2024 Coding Reference

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Rapid & Molecular Reimbursement Summary

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Rapid Diagnostics

Molecular Diagnostics

Cell Culture & Fluorescent Tests

ELISA

VITROS ECi/ECiQ

VITROS 350/XT 3400

VITROS 3600

VITROS 4600


VITROS 5600

VITROS 7600



VITROS® XT 7600 Integrated System Download this page as PDF
Test Name CPT® Code(s) LOINC® Code     CPT® Description
Please Select a State
Medicare
Coverage
Medicare
Reimbursement
Acetaminophen
80143
3298-7
More
Acetaminophen
  CCI   MUE  
$ 18.64
AFP
82105
53962-7
More
Alpha-fetoprotein (AFP); serum
  CCI   MUE   NCD
$ 16.77
Alanine Aminotransferase/
Aspartate Aminotransferase
84460
1742-6 Transferase; alanine amino (ALT) (SGPT)
  CCI   MUE  
$ 5.30
Albumin
82040
1751-7
More
Albumin; serum, plasma or whole blood
  CCI   MUE  
$ 4.95
Albumin/Total Protein
84155
35706-1 Protein, total, except by refractometry; serum, plasma or whole blood
  CCI   MUE  
$ 3.67
Alcohol
82077
5643-2
More
Alcohol (ethanol); any specimen except urine and breath, immunoassay (eg, IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)
  CCI   MUE  
$ 17.27
Alkaline Phosphatase
84075
6768-6 Phosphatase, alkaline;
  CCI   MUE  
$ 5.18
Alpha 1-antitrypsin
82103
1825-9 Alpha-1-antitrypsin; total
  CCI   MUE  
$ 13.44
ALT
84460
1742-6 Transferase; alanine amino (ALT) (SGPT)
  CCI   MUE  
$ 5.30
ALTV
84460
1742-6 Transferase; alanine amino (ALT) (SGPT)
  CCI   MUE  
$ 5.30
Amikacin*
80150
35669-1 Amikacin
  CCI   MUE  
$ 15.08
Ammonia
82140
22763-7
More
Ammonia
  CCI   MUE  
$ 14.57
Amphetamines
80307
70138-3
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Amylase
82150
1798-8
More
Amylase
  CCI   MUE  
$ 6.48
Anti-HAV IgM
86709
13950-1 Hepatitis A antibody (HAAb), IgM antibody
  CCI   MUE  
$ 11.26
Anti-HAV Total
86708
13951-9 Hepatitis A antibody (HAAb)
  CCI   MUE  
$ 12.39
Anti-HBc
86704
22316-4 Hepatitis B core antibody (HBcAb); total
  CCI   MUE   NCD
$ 12.05
Anti-HBc IgM
86705
24113-3 Hepatitis B core antibody (HBcAb); IgM antibody
  CCI   MUE  
$ 11.77
Anti-HBe
86707
22321-4 Hepatitis Be antibody (HBeAb)
  CCI   MUE  
$ 11.57
Anti-HBs
86706
5193-8 Hepatitis B surface antibody (HBsAb)
  CCI   MUE   NCD
$ 10.74
Anti-HCV
86803
13955-0 Hepatitis C antibody;
  CCI   MUE  
$ 14.27
Anti-HIV 1+2
87389
31201-7 Infectious 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
  CCI   MUE  
$ 24.08
G0433
31201-7 Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening
  CCI   MUE   NCD
$ 18.29
Anti-SARS-CoV-2 IgG
86769
94505-5 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])
  CCI   MUE  
$ 42.13
Anti-SARS-CoV-2 IgG Quantitative
86769
94505-5 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])
  CCI   MUE  
$ 42.13
Anti-SARS-CoV-2 Total
86769
94505-5 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])
  CCI   MUE  
$ 42.13
Anti-SARS-CoV-2 Total Nucleocapsid
86769
94505-5 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])
  CCI   MUE  
$ 42.13
Apolipoprotein A1
82172
1869-7 Apolipoprotein, each
  CCI   MUE  
$ 21.09
Apolipoprotein B
82172
1884-6 Apolipoprotein, each
  CCI   MUE  
$ 21.09
ASO
86060
5370-2 Antistreptolysin 0; titer
  CCI   MUE  
$ 7.30
AST
84450
1920-8 Transferase; aspartate amino (AST) (SGOT)
  CCI   MUE  
$ 5.18
Barbiturates
80307
20664-9
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Basic Metabolic Panel
80048
51990-0 Basic 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)
  CCI   MUE  
$ 8.46
Benzodiazepines
80307
70140-9
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
BuBc
82248
