 1 and/or hiv 2, screening
G0435Infectious agent antibody detection by rapid antibody test, hiv 1 and/or hiv 2, screening
G0438Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G0442Annual alcohol misuse screening, 5 to 15 minutes
G0443Brief face to face behavioral counseling for alcohol misuse, 15 minutes
G0444Annual depression screening, 5 to 15 minutes
G0445High intensity behavioral counseling to prevent sexually transmitted infection; face to face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi annually, 30 minutes
G0446Annual, face to face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
G0447Face to face behavioral counseling for obesity, 15 minutes
G0452Molecular pathology procedure; physician interpretation and report
G0472Hepatitis c antibody screening, for individual at high risk and other covered indication(s)
G0473Face to face behavioral counseling for obesity, group (2 10), 30 minutes
G0475Hiv antigen/antibody, combination assay, screening
G0476Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test
G8482Influenza immunization administered or previously received
G8483Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
G8484Influenza immunization was not administered, reason not given
J0120Injection, tetracycline, up to 250 mg
J0129Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J0130Injection abciximab, 10 mg
J0131Injection, acetaminophen, not otherwise specified,10 mg
J0132Injection, acetylcysteine, 100 mg
J0133Injection, acyclovir, 5 mg
J0134Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to j0131, 10 mg
J0135Injection, adalimumab, 20 mg
J0136Injection, acetaminophen (b braun) not therapeutically equivalent to j0131, 10 mg
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)
J0171Injection, adrenalin, epinephrine, 0.1 mg
J0173Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg
J0180Injection, agalsidase beta, 1 mg
J0190Injection, biperiden lactate, per 5 mg
J0200Injection, alatrofloxacin mesylate, 100 mg
J0202Injection, alemtuzumab, 1 mg
J0205Injection, alglucerase, per 10 units
J0207Injection, amifostine, 500 mg
J0210Injection, methyldopate hcl, up to 250 mg
J0215Injection, alefacept, 0.5 mg
J0220Injection, alglucosidase alfa, 10 mg, not otherwise specified
J0221Injection, alglucosidase alfa, (lumizyme), 10 mg
J0223Injection, givosiran, 0.5 mg
J0224Injection, lumasiran, 0.5 mg
J0256Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg
J0257Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg
J0270Injection, alprostadil, 1.25 mcg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J0275Alprostadil urethral suppository (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J0278Injection, amikacin sulfate, 100 mg
J0280Injection, aminophyllin, up to 250 mg
J0282Injection, amiodarone hydrochloride, 30 mg
J0283Injection, amiodarone hydrochloride (nexterone), 30 mg
J0285Injection, amphotericin b, 50 mg
J0287Injection, amphotericin b lipid complex, 10 mg
J0288Injection, amphotericin b cholesteryl sulfate complex, 10 mg
J0289Injection, amphotericin b liposome, 10 mg
J0290Injection, ampicillin sodium, 500 mg
J0295Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm
J0300Injection, amobarbital, up to 125 mg
J0330Injection, succinylcholine chloride, up to 20 mg
J0348Injection, anidulafungin, 1 mg
J0350Injection, anistreplase, per 30 units
J0360Injection, hydralazine hcl, up to 20 mg
J0364Injection, apomorphine hydrochloride, 1 mg
J0365Injection, aprotonin, 10,000 kiu
J0380Injection, metaraminol bitartrate, per 10 mg
J0390Injection, chloroquine hydrochloride, up to 250 mg
J0395Injection, arbutamine hcl, 1 mg
J0400Injection, aripiprazole, intramuscular, 0.25 mg
J0456Injection, azithromycin, 500 mg
J0461Injection, atropine sulfate, 0.01 mg
J0470Injection, dimercaprol, per 100 mg
J0475Injection, baclofen, 10 mg
J0476Injection, baclofen, 50 mcg for intrathecal trial
J0480Injection, basiliximab, 20 mg
J0490Injection, belimumab, 10 mg
J0500Injection, dicyclomine hcl, up to 20 mg
J0515Injection, benztropine mesylate, per 1 mg
J0520Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg
J0558Injection, penicillin g benzathine and penicillin g procaine, 100,000 units
J0561Injection, penicillin g benzathine, 100,000 units
J0583Injection, bivalirudin, 1 mg
J0585Injection, onabotulinumtoxina, 1 unit
J0586Injection, abobotulinumtoxina, 5 units
J0587Injection, rimabotulinumtoxinb, 100 units
J0588Injection, incobotulinumtoxin a, 1 unit
J0592Injection, buprenorphine hydrochloride, 0.1 mg
J0594injection, busulfan, 1 mg
J0595Injection, butorphanol tartrate, 1 mg
J0596Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units
J0597Injection, c 1 esterase inhibitor (human), berinert, 10 units
J0598Injection, c 1 esterase inhibitor (human), cinryze, 10 units
J0600Injection, edetate calcium disodium, up to 1000 mg
