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This information is provided as a convenience by CodeMap® to assist and educate Clinical Laboratories of Hawaii, LLP ("CLH") and Pan Pacific Pathologists, LLC ("PPPL") customers about Medicare national policies/articles and Medicare contractor local medical review policies/articles for laboratory tests. CodeMap® is responsible for the accuracy of all content. Website users rely on the information contained in this website at their own risk. The information provided is for illustrative purposes only, may not be conclusive or exhaustive, and does not constitute reimbursement or legal advice. While every effort is made to ensure that all information is current and complete, all information on this web site is subject to change without notice and it is the responsibility of each user to verify specific coverage information as recent changes in applicable law, regulations, rules and policies may not be reflected herein. CLH/PPPL does not guarantee that the use of any information provided herein will result in coverage or payment by Federal health care programs at any particular level or third party coverage or payment for tests. CLH/PPPL will not reimburse customers for claims that are denied by Federal health care programs or third party payors. The web site user including but not limited to physicians, physician groups, and other users, individuals and entities is ultimately responsible for consulting with Medicare, payers, reimbursement specialists, certified coders, as well as legal counsel for guidance to verify coverage and determine that the appropriate codes, coverage and medical necessity requirements for individual patients have been met to support test ordering. All questions regarding the accuracy or sources of information on this website should be directed to customerservice@codemap.com.

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Ordering Code
Test Code
Test Name
CPT® Code(s)
Medicare Coverage
Frequency Applies
2074
AHEPP
Acute Hepatitis Panel (CLH 2074)
80074
NCD 190.33
Yes
2464
ADIPO
Adiponectin (CLH 2464)
83520
   L37299
 
7327
GAFP
AFP (Alpha Fetoprotein) Maternal Serum (CLH 7327)
82105
NCD 190.25
 
0096
AFPX
AFP Alphafetoprotein Tumor Marker (CLH 0096)
82105
NCD 190.25
 
2068
AFP4Q
AFP4, Quad Screen (CLH 2068)
82105
82677
84702
86336
NCD 190.25

NCD 190.27

 
 
Yes
 
3944
RA382
Allergen Gluten IgA(CLH 3944)
83520
   L37299
 
3951
RA389
Allergen Wheat IgA(CLH 3951)
83520
   L37299
 
3289
E376
Apolipoprotein A1 (CLH 3289)
82172
   L36358
 
3290
E373
Apolipoprotein B (CLH 3290)
82172
   L36358
 
7358
ARTHSC
Arthritis Screen (Uric Acid, ESR, ANA, ASO Titer, CRP, RA Factor) (CLH 7358)
84550
85651
86431
86060
86140
86038




   L37299

 
 
 
 
 
 
0365
ABC
Automated Blood Count (CLH 0365)
85027
NCD 190.15
 
1796
BCRABN
BCR-ABL1 P210, P190(CLH 1796)
81206
81207
   L36180 L35160    A55595
   L36180 L35160    A55595
 
 
0265
KBHCGQ
Beta HCG Quantitative (CLH 0265)
84702
NCD 190.27
Yes
2968
BUPURX
Buprenorphine(CLH 2968)
80307
   L36668    A55001

 
 
0472
CRP
C Reactive Protein CRP (CLH 0472)
86140
   L37299
 
8004
C153
Cancer Antigen 15-3 (CLH 8004)
86300
NCD 190.29
 
6877
CA2729
Cancer Antigen 27.29(CLH 6877)
86300
NCD 190.29
 
0820
CA125X
Cancer Antigen CA 125 (CLH 0820)
86304
NCD 190.28
 
0360
CBC
CBC Complete Blood Count w/ Diff (CLH 0360)
85025
NCD 190.15
 
1360
CBCM
CBC Complete Blood Count with Manual Diff (CLH 1360)
85027
85007
NCD 190.15
NCD 190.15
 
 
1332
CD20PL
CD20 Enumeration Panel (CD19,CD20,CD45) (CLH 1332)
86355
86356
   L34215
   L34215
 
 
0645
CEAX
CEA Carcinoembrionic Antigen (CLH 0645)
82378
NCD 190.26
Yes
0066
CHOL
Cholesterol (CLH 0066)
82465
NCD 190.23
Yes
1361
CHOLIP
Cholesterol Reflex Lipid Panel (CLH 1361)
82465
NCD 190.23
Yes
9258
CHOHDL
Cholesterol,Reflex HDL (CLH 9258)
82465
NCD 190.23
Yes
3638
CHRMGA
Chromogranin A (CLH 3638)
86316
   L36678
 
