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National
2023 Laboratory Fee Schedule
Fee schedules do not reflect 2% Payment Adjustment (Sequestration).
Click here for more information.
RAPID DIAGNOSTIC TESTS
  • Acucy® Influenza A&B
  • OSOM® COVID-19 Antigen Rapid Test
  • OSOM® H. pylori
  • OSOM® iFOB Test
  • OSOM® Mono
  • OSOM® Strep A
  • OSOM® UltraPlus Flu A&B Test
  • OSOM® Ultra hCG Combo Test
    		• Women's Health
  • Pregnancy
  • Trichomonas
  • Bacterial Vaginosis
    • Acucy® Reader
    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 is 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




    OSOM® H. pylori
    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 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® Strep A
    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 are ordered;    		 1032 87804-QW
    and
    87804-QW-59
      CCI   MUE  
    		$ 33.10



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



    Pregnancy
    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



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



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

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