J0610Injection, calcium gluconate (fresenius kabi), per 10 ml
J0611Injection, calcium gluconate (wg critical care), per 10 ml
J0620Injection, calcium glycerophosphate and calcium lactate, per 10 ml
J0630Injection, calcitonin salmon, up to 400 units
J0636Injection, calcitriol, 0.1 mcg
J0637Injection, caspofungin acetate, 5 mg
J0638Injection, canakinumab, 1 mg
J0640Injection, leucovorin calcium, per 50 mg
J0641Injection, levoleucovorin, not otherwise specified, 0.5 mg
J0670Injection, mepivacaine hydrochloride, per 10 ml
J0689Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg
J0690Injection, cefazolin sodium, 500 mg
J0691Injection, lefamulin, 1 mg
J0692Injection, cefepime hydrochloride, 500 mg
J0694Injection, cefoxitin sodium, 1 gm
J0695Injection, ceftolozane 50 mg and tazobactam 25 mg
J0696Injection, ceftriaxone sodium, per 250 mg
J0697Injection, sterile cefuroxime sodium, per 750 mg
J0698Injection, cefotaxime sodium, per gm
J0701Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
J0702Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg
J0703Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
J0706Injection, caffeine citrate, 5 mg
J0710Injection, cephapirin sodium, up to 1 gm
J0712Injection, ceftaroline fosamil, 10 mg
J0713Injection, ceftazidime, per 500 mg
J0714Injection, ceftazidime and avibactam, 0.5 g/0.125 g
J0715Injection, ceftizoxime sodium, per 500 mg
J0717Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J0720Injection, chloramphenicol sodium succinate, up to 1 gm
J0725Injection, chorionic gonadotropin, per 1,000 usp units
J0735Injection, clonidine hydrochloride, 1 mg
J0740Injection, cidofovir, 375 mg
J0742Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg
J0743Injection, cilastatin sodium; imipenem, per 250 mg
J0744Injection, ciprofloxacin for intravenous infusion, 200 mg
J0745Injection, codeine phosphate, per 30 mg
J0770Injection, colistimethate sodium, up to 150 mg
J0775Injection, collagenase, clostridium histolyticum, 0.01 mg
J0780Injection, prochlorperazine, up to 10 mg
J0791Injection, crizanlizumab tmca, 5 mg
J0795Injection, corticorelin ovine triflutate, 1 microgram
J0800Injection, corticotropin, up to 40 units
J0834Injection, cosyntropin, 0.25 mg
J0840Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram
J0850Injection, cytomegalovirus immune globulin intravenous (human), per vial
J0875Injection, dalbavancin, 5 mg
J0877Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg
J0878Injection, daptomycin, 1 mg
J0881Injection, darbepoetin alfa, 1 microgram (non esrd use)
J0882Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)
J0885Injection, epoetin alfa, (for non esrd use), 1000 units
J0887Injection, epoetin beta, 1 microgram, (for esrd on dialysis)
J0888Injection, epoetin beta, 1 microgram, (for non esrd use)
J0891Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
J0892Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
J0893Injection, decitabine (sun pharma) not therapeutically equivalent to j0894, 1 mg
J0894Injection, decitabine, 1 mg
J0895Injection, deferoxamine mesylate, 500 mg
J0896Injection, luspatercept aamt, 0.25 mg
J0897Injection, denosumab, 1 mg
J0898Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
J0899Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
J0945Injection, brompheniramine maleate, per 10 mg
J1000Injection, depo estradiol cypionate, up to 5 mg
J1020Injection, methylprednisolone acetate, 20 mg
J1030Injection, methylprednisolone acetate, 40 mg
J1040Injection, methylprednisolone acetate, 80 mg
J1050Injection, medroxyprogesterone acetate, 1 mg
J1071Injection, testosterone cypionate, 1 mg
J1094Injection, dexamethasone acetate, 1 mg
J1100Injection, dexamethasone sodium phosphate, 1 mg
J1110Injection, dihydroergotamine mesylate, per 1 mg
J1120Injection, acetazolamide sodium, up to 500 mg
J1160Injection, digoxin, up to 0.5 mg
J1162Injection, digoxin immune fab (ovine), per vial
J1165Injection, phenytoin sodium, per 50 mg
J1170Injection, hydromorphone, up to 4 mg
J1180Injection, dyphylline, up to 500 mg
J1190Injection, dexrazoxane hydrochloride, per 250 mg
J1200Injection, diphenhydramine hcl, up to 50 mg
J1201Injection, cetirizine hydrochloride, 0.5 mg
J1205Injection, chlorothiazide sodium, per 500 mg
J1212Injection, dmso, dimethyl sulfoxide, 50%, 50 ml
J1230Injection, methadone hcl, up to 10 mg
J1240Injection, dimenhydrinate, up to 50 mg
J1245Injection, dipyridamole, per 10 mg
J1250Injection, dobutamine hydrochloride, per 250 mg
J1260Injection, dolasetron mesylate, 10 mg
J1265Injection, dopamine hcl, 40 mg
J1267Injection, doripenem, 10 mg
J1270Injection, doxercalciferol, 1 mcg
J1290Injection, ecallantide, 1 mg
J1300Injection, eculizumab, 10 mg
J1320Injection, amitriptyline hcl, up to 20 mg
J1324Injection, enfuvirtide, 1 mg
J1325Injection, epoprostenol, 0.5 mg
J1327Injection, eptifibatide, 5 mg
