National
2025 Laboratory Fee Schedule
Fee schedules do not reflect 2% Payment Adjustment (Sequestration)

DIAGNOSTIC TESTS
  • Acucy® Influenza A&B
  • Metrix® COVID-19
  • Metrix® COVID/Flu
  • OSOM® COVID-19 Antigen Rapid Test
  • OSOM® Flu SARS-CoV-2 Combo Test
  • OSOM® H. pylori
  • OSOM® iFOB
  • OSOM® Mono
  • OSOM® RSV
  • OSOM® Strep A
  • OSOM® UltraPlus Flu A&B
    		• WOMEN'S HEALTH TESTS
  • OSOM® Bacterial Vaginosis
  • OSOM® Pregnancy
  • OSOM® Trichomonas Rapid Test
  • OSOM® Ultra hCG Combo Test
    • Acucy® Influenza A&B Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    Acucy® Influenza A&B Test
    If Influenza A alone is ordered    		 1010 87804-QW
      CCI   MUE  
    		$16.55
    Acucy® Influenza A&B Test

    If Influenza B alone is ordered    		 1010 87804-QW
      CCI   MUE  
    		$16.55
    Acucy® Influenza A&B Test
    If both Influenza A and Influenza B are ordered    		 1010 87804-QW
    87804-QW-59
      CCI   MUE  
    		$ 33.10


    OSOM® COVID-19 Antigen Rapid Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® COVID-19 Antigen Rapid Test 40 Tests 1066-40 87811-QW
      CCI   MUE  
    		$41.38


    Metrix® COVID-19 Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    Metrix® COVID-19 25 Test Kit MTRX-C19-25PK 87635-QW
      CCI   MUE  
    		$51.31


    Metrix® COVID/Flu Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    Metrix® COVID/Flu Test 25 Test Kit MTRX-C19+FLU-25PK 87636-QW
      CCI   MUE  
    		$142.63


    OSOM® Flu SARS-CoV-2 Combo Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® Flu SARS-CoV-2 Combo Test (25 Tests) 1080 87811-QW
      CCI   MUE  
    		$41.38
    87804-QW
      CCI   MUE  
    		$16.55
    87804-QW-59
      CCI   MUE  
    		$16.55
    Total if all tests are ordered and performed: $74.48

    OR
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® Flu SARS-CoV-2 Combo Test (25 Tests) 1080 87428-QW
      CCI   MUE  
    		$70.29


    OSOM® H. pylori Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® H. pylori Whole Blood 175 86318
      CCI   MUE  
    		$18.09
    OSOM® H. pylori Serum or plasma 175 86677
      CCI   MUE  
    		$16.85


    OSOM® iFOB Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® iFOB Test 25 Tests 1002 Diagnostic: 82274-QW
      CCI   MUE  
    		$15.92
    OSOM® iFOB Test 25 Tests 1002 Screening: G0328-QW
      CCI   MUE   NCD
    		$18.05


    OSOM® Mono Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® Mono Test 145 86308-QW
      CCI   MUE  
    		$5.18
    OSOM® Mono Test 145 86308
      CCI   MUE  
    		$5.18


    OSOM® RSV Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® RSV Test (25 Tests) 1091 87807-QW
      CCI   MUE  
    		$13.10


    OSOM® Strep A Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® Strep A 50 Test 141 87880-QW
      CCI   MUE  
    		$16.53
    OSOM® Ultra Strep A 25 Test 147 87880-QW
      CCI   MUE  
    		$16.53
    OSOM® Ultra Strep A 50 Test 149 87880-QW
      CCI   MUE  
    		$16.53


    OSOM® UltraPlus Flu A&B Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    Osom® Ultraplus Flu A&B Test
    If Influenza A alone is ordered    		 1032 87804-QW
      CCI   MUE  
    		$16.55
    Osom® Ultraplus Flu A&B Test
    If Influenza B alone is ordered    		 1032 87804-QW
      CCI   MUE  
    		$16.55
    Osom® Ultraplus Flu A&B Test
    If both Influenza A and Influenza B is ordered    		 1032 87804-QW
    87804-QW-59
      CCI   MUE  
    		$ 33.10


    OSOM® Bacterial Vaginosis Test


    		Commonly Associated Diagnosis Codes
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® Bacterial Vaginosis Test 183 87905-QW
      CCI   MUE  
    		$12.22


    OSOM® Pregnancy Tests
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® HCG Urine 50 Test Kit (Dipstick) 101 81025-QW
      CCI   MUE  
    		$8.61
    OSOM® Card Pregnancy 25 Test 102 81025-QW
      CCI   MUE  
    		$8.61
    OSOM® HCG Combo (Urine) 124 81025-QW
      CCI   MUE  
    		$8.61
    OSOM® HCG Combo (Serum) 124 84703
      CCI   MUE  
    		$7.52


    OSOM® Trichomonas Rapid Test

         		Commonly Associated Diagnosis Codes
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® Trichomonas Rapid Test 181 87808-QW
      CCI   MUE  
    		$15.29


    OSOM® Ultra HCG Combo Test
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    OSOM® Ultra HCG Combo Test (Urine) 1004 81025
      CCI   MUE  
    		$8.61
    OSOM® Ultra HCG Combo Test (Serum) 1004 84703
      CCI   MUE  
    		$7.52





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