0768
CVHEP
Chronic Viral Hepatitis Panel (HBsAg, HBsAb, HBcAb Total, HCV) (CLH 0768)
86803
86704
86706
87340

NCD 210.6
NCD 210.6
NCD 210.6
 
 
 
 
2711
CHLDRG
Clinical Urine Drug Screen (CLH 2711)
80307
   L36668    A55001
 
3869
CHLD2X
Clinical Urine Drug Screen Reflex Amphetamine Cocaine Confirmation (CLH 3869)
80307
   L36668    A55001
 
2712
CHLDRX
Clinical Urine Drug Screen Reflex Confirmation (CLH 2712)
80307
   L36668    A55001
 
3636
CP450
Clopidogrel CYP2C19 Gt (CLH 3636)
81225
   L36310 L35160
 
3891
COLG
Collagen Cross-Linked N-Telopeptide NTx (CLH 3891)
82523
82570
NCD 190.19

Yes
 
3639
COLG24
Collagen Cross-Linked N-Telopeptide NTx Urine 24hour (CLH 3639)
82570
82523

NCD 190.19
 
Yes
2686
CTX
Collagen Type I C-Telopeptide CTx (CLH 2686)
82523
NCD 190.19
Yes
1666
HCRP
CRP C Reactive Protein, Highly Sensitive (CLH 1666)
86141
   L36358
 
2861
DPDCLU
Deoxypyridinoline Urine Crosslinks(CLH 2861)
82523
NCD 190.19
Yes
0605
DIG
Digoxin (CLH 0605)
80162
NCD 190.24
 
2375
EOSCTO
Eosinophils, Total (BI,Maui) (CLH 2375)
85048
NCD 190.15
 
0375
EOSCT
Eosinophils, Total (CLH 0375)
85048
NCD 190.15
 
1375
EOSCTN
Eosinophils, Total (Kona Only) (CLH 1375)
85048
NCD 190.15
 
2952
ETGSUC
Ethyl Glucuronide and Ethyl Sulfate urine with confirmation (CLH 2952)
80307
   L36668    A55001
 
3187
I600
Factor V Leiden (CLH 3187)
81241
   L36155 L35160
 
0075
FERR
Ferritin (CLH 0075)
82728
NCD 190.18
Yes
2720
FIRSCR
First Screen, First Semester Screen (CLH 2720)
84163
84702

NCD 190.27
 
Yes
0268
FT4
Free T4 (CLH 0268)
84439
NCD 190.22
Yes
4884
GM1
Ganglioside GM-1 Ab IgG and IgM (CLH 4884)
83520
   L37299
 
0077
GGTP
GGTP (GGT) (CLH 0077)
82977
NCD 190.32
Yes
1632
GLU11
Glucose (at 1100) (CLH 1632)
82947
NCD 190.20
Yes
0080
GLU
Glucose (CLH 0080)
82947
NCD 190.20
Yes
1080
GLUO
Glucose (Outer Islands) (CLH 1080)
82947
NCD 190.20
Yes
9224
GLU2P
Glucose 2 hr PP (CLH 9224)
82947
NCD 190.20
Yes
3705
GL110X
Glucose Reflex Hemoglobin A1C at 110 (CLH 3705)
82947
NCD 190.20
Yes
0629
GLUX
Glucose Reflex Hemoglobin A1C if >126 (CLH 0629)
82947
NCD 190.20
Yes
2365
GLUH1C
Glucose Reflex Hemoglobin A1C if >99 (CLH 2365)
82947
NCD 190.20
Yes
0259
GLUR
Glucose, Random (CLH 0259)
82947
NCD 190.20
Yes
2879
HCGQT
HCG,Quant Tumor Marker (CLH 2879)
84702
NCD 190.27
Yes
0161
HDL
HDL Cholesterol (CLH 0161)
83718
NCD 190.23
Yes
3272
HPSAG
Helicobacter Pylori Antigen Stool (CLH 3272)
87338
   L37623 L37624
 