J1330Injection, ergonovine maleate, up to 0.2 mg
J1335Injection, ertapenem sodium, 500 mg
J1364Injection, erythromycin lactobionate, per 500 mg
J1380Injection, estradiol valerate, up to 10 mg
J1410Injection, estrogen conjugated, per 25 mg
J1428Injection, eteplirsen, 10 mg
J1430Injection, ethanolamine oleate, 100 mg
J1435Injection, estrone, per 1 mg
J1436Injection, etidronate disodium, per 300 mg
J1438Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J1443Injection, ferric pyrophosphate citrate solution (triferic), 0.1 mg of iron
J1444Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron
J1447Injection, tbo filgrastim, 1 microgram
J1450Injection fluconazole, 200 mg
J1451Injection, fomepizole, 15 mg
J1452Injection, fomivirsen sodium, intraocular, 1.65 mg
J1453Injection, fosaprepitant, 1 mg
J1455Injection, foscarnet sodium, per 1000 mg
J1456Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg
J1457Injection, gallium nitrate, 1 mg
J1458Injection, galsulfase, 1 mg
J1459Injection, immune globulin (privigen), intravenous, non lyophilized (e.g., liquid), 500 mg
J1460Injection, gamma globulin, intramuscular, 1 cc
J1554Injection, immune globulin (asceniv), 500 mg
J1555Injection, immune globulin (cuvitru), 100 mg
J1557Injection, immune globulin, (gammaplex), intravenous, non lyophilized (e.g., liquid), 500 mg
J1558Injection, immune globulin (xembify), 100 mg
J1559Injection, immune globulin (hizentra), 100 mg
J1560Injection, gamma globulin, intramuscular, over 10 cc
J1561Injection, immune globulin, (gamunex c/gammaked), non lyophilized (e.g., liquid), 500 mg
J1562Injection, immune globulin (vivaglobin), 100 mg
J1566Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg
J1568Injection, immune globulin, (octagam), intravenous, non lyophilized (e.g., liquid), 500 mg
J1569Injection, immune globulin, (gammagard liquid), non lyophilized, (e.g., liquid), 500 mg
J1570Injection, ganciclovir sodium, 500 mg
J1571Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml
J1572Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non lyophilized (e.g., liquid), 500 mg
J1573Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml
J1574Injection, ganciclovir sodium (exela) not therapeutically equivalent to j1570, 500 mg
J1575Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
J1580Injection, garamycin, gentamicin, up to 80 mg
J1595Injection, glatiramer acetate, 20 mg
J1599Injection, immune globulin, intravenous, non lyophilized (e.g., liquid), not otherwise specified, 500 mg
J1600Injection, gold sodium thiomalate, up to 50 mg
J1610Injection, glucagon hydrochloride, per 1 mg
J1611Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg
J1620Injection, gonadorelin hydrochloride, per 100 mcg
J1626Injection, granisetron hydrochloride, 100 mcg
J1627Injection, granisetron, extended release, 0.1 mg
J1630Injection, haloperidol, up to 5 mg
J1631Injection, haloperidol decanoate, per 50 mg
J1640Injection, hemin, 1 mg
J1642Injection, heparin sodium, (heparin lock flush), per 10 units
J1643Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
J1644Injection, heparin sodium, per 1000 units
J1645Injection, dalteparin sodium, per 2500 iu
J1650Injection, enoxaparin sodium, 10 mg
J1652Injection, fondaparinux sodium, 0.5 mg
J1655Injection, tinzaparin sodium, 1000 iu
J1670Injection, tetanus immune globulin, human, up to 250 units
J1675Injection, histrelin acetate, 10 micrograms
J1700Injection, hydrocortisone acetate, up to 25 mg
J1710Injection, hydrocortisone sodium phosphate, up to 50 mg
J1720Injection, hydrocortisone sodium succinate, up to 100 mg
J1726Injection, hydroxyprogesterone caproate, (makena), 10 mg
J1729Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
J1730Injection, diazoxide, up to 300 mg
J1740Injection, ibandronate sodium, 1 mg
J1741Injection, ibuprofen, 100 mg
J1742Injection, ibutilide fumarate, 1 mg
J1743Injection, idursulfase, 1 mg
J1745Injection, infliximab, excludes biosimilar, 10 mg
J1750Injection, iron dextran, 50 mg
J1756Injection, iron sucrose, 1 mg
J1786Injection, imiglucerase, 10 units
J1790Injection, droperidol, up to 5 mg
J1800Injection, propranolol hcl, up to 1 mg
J1810Injection, droperidol and fentanyl citrate, up to 2 ml ampule
J1815Injection, insulin, per 5 units
J1826Injection, interferon beta 1a, 30 mcg
J1830Injection, interferon beta 1b, 0.25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J1833Injection, isavuconazonium, 1 mg
J1835Injection, itraconazole, 50 mg
J1840Injection, kanamycin sulfate, up to 500 mg
J1850Injection, kanamycin sulfate, up to 75 mg
J1885Injection, ketorolac tromethamine, per 15 mg
J1890Injection, cephalothin sodium, up to 1 gram
J1930Injection, lanreotide, 1 mg
J1931Injection, laronidase, 0.1 mg
J1940Injection, furosemide, up to 20 mg
J1945Injection, lepirudin, 50 mg
J1950Injection, leuprolide acetate (for depot suspension), per 3.75 mg