33898-8 Bilirubin; direct
  CCI   MUE  
$ 5.02
BUN/Urea
84520
3094-0
More
Urea nitrogen; quantitative
  CCI   MUE  
$ 3.95
Buprenorphine/Suboxone*
80307
3413-2
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
C-Peptide
84681
1986-9
More
C-peptide
  CCI   MUE  
$ 20.81
C3
86160
4485-9 Complement; antigen, each component
  CCI   MUE  
$ 12.00
C4
86160
4498-2 Complement; antigen, each component
  CCI   MUE  
$ 12.00
CA 125 II
86304
10334-1 Immunoassay for tumor antigen, quantitative; CA 125
  CCI   MUE   NCD
$ 20.81
CA 15-3
86300
6875-9 Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)
  CCI   MUE   NCD
$ 20.81
CA 19-9
86301
24108-3 Immunoassay for tumor antigen, quantitative; CA 19-9
  CCI   MUE   NCD
$ 20.81
Caffeine
80155
3422-3
More
Caffeine
  CCI   MUE  
$ 38.57
Calcium
82310
17861-6
More
Calcium; total
  CCI   MUE  
$ 5.16
82331
17861-6
More
Calcium; after calcium infusion test
  CCI   MUE  
$ 13.34
82340
17861-6
More
Calcium; urine quantitative, timed specimen
  CCI   MUE  
$ 6.03
Carbamazepine
80156
3432-2
More
Carbamazepine; total
  CCI   MUE  
$ 14.57
Carbon Dioxide
82374
2024-8
More
Carbon dioxide (bicarbonate)
  CCI   MUE  
$ 4.88
CEA
82378
2039-6
More
Carcinoembryonic antigen (CEA)
  CCI   MUE   NCD
$ 18.96
Chloride
82435
2075-0
More
Chloride; blood
  CCI   MUE  
$ 4.60
82436
2075-0
More
Chloride; urine
  CCI   MUE  
$ 5.75
Cholesterol
82465
2093-3
More
Cholesterol, serum or whole blood, total
  CCI   MUE   NCD
$ 4.35
Cholinesterase
82480
2098-2 Cholinesterase; serum
  CCI   MUE  
$ 7.87
CK
82550
2157-6 Creatine kinase (CK), (CPK); total
  CCI   MUE  
$ 6.51
CK-MB
82553
49551-5 Creatine kinase (CK), (CPK); MB fraction only
  CCI   MUE  
$ 11.55
CKMB Mass
82553
50757-4
More
Creatine kinase (CK), (CPK); MB fraction only
  CCI   MUE  
$ 11.55
Cocaine Metabolites
80307
70146-6
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Comprehensive Metabolic Panel
80053
24323-8 Comprehensive 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)
  CCI   MUE  
$ 10.56
Comprehensive Metabolic Panel
80053
24323-8 Comprehensive 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)
  CCI   MUE  
$ 10.56
Cortisol
82533
2143-6
More
Cortisol; total
  CCI   MUE  
$ 16.30
Creatinine
82565
2160-0
More
Creatinine; blood
  CCI   MUE  
$ 5.12
82570
2160-0
More
Creatinine; other source
  CCI   MUE  
$ 5.18
CRP
86140
1988-5 C-reactive protein;
  CCI   MUE  
$ 5.18
Cyclosporine*
80158
3520-4
More
Cyclosporine
  CCI   MUE  
$ 18.05
Cystatin C*
82610
33863-2
More
Cystatin C
  CCI   MUE  
$ 18.52
D-Dimer*
85379
91556-1
More
Fibrin degradation products, D-dimer; quantitative
  CCI   MUE  
$ 10.18
Digoxin
80162
10535-3
More
Digoxin; total
  CCI   MUE   NCD
$ 13.28
Direct HDL
83718
9322-9
More
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
  CCI   MUE   NCD
$ 8.19
Direct LDL
83721
18262-6
More
Lipoprotein, direct measurement; LDL cholesterol
  CCI   MUE   NCD
$ 10.50
dTIBC
83540
2500-7
More
Iron
  CCI   MUE   NCD
$ 6.47
83550
2500-7
More
Iron binding capacity
  CCI   MUE   NCD
$ 8.74
Ecstasy*
80307
18356-6
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Electrolytes Panel
80051
55231-5 Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295)
  CCI   MUE  
$ 7.01
Estradiol
82670
2243-4
More
Estradiol; total
  CCI   MUE  
$ 27.94
Everolimus*
80169
50544-6 Everolimus
  CCI   MUE  
$ 13.73
Ferritin
82728
2276-4
More
Ferritin
  CCI   MUE   NCD
$ 13.63
Folate
82746
2284-8
More
Folic acid; serum
  CCI   MUE  
$ 14.70
82747
2284-8
More
Folic acid; RBC
  CCI   MUE  
$ 17.65
Free T3
84481
3051-0
More
Triiodothyronine T3; free
  CCI   MUE  
$ 16.94
Free T4
