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National
2024 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
  • Metrix® COVID-19 Test
  • OSOM® Flu SARS-CoV-2 Combo 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


    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


    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 87428-QW
      CCI   MUE  
    		$70.29




    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

    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. For technical questions, please contact CodeMap at (847) 381-5465.

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