J1951Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg
J1953Injection, levetiracetam, 10 mg
J1955Injection, levocarnitine, per 1 gm
J1956Injection, levofloxacin, 250 mg
J1960Injection, levorphanol tartrate, up to 2 mg
J1980Injection, hyoscyamine sulfate, up to 0.25 mg
J1990Injection, chlordiazepoxide hcl, up to 100 mg
J2001Injection, lidocaine hcl for intravenous infusion, 10 mg
J2010Injection, lincomycin hcl, up to 300 mg
J2020Injection, linezolid, 200 mg
J2021Injection, linezolid (hospira) not therapeutically equivalent to j2020, 200 mg
J2060Injection, lorazepam, 2 mg
J2150Injection, mannitol, 25% in 50 ml
J2170Injection, mecasermin, 1 mg
J2175Injection, meperidine hydrochloride, per 100 mg
J2180Injection, meperidine and promethazine hcl, up to 50 mg
J2184Injection, meropenem (b. braun) not therapeutically equivalent to j2185, 100 mg
J2185Injection, meropenem, 100 mg
J2210Injection, methylergonovine maleate, up to 0.2 mg
J2247Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg
J2248Injection, micafungin sodium, 1 mg
J2250Injection, midazolam hydrochloride, per 1 mg
J2251Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to j2250, per 1 mg
J2260Injection, milrinone lactate, 5 mg
J2265Injection, minocycline hydrochloride, 1 mg
J2270Injection, morphine sulfate, up to 10 mg
J2272Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to j2270, up to 10 mg
J2274Injection, morphine sulfate, preservative free for epidural or intrathecal use, 10 mg
J2278Injection, ziconotide, 1 microgram
J2280Injection, moxifloxacin, 100 mg
J2281Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to j2280, 100 mg
J2300Injection, nalbuphine hydrochloride, per 10 mg
J2310Injection, naloxone hydrochloride, per 1 mg
J2311Injection, naloxone hydrochloride (zimhi), 1 mg
J2315Injection, naltrexone, depot form, 1 mg
J2320Injection, nandrolone decanoate, up to 50 mg
J2323Injection, natalizumab, 1 mg
J2325Injection, nesiritide, 0.1 mg
J2326Injection, nusinersen, 0.1 mg
J2350Injection, ocrelizumab, 1 mg
J2353Injection, octreotide, depot form for intramuscular injection, 1 mg
J2354Injection, octreotide, non depot form for subcutaneous or intravenous injection, 25 mcg
J2355Injection, oprelvekin, 5 mg
J2357Injection, omalizumab, 5 mg
J2358Injection, olanzapine, long acting, 1 mg
J2360Injection, orphenadrine citrate, up to 60 mg
J2370Injection, phenylephrine hcl, up to 1 ml
J2400Injection, chloroprocaine hydrochloride, per 30 ml
J2401Injection, chloroprocaine hydrochloride, per 1 mg
J2402Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg
J2405Injection, ondansetron hydrochloride, per 1 mg
J2407Injection, oritavancin (orbactiv), 10 mg
J2410Injection, oxymorphone hcl, up to 1 mg
J2425Injection, palifermin, 50 micrograms
J2426Injection, paliperidone palmitate extended release, 1 mg
J2430Injection, pamidronate disodium, per 30 mg
J2440Injection, papaverine hcl, up to 60 mg
J2460Injection, oxytetracycline hcl, up to 50 mg
J2469Injection, palonosetron hcl, 25 mcg
J2501Injection, paricalcitol, 1 mcg
J2502Injection, pasireotide long acting, 1 mg
J2503Injection, pegaptanib sodium, 0.3 mg
J2504Injection, pegademase bovine, 25 iu
J2505Injection, pegfilgrastim, 6 mg
J2507Injection, pegloticase, 1 mg
J2510Injection, penicillin g procaine, aqueous, up to 600,000 units
J2513Injection, pentastarch, 10% solution, 100 ml
J2515Injection, pentobarbital sodium, per 50 mg
J2540Injection, penicillin g potassium, up to 600,000 units
J2543Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)
J2545Pentamidine isethionate, inhalation solution, fda approved final product, non compounded, administered through dme, unit dose form, per 300 mg
J2547Injection, peramivir, 1 mg
J2550Injection, promethazine hcl, up to 50 mg
J2560Injection, phenobarbital sodium, up to 120 mg
J2562Injection, plerixafor, 1 mg
J2590Injection, oxytocin, up to 10 units
J2597Injection, desmopressin acetate, per 1 mcg
J2650Injection, prednisolone acetate, up to 1 ml
J2670Injection, tolazoline hcl, up to 25 mg
J2675Injection, progesterone, per 50 mg
J2680Injection, fluphenazine decanoate, up to 25 mg
J2690Injection, procainamide hcl, up to 1 gm
J2700Injection, oxacillin sodium, up to 250 mg
J2710Injection, neostigmine methylsulfate, up to 0.5 mg
J2720Injection, protamine sulfate, per 10 mg
J2724Injection, protein c concentrate, intravenous, human, 10 iu
J2725Injection, protirelin, per 250 mcg
J2730Injection, pralidoxime chloride, up to 1 gm
J2760Injection, phentolamine mesylate, up to 5 mg
J2765Injection, metoclopramide hcl, up to 10 mg
J2770Injection, quinupristin/dalfopristin, 500 mg (150/350)
J2778Injection, ranibizumab, 0.1 mg
J2780Injection, ranitidine hydrochloride, 25 mg
J2783Injection, rasburicase, 0.5 mg
J2785Injection, regadenoson, 0.1 mg
J2788Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.)