84439
3024-7
More
Thyroxine; free
  CCI   MUE   NCD
$ 9.02
FSH
83001
15067-2 Gonadotropin; follicle stimulating hormone (FSH)
  CCI   MUE  
$ 18.58
Gentamicin
80170
35668-3
More
Gentamicin
  CCI   MUE  
$ 16.38
GGT
82977
2324-2 Glutamyltransferase, gamma (GGT)
  CCI   MUE   NCD
$ 7.20
Glucose
82947
2345-7
More
Glucose; quantitative, blood (except reagent strip)
  CCI   MUE   NCD
$ 3.93
Glucose (csf)
82945
2342-4
More
Glucose, body fluid, other than blood
  CCI   MUE  
$ 3.93
Glucose/Calcium
80048
24320-4 Basic 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)
  CCI   MUE  
$ 8.46
Glycated Serum Protein*
82985
1758-2 Glycated protein
  CCI   MUE   NCD
$ 16.76
Haptoglobin
83010
4542-7 Haptoglobin; quantitative
  CCI   MUE  
$ 12.58
HbA1c
83036
41995-2
More
Hemoglobin; glycosylated (A1C)
  CCI   MUE   NCD
$ 9.71
HBeAg
87350
13953-5 Infectious 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)
  CCI   MUE  
$ 11.53
HBsAg
87340
5196-1 Infectious 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)
  CCI   MUE   NCD
$ 10.33
Hepatic Function Panel
80076
24325-3 Hepatic 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)
  CCI   MUE  
$ 8.17
Hepatitis Acute Panel
80074
24363-4 Acute 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)
  CCI   MUE   NCD
$ 47.63
Heroin Metabolite (6-MAM)*
80307
12788-6
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
HIV Combo
86703
95524-5 Antibody; HIV-1 and HIV-2, single result
  CCI   MUE   NCD
$ 13.71
Homocysteine
83090
13965-9 Homocysteine
  CCI   MUE  
$ 17.92
hsCRP
86141
30522-7 C-reactive protein; high sensitivity (hsCRP)
  CCI   MUE  
$ 12.95
Hydrocodone*
80307
12786-0
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
IgA
82784
2458-8 Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
  CCI   MUE  
$ 9.30
IgG
82784
2465-3 Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
  CCI   MUE  
$ 9.30
IgM
82784
2472-9 Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
  CCI   MUE  
$ 9.30
Insulin
83525
20448-7
More
Insulin; total
  CCI   MUE  
$ 11.43
Intact PTH
83970
2731-8
More
Parathormone (parathyroid hormone)
  CCI   MUE  
$ 41.28
Iron
83540
2498-4
More
Iron
  CCI   MUE   NCD
$ 6.47
Kappa Free Light Chain*
83883
36916-5
More
Nephelometry, each analyte not elsewhere specified
  CCI   MUE  
$ 13.60
Lactate
83605
14118-4 Lactate (lactic acid)
  CCI   MUE  
$ 11.57
Lambda Free Light Chain*
83883
38178-0
More
Nephelometry, each analyte not elsewhere specified
  CCI   MUE  
$ 13.60
LDHi
83615
14804-9 Lactate dehydrogenase (LD), (LDH);
  CCI   MUE  
$ 6.04
LH
83002
10501-5 Gonadotropin; luteinizing hormone (LH)
  CCI   MUE  
$ 18.52
Lipase
83690
3040-3 Lipase
  CCI   MUE  
$ 6.89
Lipid Panel
80061
100898-6 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)
  CCI   MUE   NCD
$ 13.39
Lithium
80178
14334-7 Lithium
  CCI   MUE  
$ 6.61
Lp(a)*
83695
1881-2
More
Lipoprotein (a)
  CCI   MUE  
$ 14.32
Magnesium
83735
19123-9
More
Magnesium
  CCI   MUE  
$ 6.70
Methadone
80307
70147-4
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Methadone Metabolite (EDDP)*
80307
60071-8
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Methotrexate*
80204
80969-9
More
Methotrexate
  CCI   MUE  
$ 38.57
Microalbumin
82043
14957-5 Albumin; urine (eg, microalbumin), quantitative
  CCI   MUE  
$ 5.78
Mycophenolic Acid*
80180
23905-3
More
Mycophenolate (mycophenolic acid)
  CCI   MUE  
$ 18.05
Myoglobin
83874
2639-3 Myoglobin
  CCI   MUE  
$ 12.92
NT-proBNP
83880
33763-4 Natriuretic peptide
  CCI   MUE  
$ 39.26
NTx
82523
14115-0 Collagen cross links, any method
  CCI   MUE   NCD
$ 18.68
Opiates
80307