0368
HCT
Hematocrit (CLH 0368)
85014
NCD 190.15
 
1982
HFEPCR
Hemochromatosis Mutation PCR (CLH 1982)
81256
   L35160
 
0367
HGB
Hemoglobin (CLH 0367)
85018
NCD 190.15
 
0091
HGBA1C
Hemoglobin A1C and EAG (CLH 0091)
83036
NCD 190.21
Yes
0136
HH
Hemoglobin and Hematocrit HH (CLH 0136)
85018
85014
NCD 190.15
NCD 190.15
 
 
2288
HGVAR
Hemoglobin Variants (CLH 2288)
83021
85041
85014
85018


NCD 190.15
NCD 190.15
 
 
 
 
3826
HBABQ
Hepatitis B Antibody Quantitative (CLH 3826)
86706
NCD 210.6
 
3451
HBCBTX
Hepatitis B Core Antibody Reflex Hepatitis B DNA (CLH 3451)
86704
NCD 210.6
 
2946
HBCTX
Hepatitis B Core Antibody Reflex Hepatitis B Surface Ag/Ab (CLH 2946)
86704
NCD 210.6
 
0451
HBCABT
Hepatitis B Core Antibody Total (CLH 0451)
86704
NCD 210.6
 
2972
HBCTDX
Hepatitis B Core Antibody Total Reflex IgM (CLH 2972)
86704
NCD 210.6
 
7338
HBPAN
Hepatitis B Panel (HBsAg, HBsAb, HBc Ab Total) (CLH 7338)
86706
87340
86704
NCD 210.6
NCD 210.6
NCD 210.6
 
 
 
0452
HBSAB
Hepatitis B Surface Antibody (CLH 0452)
86706
NCD 210.6
 
0475
HBSAG
Hepatitis B Surface Antigen (CLH 0475)
87340
NCD 210.6
 
8027
HIV1QT
HIV 1 Quantitative PCR(CLH 8027)
87536
NCD 190.13
Yes
4054
HVRNA1
HIV 1 RNA Qualitative TMA (CLH 4054)
87535
NCD 190.14
Yes
3800
HLAB27
HLA B27 Antigen (CLH 3800)
86812
NCD 190.1
 
6828
HCY
Homocysteine, Total (CLH 6828)
83090
   L36358
 
3560
GIN2NT
Integrated Screen - 2nd Draw, No NT required(CLH 3560)
82105
82677
84163
84702
86336
NCD 190.25


NCD 190.27

 
 
 
Yes
 
3228
GINT2
Integrated Screen, 2nd Draw (CLH 3228)
82105
82677
84163
84702
86336
NCD 190.25


NCD 190.27

 
 
 
Yes
 
3385
ILTWO
Interleukin 2 Receptor (CLH 3385)
83520
   L37299
 
4021
MAFD
Interleukin 5 (CLH 4021)
83520
   L37299
 
1979
ILSIX
Interleukin 6 (CLH 1979)
83520
   L37299
 
0095
IRON
Iron (CLH 0095)
83540
NCD 190.18
 
1019
IRONPX
Iron Profile Reflex Ferritin (CLH 1019)
83540
83550
NCD 190.18
NCD 190.18
 
 
0019
IRONP
Iron Profile, Includes TIBC, Percent Saturation (CLH 0019)
83540
83550
NCD 190.18
NCD 190.18
 
 
3283
U750
JAK2 V617F Mutation(CLH 3283)
81270
   L36180 L35160
 
0308
RLDLD
LDL-Chol, Direct(CLH 0308)
83721
NCD 190.23    L36358
Yes
2577
LEPTIN
Leptin (CLH 2577)
83520
   L37299
 
0087
CRISK
Lipid Profile (CLH 0087)
80061
NCD 190.23
Yes
3033
LIPIDX
Lipid Profile reflex Direct LDL (CLH 3033)
80061
NCD 190.23
Yes
3294
LFNMR
LipoFit by NMR(CLH 3294)
83704
80061
NCD 190.23    L36358
NCD 190.23
 
Yes
3165
LIPAA
Lipoprotein (a) (CLH 3165)
83695
   L36358
 
8819
LPELP
Lipoprotein Electrophoresis (CLH 8819)
82465
82664
84478
NCD 190.23

NCD 190.23
Yes
 
Yes
4116
LSP1
Lmphyocyte Subset Panel 1 (CD19,CD56,CD3,CD4,CD80) (CLH 4116)
86355
86357
86359
86360
   L34215
   L34215
   L34215
   L34215
 