J2790Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)
J2791Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu
J2792Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu
J2793Injection, rilonacept, 1 mg
J2794Injection, risperidone (risperdal consta), 0.5 mg
J2795Injection, ropivacaine hydrochloride, 1 mg
J2796Injection, romiplostim, 10 micrograms
J2797Injection, rolapitant, 0.5 mg
J2800Injection, methocarbamol, up to 10 ml
J2805Injection, sincalide, 5 micrograms
J2810Injection, theophylline, per 40 mg
J2820Injection, sargramostim (gm csf), 50 mcg
J2850Injection, secretin, synthetic, human, 1 microgram
J2860Injection, siltuximab, 10 mg
J2910Injection, aurothioglucose, up to 50 mg
J2916Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg
J2920Injection, methylprednisolone sodium succinate, up to 40 mg
J2930Injection, methylprednisolone sodium succinate, up to 125 mg
J2940Injection, somatrem, 1 mg
J2941Injection, somatropin, 1 mg
J2950Injection, promazine hcl, up to 25 mg
J2993Injection, reteplase, 18.1 mg
J2995Injection, streptokinase, per 250,000 iu
J2997Injection, alteplase recombinant, 1 mg
J3000Injection, streptomycin, up to 1 gm
J3010Injection, fentanyl citrate, 0.1 mg
J3030Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J3032Injection, eptinezumab jjmr, 1 mg
J3070Injection, pentazocine, 30 mg
J3090Injection, tedizolid phosphate, 1 mg
J3095Injection, telavancin, 10 mg
J3101Injection, tenecteplase, 1 mg
J3105Injection, terbutaline sulfate, up to 1 mg
J3110Injection, teriparatide, 10 mcg
J3121Injection, testosterone enanthate, 1 mg
J3145Injection, testosterone undecanoate, 1 mg
J3230Injection, chlorpromazine hcl, up to 50 mg
J3240Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial
J3243Injection, tigecycline, 1 mg
J3244Injection, tigecycline (accord) not therapeutically equivalent to j3243, 1 mg
J3245Injection, tildrakizumab, 1 mg
J3246Injection, tirofiban hcl, 0.25 mg
J3250Injection, trimethobenzamide hcl, up to 200 mg
J3260Injection, tobramycin sulfate, up to 80 mg
J3262Injection, tocilizumab, 1 mg
J3265Injection, torsemide, 10 mg/ml
J3280Injection, thiethylperazine maleate, up to 10 mg
J3285Injection, treprostinil, 1 mg
J3300Injection, triamcinolone acetonide, preservative free, 1 mg
J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg
J3302Injection, triamcinolone diacetate, per 5 mg
J3303Injection, triamcinolone hexacetonide, per 5 mg
J3305Injection, trimetrexate glucuronate, per 25 mg
J3310Injection, perphenazine, up to 5 mg
J3315Injection, triptorelin pamoate, 3.75 mg
J3320Injection, spectinomycin dihydrochloride, up to 2 gm
J3350Injection, urea, up to 40 gm
J3355Injection, urofollitropin, 75 iu
J3357Ustekinumab, for subcutaneous injection, 1 mg
J3358Ustekinumab, for intravenous injection, 1 mg
J3360Injection, diazepam, up to 5 mg
J3364Injection, urokinase, 5000 iu vial
J3365Injection, iv, urokinase, 250,000 i.u. vial
J3370Injection, vancomycin hcl, 500 mg
J3371Injection, vancomycin hcl (mylan) not therapeutically equivalent to j3370, 500 mg
J3372Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg
J3380Injection, vedolizumab, 1 mg
J3385Injection, velaglucerase alfa, 100 units
J3396Injection, verteporfin, 0.1 mg
J3400Injection, triflupromazine hcl, up to 20 mg
J3410Injection, hydroxyzine hcl, up to 25 mg
J3411Injection, thiamine hcl, 100 mg
J3415Injection, pyridoxine hcl, 100 mg
J3420Injection, vitamin b 12 cyanocobalamin, up to 1000 mcg
J3430Injection, phytonadione (vitamin k), per 1 mg
J3465Injection, voriconazole, 10 mg
J3470Injection, hyaluronidase, up to 150 units
J3471Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)
J3472Injection, hyaluronidase, ovine, preservative free, per 1000 usp units
J3473Injection, hyaluronidase, recombinant, 1 usp unit
J3475Injection, magnesium sulfate, per 500 mg
J3480Injection, potassium chloride, per 2 meq
J3485Injection, zidovudine, 10 mg
J3486Injection, ziprasidone mesylate, 10 mg
J3490Unclassified drugs
J3520Edetate disodium, per 150 mg
J3530Nasal vaccine inhalation
J3535Drug administered through a metered dose inhaler
J3570Laetrile, amygdalin, vitamin b17
J3590Unclassified biologics
J7030Infusion, normal saline solution , 1000 cc
J7040Infusion, normal saline solution, sterile (500 ml = 1 unit)
J70425% dextrose/normal saline (500 ml = 1 unit)
J7050Infusion, normal saline solution, 250 cc
J70605% dextrose/water (500 ml = 1 unit)
J7070Infusion, d5w, 1000 cc
J7100Infusion, dextran 40, 500 ml
J7110Infusion, dextran 75, 500 ml
J7120Ringers lactate infusion, up to 1000 cc
J71215% dextrose in lactated ringers infusion, up to 1000 cc
J7131Hypertonic saline solution, 1 ml
J7168Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
J7180Injection, factor xiii (antihemophilic factor, human), 1 i.u.
J7181Injection, factor xiii a subunit, (recombinant), per iu
J7182Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu
J7183Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco
J7185Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.
J7186Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.
J7187Injection, von willebrand factor complex (humate p), per iu vwf:rco
J7188Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u.
J7189Factor viia (antihemophilic factor, recombinant), per 1 microgram
J7190Factor viii (antihemophilic factor, human) per i.u.
J7191Factor viii (antihemophilic factor (porcine)), per i.u.
J7192Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified
J7193Factor ix (antihemophilic factor, purified, non recombinant) per i.u.
J7194Factor ix, complex, per i.u.
J7195Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
J7196Injection, antithrombin recombinant, 50 i.u.
J7197Antithrombin iii (human), per i.u.
J7198Anti inhibitor, per i.u.
J7199Hemophilia clotting factor, not otherwise classified
J7200Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
J7201Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
J7205Injection, factor viii fc fusion protein (recombinant), per iu
J7208Injection, factor viii, (antihemophilic factor, recombinant), pegylated aucl, (jivi), 1 i.u.