More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Oxycodone*
80307

More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
PCP
80307
19659-2
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Phenobarbital
80184
3948-7 Phenobarbital
  CCI   MUE  
$ 15.30
Phenytoin
80185
3968-5
More
Phenytoin; total
  CCI   MUE  
$ 13.25
Phosphorus
84100
2777-1
More
Phosphorus inorganic (phosphate);
  CCI   MUE  
$ 4.74
84105
2777-1
More
Phosphorus inorganic (phosphate); urine
  CCI   MUE  
$ 5.78
Potassium
84132
2823-3
More
Potassium; serum, plasma or whole blood
  CCI   MUE  
$ 4.76
84133
2823-3
More
Potassium; urine
  CCI   MUE  
$ 4.73
Prealbumin
84134
14338-8 Prealbumin
  CCI   MUE  
$ 14.59
Procalcitonin
84145
33959-8
More
Procalcitonin (PCT)
  CCI   MUE  
$ 27.22
Progesterone
84144
2839-9
More
Progesterone
  CCI   MUE  
$ 20.86
Prolactin
84146
2842-3
More
Prolactin
  CCI   MUE  
$ 19.38
Propoxyphene*
80307
3543-6
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
PSA
84153
2857-1 Prostate specific antigen (PSA); total
  CCI   MUE   NCD
$ 18.39
G0103
2857-1 Prostate cancer screening; prostate specific antigen test (psa)
  CCI   MUE   NCD
$ 19.31
Renal Function Panel
80069
24362-6 Renal 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)
  CCI   MUE  
$ 8.68
RF
86431
11572-5 Rheumatoid factor; quantitative
  CCI   MUE  
$ 5.67
Rubella IgG
86762
40667-8 Antibody; rubella
  CCI   MUE  
$ 14.39
ß-hydroxybuturate*
82010
29512-1
More
Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative
  CCI   MUE  
$ 8.17
Salicylate
80179
4024-6
More
Salicylate
  CCI   MUE  
$ 18.64
SARS-CoV-2 Antigen
87426
94558-4 Infectious 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])
  CCI   MUE  
$ 35.33
Sodium
84295
2951-2
More
Sodium; serum, plasma or whole blood
  CCI   MUE  
$ 4.81
84300
2951-2
More
Sodium; urine
  CCI   MUE  
$ 5.06
T3 Uptake
84479
3050-2 Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)
  CCI   MUE   NCD
$ 6.47
Tacrolimus*
80197
11253-2
More
Tacrolimus
  CCI   MUE  
$ 13.73
Testosterone
84403
2986-8
More
Testosterone; total
  CCI   MUE  
$ 25.81
THC
80307
70143-3
More
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Theophylline
80198
4049-3
More
Theophylline
  CCI   MUE  
$ 14.14
Tobramycin
80200
35670-9
More
Tobramycin
  CCI   MUE  
$ 16.13
Total Bilirubin
82247
1975-2
More
Bilirubin; total
  CCI   MUE  
$ 5.02
Total Bilirubin/Alkaline Phosphatase
82247
Bilirubin; total
  CCI   MUE  
$ 5.02
84075
Phosphatase, alkaline;
  CCI   MUE  
$ 5.18
Total Protein
84155
2885-2 Protein, total, except by refractometry; serum, plasma or whole blood
  CCI   MUE  
$ 3.67
Total Protein (csf)
84157
2880-3 Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)
  CCI   MUE  
$ 4.00
Total ß-hCG Generation II
84702
2116-2
More
Gonadotropin, chorionic (hCG); quantitative
  CCI   MUE   NCD
$ 15.05
Total T3
84480
3053-6
More
Triiodothyronine T3; total (TT-3)
  CCI   MUE  
$ 14.18
Total T4
84436
3026-2
More
Thyroxine; total
  CCI   MUE   NCD
$ 6.87
Transferrin
84466
3034-6 Transferrin
  CCI   MUE   NCD
$ 12.76
Tricyclic antidepressants*
80337
10552-8 Antidepressants, tricyclic and other cyclicals; 6 or more
  CCI   MUE  
TBD
Triglyceride/Cholesterol
80061
100898-6 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)
  CCI   MUE   NCD
$ 13.39
Triglycerides
84478
2571-8
More
Triglycerides
  CCI   MUE   NCD
$ 5.74
Troponin I ES
84484
10839-9 Troponin, quantitative
  CCI   MUE  
$ 12.47
TSH
84443
11579-0 Thyroid stimulating hormone (TSH)
  CCI   MUE   NCD
$ 16.80
Urea/Creatinine
84520
56997-0 Urea nitrogen; quantitative
  CCI   MUE  
$ 3.95
82540
56997-0 Creatine
  CCI   MUE  
$ 4.64
Uric Acid
84550
3084-1
More
Uric acid; blood
  CCI   MUE  
$ 4.52
84560
3084-1
More
Uric acid; other source
  CCI   MUE  
$ 5.08
Urine Protein
84156
2888-6 Protein, total, except by refractometry; urine
  CCI   MUE  
$ 3.67
Valproic Acid
80164
4086-5
More
Valproic acid (dipropylacetic acid); total
  CCI   MUE  
$ 13.54
Vancomycin
80202
20578-1
More
Vancomycin
  CCI   MUE  
$ 13.54
Vitamin B12
82607
2132-9 Cyanocobalamin (Vitamin B-12);
  CCI   MUE  
$ 15.08
Vitamin D
82306
1989-3
More
Vitamin D; 25 hydroxy, includes fraction(s), if performed
  CCI   MUE  
$ 29.60
Wide-Range CRP*
86141
71426-1 C-reactive protein; high sensitivity (hsCRP)
  CCI   MUE  
$ 12.95

