150 North Wacker Drive
Suite 2360
Chicago, IL 60606
847-381-5465


NATIONAL LIMIT
2025 Clinical Laboratory Fee Schedule1

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 CLIA WAIVED
 CHEMISTRIES
Cartridge Product Code Analytes CPT Code(s)
Medicare Coverage
NATIONAL LIMIT
Medicare1 
Medicaid2
Crea 03P84-26 Crea 82565-QW
CCI
MUE
Medically Unlikely Edits for 82565

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 2
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 5.12
N/A
G 03P83-26 Glu 82947-QW
CCI
MUE
Medically Unlikely Edits for 82947

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 5 5
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data


NCD
Screening
$ 3.93
N/A
 ENDOCRINOLOGY
Cartridge Product Code Analytes CPT Code(s)
Medicare Coverage
NATIONAL LIMIT
Medicare1 
Medicaid2
Total ß-hCG 05P58-25 ß-hCG 80051-QW
CCI
MUE
Medically Unlikely Edits for 80051

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 7.01
N/A
 MODERATELY COMPLEX
 CHEMISTRIES, ELECTROLYTES
Cartridge Product Code Analytes CPT Code(s)
Medicare Coverage
NATIONAL LIMIT
Medicare1 
Medicaid2
CHEM8+ 09P31-26 Na, K, Cl, iCa, TCO2, Glu, BUN/Urea, Crea, Agap†, Hct, Hgb† 80047
CCI
MUE
Medically Unlikely Edits for 80047

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 2
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 13.73
N/A
85014
CCI
MUE
Medically Unlikely Edits for 85014

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data


NCD
$ 2.37
N/A
If all tests are ordered, performed, and reported:
$ 16.10
N/A
G 03P83-26 Glu 82947
CCI
MUE
Medically Unlikely Edits for 82947

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 5 5
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data


NCD
Screening
$ 3.93
N/A
 BLOOD GASES
Cartridge Product Code Analytes CPT Code(s)
Medicare Coverage
NATIONAL LIMIT
Medicare1 
Medicaid2
CG4+ (blue) 03P85-51 pH, PCO2, PO2, TCO2†, HCO3†,
BEecf †, sO2†, Lactate		 82803
CCI
MUE
Medically Unlikely Edits for 82803

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Not Listed

$ 26.07
N/A
83605
CCI
MUE
Medically Unlikely Edits for 83605

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 1 2
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 11.57
N/A
If all tests are ordered, performed, and reported:
$ 37.64
N/A
G3+ 03P78-26 pH, PCO2, PO2 , TCO2†, HCO3†,
BEecf †, sO2		 82803
CCI
MUE
Medically Unlikely Edits for 82803

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Not Listed

$ 26.07
N/A
 BLOOD GASES, ELECTROLYTES, HEMATOLOGY
Cartridge Product Code Analytes CPT Code(s)
Medicare Coverage
NATIONAL LIMIT
Medicare1 
Medicaid2
EG6+ 03P77-25 Na, K, pH, PCO2, PO2, TCO2†, HCO3†, BEecf †, sO2†, Hct 82803
CCI
MUE
Medically Unlikely Edits for 82803

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Not Listed

$ 26.07
N/A
84295
CCI
MUE
Medically Unlikely Edits for 84295

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 1 2
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 4.81
N/A
84132
CCI
MUE
Medically Unlikely Edits for 84132

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 3
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 4.76
N/A
85014
CCI
MUE
Medically Unlikely Edits for 85014

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data


NCD
$ 2.37
N/A
If all tests are ordered, performed, and reported:
$ 38.01
N/A
EG7+ 03P76-25 Na, K, iCa, pH, PCO2, PO2, TCO2†, HCO3†, BEecf †, sO2†, Hct 82803
CCI
MUE
Medically Unlikely Edits for 82803

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Not Listed

$ 26.07
N/A
84295
CCI
MUE
Medically Unlikely Edits for 84295

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 1 2
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 4.81
N/A
84132
CCI
MUE
Medically Unlikely Edits for 84132

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 3
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 4.76
N/A
82330
CCI
MUE
Medically Unlikely Edits for 82330

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 13.68
N/A
85014
CCI
MUE
Medically Unlikely Edits for 85014

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data


NCD
$ 2.37
N/A
If all tests are ordered, performed, and reported:
$ 51.69
N/A
CG8+ 03P88-25 Na, K, iCa, Glu, pH, PCO2, PO2, TCO2†, HCO3†, BEecf †, sO2†, Hct 82803
CCI
MUE
Medically Unlikely Edits for 82803

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Not Listed

$ 26.07
N/A
84295
CCI
MUE
Medically Unlikely Edits for 84295

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 1 2
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 4.81
N/A
84132
CCI
MUE
Medically Unlikely Edits for 84132

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 3
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 4.76
N/A
82947
CCI
MUE
Medically Unlikely Edits for 82947

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 5 5
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data


NCD
Screening
$ 3.93
N/A
82330
CCI
MUE
Medically Unlikely Edits for 82330

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 13.68
N/A
85014
CCI
MUE
Medically Unlikely Edits for 85014

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data


NCD
$ 2.37
N/A
If all tests are ordered, performed, and reported:
$ 55.62
N/A
 CARDIAC MARKERS
Cartridge Product Code Analytes CPT Code(s)
Medicare Coverage
NATIONAL LIMIT
Medicare1 
Medicaid2
hs-Tnl 09P81-25 Troponin l 84484
CCI
MUE
Medically Unlikely Edits for 84484

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 12.47
N/A
cTnl 03P90-25 Troponin l 84484
CCI
MUE
Medically Unlikely Edits for 84484

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 12.47
N/A
BNP 03P93-25 BNP 83880
CCI
MUE
Medically Unlikely Edits for 83880

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 1 1
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 39.26
N/A
CK-MB 03P92-25 CK-MB 82553
CCI
MUE
Medically Unlikely Edits for 82553

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 3 3
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 11.55
N/A
 COAGULATION
Cartridge Product Code Analytes CPT Code(s)
Medicare Coverage
NATIONAL LIMIT
Medicare1 
Medicaid2
PTplus 03P89-50 Prothrombin Time 85610
CCI
MUE
Medically Unlikely Edits for 85610

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 4 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data


NCD
$ 4.29
N/A
Celite ACT 03P86-25 Celite ACT 85347
CCI
MUE
Medically Unlikely Edits for 85347

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 3 9
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 4.28
N/A
Kaolin ACT 03P87-25 Kaolin ACT 85347
CCI
MUE
Medically Unlikely Edits for 85347

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 3 9
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 4.28
N/A
 ENDOCRINOLOGY
Cartridge Product Code Analytes CPT Code(s)
Medicare Coverage
NATIONAL LIMIT
Medicare1 
Medicaid2
Total ß-hCG 05P58-25 ß-hCG 80051
CCI
MUE
Medically Unlikely Edits for 80051

Practitioner
Hospital Outpatient
Allowed Frequency per Day: 2 4
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical
Rationale: Clinical: Data Clinical: Data

$ 7.01
N/A
 ADDITIONAL SERVICES
CPT Code
NATIONAL LIMIT
Medicare1 
Medicaid2
Routine Venipuncture 36415
$ 9.09
N/A


† Calculated

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1Reimbursement information source: Centers for Medicare and Medicaid Clinical Diagnostic Laboratory Fee Schedule (CLFS) 2025, available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Clinical-Laboratory-Fee-Schedule-Files.html

CLFS does not reflect 2% Payment Adjustment (Sequestration). Click here for more information.



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