J7210Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u.
J7211Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.
J7214Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u.
J7296Levonorgestrel releasing intrauterine contraceptive system, (kyleena), 19.5 mg
J7297Levonorgestrel releasing intrauterine contraceptive system (liletta), 52 mg
J7298Levonorgestrel releasing intrauterine contraceptive system (mirena), 52 mg
J7300Intrauterine copper contraceptive
J7303Contraceptive supply, hormone containing vaginal ring, each
J7306Levonorgestrel (contraceptive) implant system, including implants and supplies
J7307Etonogestrel (contraceptive) implant system, including implant and supplies
J7309Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram
J7310Ganciclovir, 4.5 mg, long acting implant
J7325Hyaluronan or derivative, synvisc or synvisc one, for intra articular injection, 1 mg
J7326Hyaluronan or derivative, gel one, for intra articular injection, per dose
J7340Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml
J7501Azathioprine, parenteral, 100 mg
J7503Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg
J7504Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg
J7505Muromonab cd3, parenteral, 5 mg
J7509Methylprednisolone oral, per 4 mg
J7510Prednisolone oral, per 5 mg
J7511Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg
J7512Prednisone, immediate release or delayed release, oral, 1 mg
J7513Daclizumab, parenteral, 25 mg
J7516Cyclosporin, parenteral, 250 mg
J7525Tacrolimus, parenteral, 5 mg
J7599Immunosuppressive drug, not otherwise classified
J7677Revefenacin inhalation solution, fda approved final product, non compounded, administered through dme, 1 microgram
J8498Antiemetic drug, rectal/suppository, not otherwise specified
J8499Prescription drug, oral, non chemotherapeutic, nos
J8540Dexamethasone, oral, 0.25 mg
J8597Antiemetic drug, oral, not otherwise specified
J8655Netupitant 300 mg and palonosetron 0.5 mg, oral
J9000Injection, doxorubicin hydrochloride, 10 mg
J9015Injection, aldesleukin, per single use vial
J9017Injection, arsenic trioxide, 1 mg
J9020Injection, asparaginase, not otherwise specified, 10,000 units
J9025Injection, azacitidine, 1 mg
J9027Injection, clofarabine, 1 mg
J9030Bcg live intravesical instillation, 1 mg
J9032Injection, belinostat, 10 mg
J9033Injection, bendamustine hcl (treanda), 1 mg
J9035Injection, bevacizumab, 10 mg
J9036Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg
J9039Injection, blinatumomab, 1 microgram
J9040Injection, bleomycin sulfate, 15 units
J9041Injection, bortezomib, 0.1 mg
J9043Injection, cabazitaxel, 1 mg
J9045Injection, carboplatin, 50 mg
J9050Injection, carmustine, 100 mg
J9055Injection, cetuximab, 10 mg
J9060Injection, cisplatin, powder or solution, 10 mg
J9065Injection, cladribine, per 1 mg
J9070Cyclophosphamide, 100 mg
J9098Injection, cytarabine liposome, 10 mg
J9100Injection, cytarabine, 100 mg
J9120Injection, dactinomycin, 0.5 mg
J9130Dacarbazine, 100 mg
J9150Injection, daunorubicin, 10 mg
J9151Injection, daunorubicin citrate, liposomal formulation, 10 mg
J9153Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
J9155Injection, degarelix, 1 mg
J9160Injection, denileukin diftitox, 300 micrograms
J9165Injection, diethylstilbestrol diphosphate, 250 mg
J9171Injection, docetaxel, 1 mg
J9175Injection, elliotts' b solution, 1 ml
J9177Injection, enfortumab vedotin ejfv, 0.25 mg
J9178Injection, epirubicin hcl, 2 mg
J9179Injection, eribulin mesylate, 0.1 mg
J9181Injection, etoposide, 10 mg
J9185Injection, fludarabine phosphate, 50 mg
J9190Injection, fluorouracil, 500 mg
J9196Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to J9201, 200 mg
J9200Injection, floxuridine, 500 mg
J9201Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
J9202Goserelin acetate implant, per 3.6 mg
J9206Injection, irinotecan, 20 mg
J9207Injection, ixabepilone, 1 mg
J9208Injection, ifosfamide, 1 gram
J9209Injection, mesna, 200 mg
J9211Injection, idarubicin hydrochloride, 5 mg
J9212Injection, interferon alfacon 1, recombinant, 1 microgram
J9213Injection, interferon, alfa 2a, recombinant, 3 million units
J9214Injection, interferon, alfa 2b, recombinant, 1 million units
J9215Injection, interferon, alfa n3, (human leukocyte derived), 250,000 iu
J9216Injection, interferon, gamma 1 b, 3 million units
J9217Leuprolide acetate (for depot suspension), 7.5 mg
J9218Leuprolide acetate, per 1 mg
J9219Leuprolide acetate implant, 65 mg
J9225Histrelin implant (vantas), 50 mg
J9226Histrelin implant (supprelin la), 50 mg
J9228Injection, ipilimumab, 1 mg
J9230Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg
J9245Injection, melphalan hydrochloride, not otherwise specified, 50 mg
J9250Methotrexate sodium, 5 mg
J9260Methotrexate sodium, 50 mg
J9261Injection, nelarabine, 50 mg
J9263Injection, oxaliplatin, 0.5 mg
J9264Injection, paclitaxel protein bound particles, 1 mg
J9266Injection, pegaspargase, per single dose vial
J9267Injection, paclitaxel, 1 mg
J9268Injection, pentostatin, 10 mg
J9270Injection, plicamycin, 2.5 mg
J9271Injection, pembrolizumab, 1 mg
J9280Injection, mitomycin, 5 mg
J9293Injection, mitoxantrone hydrochloride, per 5 mg
J9294Injection, pemetrexed (hospira) not therapeutically equivalent to j9305, 10 mg
J9295Injection, necitumumab, 1 mg