 
 
 
8051
CDRVVC
Lupus Anticoagulant Screen Reflex Confirmation (CLH 8051)
85610
85613
85730
NCD 190.17

NCD 190.16
Yes
 
 
1752
LSP2
Lymphocyte Subset Panel 2 (CD19,CD3,CD4,CD8) (CLH 1752)
86355
86359
86360
   L34215
   L34215
   L34215
 
 
 
1753
LSP3
Lymphocyte Subset Panel 3 (CD4,CD3,CD8) (CLH 1753)
86360
86359
   L34215
   L34215
 
 
0101
MG
Magnesium (CLH 0101)
83735
   L36702
 
3144
AMGRBC
Magnesium RBC, Intracellular Magnesium (CLH 3144)
83735
   L36702
 
9247
UMGR
Magnesium Urine Random (CLH 9247)
83735
   L36702
 
0109
UMGT
Magnesium Urine Timed (CLH 0109)
83735
   L36702
 
1857
MAGF
Magnesium, Feces (CLH 1857)
83735
   L36702
 
7396
MDIFF
Manual Diff (CLH 7396)
85007
NCD 190.15
 
3189
W001
MTHFR Mutation Detection (CLH 3189)
81291
   L36155 L35160
 
3360
NTXS
N-Telopeptide Crosslinked Serum, NTx (CLH 3360)
82523
NCD 190.19
Yes
3074
PROBNP
N-Terminal Pro-B-Type Natriuretic Peptide (CLH 3074)
83880
   L35526
 
3683
NTBNP
N-Terminal Pro-B-Type Natriuretic Peptide (CLH 3683)
83880
   L35526
 
3014
NKC
Natural Killer Cells (CLH 3014)
86357
   L34215
 
2496
NSENOL
Neuron Specific Enolase (CLH 2496)
86316
   L36678
 
1200
NICOMT
Nicotine and Cotinine Screen(CLH 1200)
80307
   L36668    A55001
 
0510
ONP
Ova and Parasites (CLH 0510)
87177
88313

   L36351    A55802
 
 
0400
PLTC
Platelet Count (CLH 0400)
85049
NCD 190.15
 
1146
O1146
Pregnancy Induced Hypertension Profile (ALT, AST, CBC, Creatinine, Uric Acid) (CLH 1146)
84450
84460
84520
82565
84550
85025





NCD 190.15
 
 
 
 
 
 
1040
O39NU
Prenatal III Panel (CBC, RPR, RUBL, HBSAg, ABORH, Ab Screen) (CLH 1040)
85025
87340
86592
86762
NCD 190.15
NCD 210.6


 
 
 
 
0039
O39
Prenatal III Panel w/Urine (CBC, RPR, RUBL, HBSAg, ABORH, Ab Screen) Order ABRIC too. (CLH 0039)
85025
81001
87340
86592
86762
NCD 190.15

NCD 210.6


 
 
 
 
 
2282
UPSA
Prostate Specific Antigen Ultrasensitive (CLH 2282)
84153
NCD 190.31
Yes
3188
W150
Prothrombin Gene Mutation (CLH 3188)
81240
   L36155 L35160
 
0410
PT
Protime (CLH 0410)
85610
NCD 190.17
Yes
1896
FPSA1
PSA Free and Total (CLH 1896)
84153
84154
NCD 190.31

Yes
 
1898
PSAFRX
PSA, Total w/Reflex to Free PSA (CLH 1898)
84153
NCD 190.31
Yes
0481
PSAG1
PSA, Total (CLH 0481)
84153
NCD 190.31
Yes
1293
PSAM
PSA, Total, Medicare Screening (CLH 1293)
G0103
NCD 210.1
Yes
2347
PSAXPA
PSA, Total, Reflex to Prostatic Acid Phosphatase (CLH 2347)
84153
NCD 190.31
Yes
0158
O158
PT and PTT (CLH 0158)
85610
85730
NCD 190.17
NCD 190.16
Yes
 
0420
PTT
PTT (CLH 0420)
85730
NCD 190.16
 
4106
RESPCR
Respiratory Panel PCR (CLH 4106)
87633
87798
87486
87581
   L37300 L37301
   A55326


 
 