  For Medicare Clinical Laboratory Fee Schedule, go to www.cms.hhs.gov.

*QW modifier is added to report use of CLIA-waived test system(s) for Medicare/Medicaid claims.

CMS has set the effective date for the addition of the QW modifier with 87420 and 87430 as October 6, 2020 and an implementation date of July 6, 2021. That means Medicare/Medicaid have until July 6, 2021 to update their systems to accept the QW modifier with these codes. We recommend customers check with their payers prior to submitting claims to verify if their system has been updated.

Effective January 1, 2010, CPT 81025 DOES NOT require a QW modifier to be recognized as a waived test. Source: CMS Job Aid 6685.

This information is being provided as a reference, for informational purposes only, with no expressed or implied warranty and does not purport to provide legal or certified coding advice. Under Federal and State law, it is the individual provider's responsibility to determine appropriate coding, charges and claims for a particular service. Policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. Quidel Corporation strongly recommends that providers contact their contracted payers to determine appropriate coding and charge or payment levels prior to submitting claims.

The information contained in this website has been compiled by CodeMap, L.L.C. who remains solely responsible for its content. The information provided is for general educational purposes only and may not be conclusive or exhaustive. Reimbursement information does not indicate overage for these services. While every effort is made to ensure that all payment amounts and regulatory information is current and complete, it is the responsibility of each user to verify specific coverage and payment information with their Medicare contractors. Actual reimbursement for healthcare facilities will vary depending on local carrier coverage and payment policies. Recent changes in applicable law, regulations and interpretations may not be reflected in the information contained herein.

This website is a private website and is not associated, endorsed or authorized by the Department of Health and Human Services, the Center for Medicare and Medicaid Services or any other public or government organization or agency.

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02/23/2024 11:54:52 100.26.196.222