J9296Injection, pemetrexed (accord) not therapeutically equivalent to j9305, 10 mg
J9297Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg
J9299Injection, nivolumab, 1 mg
J9301Injection, obinutuzumab, 10 mg
J9302Injection, ofatumumab, 10 mg
J9303Injection, panitumumab, 10 mg
J9304Injection, pemetrexed (pemfexy), 10 mg
J9305Injection, pemetrexed, not otherwise specified, 10 mg
J9307Injection, pralatrexate, 1 mg
J9308Injection, ramucirumab, 5 mg
J9311Injection, rituximab 10 mg and hyaluronidase
J9312Injection, rituximab, 10 mg
J9314Injection, pemetrexed (teva) not therapeutically equivalent to j9305, 10 mg
J9315Injection, romidepsin, 1 mg
J9320Injection, streptozocin, 1 gram
J9328Injection, temozolomide, 1 mg
J9330Injection, temsirolimus, 1 mg
J9340Injection, thiotepa, 15 mg
J9349Injection, tafasitamab-cxix, 2 mg
J9351Injection, topotecan, 0.1 mg
J9353Injection, margetuximab-cmkb, 5 mg
J9355Injection, trastuzumab, excludes biosimilar, 10 mg
J9356Injection, trastuzumab, 10 mg and hyaluronidase oysk
J9357Injection, valrubicin, intravesical, 200 mg
J9358Injection, fam trastuzumab deruxtecan nxki, 1 mg
J9360Injection, vinblastine sulfate, 1 mg
J9370Vincristine sulfate, 1 mg
J9390Injection, vinorelbine tartrate, 10 mg
J9395Injection, fulvestrant, 25 mg
J9600Injection, porfimer sodium, 75 mg
J9999Not otherwise classified, antineoplastic drugs
M0201COVID-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient's home.
M0239Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
M0243Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring
M0244Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency
M0245Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
M0246Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider based to the hospital during the covid 19 public health emerge
M0247Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
M0248Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency
P2038Mucoprotein, blood (seromucoid) (medical necessity procedure)
P3000Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision
P9612Catheterization for collection of specimen, single patient, all places of service
P9615Catheterization for collection of specimen(s) (multiple patients)
Q0111Wet mounts, including preparations of vaginal, cervical or skin specimens
Q0112All potassium hydroxide (koh) preparations
Q0113Pinworm examinations
Q0114Fern test
Q0115Post coital direct, qualitative examinations of vaginal or cervical mucous
Q0138Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non esrd use)
Q0139Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis)
Q0162Ondansetron 1 mg, oral, fda approved prescription anti emetic, for use as a complete therapeutic substitute for an iv anti emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q2026Injection, radiesse, 0.1 ml
Q2035Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
Q2036Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
Q2037Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
Q2038Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
Q2039Influenza virus vaccine, not otherwise specified
Q2043Sipuleucel t, minimum of 50 million autologous cd54+ cells activated with pap gm csf, including leukapheresis and all other preparatory procedures, per infusion
Q3014Telehealth originating site facility fee
Q4001Casting supplies, body cast adult, with or without head, plaster
Q4002Cast supplies, body cast adult, with or without head, fiberglass
Q4003Cast supplies, shoulder cast, adult (11 years +), plaster
Q4004Cast supplies, shoulder cast, adult (11 years +), fiberglass
Q4005Cast supplies, long arm cast, adult (11 years +), plaster
Q4006Cast supplies, long arm cast, adult (11 years +), fiberglass
Q4007Cast supplies, long arm cast, pediatric (0 10 years), plaster
Q4008Cast supplies, long arm cast, pediatric (0 10 years), fiberglass
Q4009Cast supplies, short arm cast, adult (11 years +), plaster
Q4010Cast supplies, short arm cast, adult (11 years +), fiberglass
Q4011Cast supplies, short arm cast, pediatric (0 10 years), plaster
Q4012Cast supplies, short arm cast, pediatric (0 10 years), fiberglass
Q4013Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster
Q4014Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass
Q4015Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0 10 years), plaster
Q4016Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0 10 years), fiberglass
Q4017Cast supplies, long arm splint, adult (11 years +), plaster
Q4018Cast supplies, long arm splint, adult (11 years +), fiberglass
Q4019Cast supplies, long arm splint, pediatric (0 10 years), plaster
Q4020Cast supplies, long arm splint, pediatric (0 10 years), fiberglass
Q4021Cast supplies, short arm splint, adult (11 years +), plaster
Q4022Cast supplies, short arm splint, adult (11 years +), fiberglass
Q4023Cast supplies, short arm splint, pediatric (0 10 years), plaster
Q4024Cast supplies, short arm splint, pediatric (0 10 years), fiberglass
Q4025Cast supplies, hip spica (one or both legs), adult (11 years +), plaster
Q4026Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass
Q4027Cast supplies, hip spica (one or both legs), pediatric (0 10 years), plaster
Q4028Cast supplies, hip spica (one or both legs), pediatric (0 10 years), fiberglass
