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National
2021 Laboratory Fee Schedule
The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended
the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1
through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends
the suspension period to March 31, 2021.
Click here for more information.
Index:
Test Performed |
Part ## |
Procedure Code |
Medicare Coverage |
National Limit
|
FastPack® IP Free T4 Immunoassay |
25000043 |
84439
|
CCI
MUE
NCD
|
$9.02
|
FastPack® IP Prostate Specific Antigen (PSA) Immunoassay |
25000040 |
84153
|
CCI
MUE
NCD
|
$18.39
|
FastPack® IP Testosterone Immunoassay |
25000043 |
84403
|
CCI
MUE
|
$25.81
|
FastPack® IP Thyroid Stimulating Hormone (TSH) Immunoassay |
25000042 |
84443
|
CCI
MUE
NCD
|
$16.80
|
FastPack® IP Vitamin D Immunoassay |
25000068 |
82306
|
CCI
MUE
|
$29.60
|
FastPack® IP hCG Immunoassay |
25000044 |
84702
|
CCI
MUE
NCD
|
$15.05
|
FastPack® FastPack IP SHBG |
25000044 |
84270
|
CCI
MUE
|
$21.73
|
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
|

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
|
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
|
Test Performed |
Part # |
Procedure Code |
Medicare Coverage |
National Limit
|
OSOM® Influenza A & B Test If Influenza A alone is ordered; |
190 |
87804
|
CCI
MUE
|
$16.55
|
OSOM® Influenza A & B Test If Influenza B alone is ordered; |
190 |
87804
|
CCI
MUE
|
$16.55
|
OSOM® Influenza A & B Test If both Influenza A and Influenza B are ordered; |
190 |
87804 and 87804-59
|
CCI
MUE
|
$ 33.10
|
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
|
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
|
Test Performed |
Part # |
Procedure Code |
Medicare Coverage |
National Limit
|
OSOM® Ultra Flu A&B Test If both Influenza A and Influenza B are ordered; |
1006 |
87804-QW and 87804-QW-59
|
CCI
MUE
|
$ 33.10
|
OSOM® Ultra Flu A&B Test If Influenza A alone is ordered; |
1006 |
87804-QW
|
CCI
MUE
|
$16.55
|
OSOM® Ultra Flu A&B Test If Influenza B alone is ordered; |
1006 |
87804-QW
|
CCI
MUE
|
$16.55
|
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
|
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
|
Test Performed |
Part # |
Procedure Code |
Medicare Coverage |
National Limit
|
OSOM® Trichomonas Rapid Test |
181 |
87808-QW
|
CCI
MUE
|
$15.29
|
Test Performed |
Part # |
Procedure Code |
Medicare Coverage |
National Limit
|
OSOM® BVBLUE® Test |
183 |
87905-QW
|
CCI
MUE
|
$12.22
|
|