 
 
1021
UROH
Rohypnol Urine (CLH 1021)
80307
   L36668    A55001
 
3227
SEQ1
Sequential Screen, 1st Trimester (CLH 3227)
84163
84702

NCD 190.27
 
Yes
2973
SEQ2
Sequential Screen, 2nd Trimester (CLH 2973)
82677
84702
86336
82105

NCD 190.27

NCD 190.25
 
Yes
 
 
3719
STACHP
Stachybotrys Chartarum/ATRA Panel II (CLH 3719)
86001
86003
83520
  L30471
   L34313
   L37299
 
 
 
0262
T3U
T3 Uptake (CLH 0262)
84479
NCD 190.22
Yes
2883
T4FD
T4 Free Direct Dialysis (CLH 2883)
84439
NCD 190.22
Yes
0264
T4
T4, Total (CLH 0264)
84436
NCD 190.22
Yes
0048
THYP
Thyroid Panel (CLH 0048)
84479
84436
NCD 190.22
NCD 190.22
Yes
Yes
0026
O026
Thyroid Panel w/TSH (T3 Uptake, T4, FTI, TSH) (CLH 0026)
84479
84436
84443
NCD 190.22
NCD 190.22
NCD 190.22
Yes
Yes
Yes
2970
TRAMUX
Tramadol(CLH 2970)
80307
   L36668    A55001

 
 
0438
TRANS
Transferrin (CLH 0438)
84466
NCD 190.18
 
0160
TRIG
Triglyceride (CLH 0160)
84478
NCD 190.23
Yes
1567
TRYP
Tryptase Level (CLH 1567)
83520
   L37299
 
0261
TSH
TSH (CLH 0261)
84443
NCD 190.22
Yes
3356
F804
TSH Receptor Antibody (CLH 3356)
83520
   L37299
 
1434
TSHX
TSH Reflex Free T4 and Thyroid Binding Globulin (CLH 1434)
84443
NCD 190.22
Yes
0267
TSHRF
TSH With Reflex FT4 (CLH 0267)
84443
NCD 190.22
Yes
0785
TNFA
Tumor Necrosis Factor Alpha TNF-a (CLH 0785)
83520
   L37299
 
0525
URCUL
Urine Culture (CLH 0525)
87086
NCD 190.12
 
9049
URCULG
Urine Culture with Gram Stain (CLH 9049)
87086
87205
NCD 190.12

 
 
3319
CSA10
Urine Drug Substance Abuse 10 (CLH 3319)
80307
   L36668    A55001
 
3320
CSA10X
Urine Drug Substance Abuse 10 Reflex Confirmation (CLH 3320)
80307
   L36668    A55001
 
3317
CSA5
Urine Drug Substance Abuse 5 (CLH 3317)
80307
   L36668    A55001
 
3318
CSA5X
Urine Drug Substance Abuse 5 Reflex Confirmation (CLH 3318)
80307
   L36668    A55001
 
1092
PMPO
Urine Drug, Pain Management Panel w/Oxycodone (CLH 1092)
80307
   L36668    A55001
 
1094
PMPOA
Urine Drug, Pain Management Panel w/Oxycodone and Alcohol (CLH 1094)
80307
   L36668    A55001
 
1093
PMPOX
Urine Drug, Pain Management Panel w/Oxycodone, Reflex Confirmation (CLH 1093)
80307
   L36668    A55001
 
3343
URORSK
Urorisk Diagnostic Profile (CLH 3343)
82340
82570
82507
83986
83735
83945
84105
84133
84300
84560
84392




   L36702






 
 
 
 
 
 
 
 
 
 
 
3096
VEGF
Vascular Endothelial Growth Factor VEGF (CLH 3096)
83520
   L37299
 
4829
VD125
Vitamin D (1,25,OH2) (CLH 4829)
82652
   L36692
 
4830
VD25
Vitamin D (25-OH), Total (CLH 4830)
82306
   L36692
  Yes
3159
VID25
Vitamin D2, D3, and Total 25-OH (CLH 3159)
82306
   L36692
  Yes
0370
WBC
WBC (CLH 0370)
85048
NCD 190.15
 




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07/20/2019 01:38:29 54.92.148.165