Q4029Cast supplies, long leg cast, adult (11 years +), plaster
Q4030Cast supplies, long leg cast, adult (11 years +), fiberglass
Q4031Cast supplies, long leg cast, pediatric (0 10 years), plaster
Q4032Cast supplies, long leg cast, pediatric (0 10 years), fiberglass
Q4033Cast supplies, long leg cylinder cast, adult (11 years +), plaster
Q4034Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass
Q4035Cast supplies, long leg cylinder cast, pediatric (0 10 years), plaster
Q4036Cast supplies, long leg cylinder cast, pediatric (0 10 years), fiberglass
Q4037Cast supplies, short leg cast, adult (11 years +), plaster
Q4038Cast supplies, short leg cast, adult (11 years +), fiberglass
Q4039Cast supplies, short leg cast, pediatric (0 10 years), plaster
Q4040Cast supplies, short leg cast, pediatric (0 10 years), fiberglass
Q4041Cast supplies, long leg splint, adult (11 years +), plaster
Q4042Cast supplies, long leg splint, adult (11 years +), fiberglass
Q4043Cast supplies, long leg splint, pediatric (0 10 years), plaster
Q4044Cast supplies, long leg splint, pediatric (0 10 years), fiberglass
Q4045Cast supplies, short leg splint, adult (11 years +), plaster
Q4046Cast supplies, short leg splint, adult (11 years +), fiberglass
Q4047Cast supplies, short leg splint, pediatric (0 10 years), plaster
Q4048Cast supplies, short leg splint, pediatric (0 10 years), fiberglass
Q5010Hospice home care provided in a hospice facility
Q5112Injection, trastuzumab dttb, biosimilar, (ontruzant), 10 mg
Q5113Injection, trastuzumab pkrb, biosimilar, (herzuma), 10 mg
Q5114Injection, trastuzumab dkst, biosimilar, (ogivri), 10 mg
Q5115Injection, rituximab abbs, biosimilar, (truxima), 10 mg
Q5119Injection, rituximab pvvr, biosimilar, (ruxience), 10 mg
Q5120Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg
Q9968Injection, non radioactive, non contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg
S0012Butorphanol tartrate, nasal spray, 25 mg
S0014Tacrine hydrochloride, 10 mg
S0017Injection, aminocaproic acid, 5 grams
S0020Injection, bupivicaine hydrochloride, 30 ml
S0021Injection, cefoperazone sodium, 1 gram
S0023Injection, cimetidine hydrochloride, 300 mg
S0028Injection, famotidine, 20 mg
S0030Injection, metronidazole, 500 mg
S0032Injection, nafcillin sodium, 2 grams
S0034Injection, ofloxacin, 400 mg
S0039Injection, sulfamethoxazole and trimethoprim, 10 ml
S0040Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams
S0073Injection, aztreonam, 500 mg
S0074Injection, cefotetan disodium, 500 mg
S0077Injection, clindamycin phosphate, 300 mg
S0078Injection, fosphenytoin sodium, 750 mg
S0080Injection, pentamidine isethionate, 300 mg
S0081Injection, piperacillin sodium, 500 mg
S0088Imatinib, 100 mg
S0090Sildenafil citrate, 25 mg
S0117Tretinoin, topical, 5 grams
S0119Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code)
S0122Injection, menotropins, 75 iu
S0126Injection, follitropin alfa, 75 iu
S0128Injection, follitropin beta, 75 iu
S0132Injection, ganirelix acetate, 250 mcg
S0136Clozapine, 25 mg
S0137Didanosine (ddi), 25 mg
S0138Finasteride, 5 mg
S0139Minoxidil, 10 mg
S0140Saquinavir, 200 mg
S0145Injection, pegylated interferon alfa 2a, 180 mcg per ml
S0148Injection, pegylated interferon alfa 2b, 10 mcg
S0155Sterile dilutant for epoprostenol, 50 ml
S0156Exemestane, 25 mg
S0157Becaplermin gel 0.01%, 0.5 gm
S0160Dextroamphetamine sulfate, 5 mg
S0164Injection, pantoprazole sodium, 40 mg
S0166Injection, olanzapine, 2.5 mg
S0169Calcitrol, 0.25 microgram
S0171Injection, bumetanide, 0.5 mg
S0189Testosterone pellet, 75 mg
S0199Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs
S0280Medical home program, comprehensive care coordination and planning, initial plan
S0281Medical home program, comprehensive care coordination and planning, maintenance of plan
S3722Dose optimization by area under the curve (auc) analysis, for infusional 5 fluorouracil
S4981Insertion of levonorgestrel releasing intrauterine system
S4989Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies
S5550Insulin, rapid onset, 5 units
S5551Insulin, most rapid onset (lispro or aspart); 5 units
S5552Insulin, intermediate acting (nph or lente); 5 units
S5553Insulin, long acting; 5 units
S8130Interferential current stimulator, 2 channel
S8131Interferential current stimulator, 4 channel
S9097Home visit for wound care
S9098Home visit, phototherapy services (e.g., bili lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem
S9126Hospice care, in the home, per diem
S9140Diabetic management program, follow up visit to non md provider
S9452Nutrition classes, non physician provider, per session
S9460Diabetic management program, nurse visit
S9472Cardiac rehabilitation program, non physician provider, per diem
S9474Enterostomal therapy by a registered nurse certified in enterostomal therapy, per diem
S9529Routine venipuncture for collection of specimen(s), single home bound, nursing home, or skilled nursing facility patient
U0001Cdc 2019 novel coronavirus (2019 ncov) real time rt pcr diagnostic panel
U00022019 ncov coronavirus, sars cov 2/2019 ncov (covid 19), any technique, multiple types or subtypes (includes all targets), non cdc
Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
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