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National
2020 Laboratory Fee Schedule
Effective April 1, 2013 and while sequestration is in effect, all CMS payments for services will be reduced by 2%.
The fees below do not reflect this reduction. Click here for more information.
Index:
POINT OF CARE IMMUNOASSAY TESTING

  • FastPack® IP Free T4 Immunoassay
  • FastPack® IP Prostate Specific Antigen (PSA) Immunoassay
  • FastPack® IP Testosterone Immunoassay
  • FastPack® IP Thyroid Stimulating Hormone (TSH) Immunoassay
  • FastPack® IP Vitamin D Immunoassay
  • FastPack® IP hCG Immunoassay
  • FastPack® FastPack IP SHBG
    		•  RAPID DIAGNOSTIC TESTS

    Family Health
  • Acucy® Influenza A&B
  • Silaris® Influenza and RSV
  • OSOM® H. pylori
  • OSOM® iFOB Test
  • OSOM® Influenza A & B
  • OSOM® Mono
  • OSOM® Strep A
  • OSOM® Ultra Flu A&B Test
  • OSOM® Ultra hCG Combo Test

    Women's Health
  • Pregnancy
  • Trichomonas
  • Bacterial Vaginosis
    • FastPack® IP
    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


    Acucy® Influenza A&B
    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




    Silaris® Influenza and RSV
    Test Performed Part # Procedure Code Medicare Coverage National Limit
    Silaris® Influenza A&B Test 1027 87502-QW
      CCI   MUE  
    		$95.80
    Silaris® RSV 1030 87634-QW
      CCI   MUE  
    		$70.20



    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® Influenza A & B
    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



    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® Ultra Flu A&B Test
    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



    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