beacon hipaa x walk covered services grid...

Beacon HIPAA X_Walk Covered Services Grid 05/01/2020

Service Class DescriptionService Class Description

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ALL)

Form Type (blank = 837P/HCFA

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Inpatient Psychiatric Services IPC Extended Care 0904 01 010 21 per diem 837I/UB I I PP IP Y PSY N DOD



Inpatient Psychiatric Services IPE Enhanced 0204 01 010 21 per diem 837I/UB I I PP IP Y PSY N DOD



Inpatient Psychiatric Services IPA Acute 0124 01 010 21 per diem 837I/UB I I PP IP Y PSY N DOD



Inpatient Psychiatric Services IPP Specialized 0114 01 010 21 per diem 837I/UB I I PG IG Y PSY N DOD



Inpatient Psychiatric Services IPW Extended Acute Care 0120 01 010 21 per diem 837I/UB I I PP IP Y PSY N DOD



Inpatient Dual Diagnosis IPD Other (Dual) 0929 01 010 21 per diem 837I/UB I I UI IF Y SUB N DOD



Inpatient Drug & Alcohol Services IDD Inpatient Withdrawal Management 4WM 0126 01 010 21 per diem 837I/UB I I D DT Y SUB N DOD



Inpatient Drug & Alcohol Services IDR Inpatient Residential Level 4 0128 01 010 21 per diem 837I/UB I I SR RE Y SUB N DOD



Non-Hospital Drug & Alcohol NHD Withdrawal Management 3.7 H0013 11 132 99 per diem R R SD DT Y SUB Y DOD

Non-Hospital Drug & Alcohol NHSClinically Managed, High Intensity Residential Services (3.5 R) H0018 HF 11 133 99 per diem R R SR RE Y SUB Y DOD

Non-Hospital Drug & Alcohol NHS Medically Monitored Intensive Inpatient Services (3.7) H0018 HF 11 133 99 per diem R R SR RE Y SUB Y DOD

Non-Hospital Drug & Alcohol NHSClinically Managed, High Intesity Residential Services (3.5 R) Dual H0018 HH 11 133 99 per diem R R SR RE Y SUB Y DOD

Non-Hospital Drug & Alcohol NHSMedically Monitored Intensive Inpatient Services (3.7) Dual H0018 HH 11 133 99 per diem R R SR RE Y SUB Y DOD

Non-Hospital Drug & Alcohol NHL Long Term Rehab 3.5 H Highest Intensity T2048 HF 11 134 99 per diem R R SR RE Y SUB Y DOD

Non-Hospital Drug & Alcohol NHH Halfway House 3.1 H2034 11 131 99 per diem R R SA DA Y SUB Y DOD

Non-Hospital Drug & Alcohol NHH Halfway House for Women with Children 3.1 H2034 U3 11 131 99 per diem R R SA DA Y SUB Y DOD

Non-Hospital Drug & Alcohol ST3 Short Term Rehab 3.5 H0018 SC 11 133 99 per diem R R SD NA Y SUB Y DOD

Non-Hospital Drug & Alcohol AR3 Long Term Rehab 3.1 T2048 SC 11 134 99 per diem R R SR NA Y SUB Y DOD

Non-Hospital Drug & Alcohol YES Adolescent Male Rehab YES Program H0018 U5 U9 11 133 99 per diem R R SR RE Y SUB Y DOD

Non-Hospital Drug & Alcohol AR2 Non-Hosp Adol Rehab Long Term (3.1) T2048 UB U9 11 134 99 per diem R R SR RE Y SUB Y DOD

Non-Hospital Drug & Alcohol STR Short Term Rehab (3B) 3.5 H0018 U9 11 133 99 per diem R R SR RE Y SUB Y DOD



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Non-Hospital Dual NHA Adult Res/Dual H0018 HE 11 133 99 per diem R R UD DD Y SUB Y DOD

Non-Hospital Drug & Alcohol ERB Enhanced Residential (Glenbeigh Only) H0018 U4 11 133 99 per diem R R SR RE Y SUB Y DOD

Residential Treatment Facility RF1 Transitional RTF JCAHO 0949 01 013 56 per diem 837I/UB R R D DT Y PSY N DOD

Residential Treatment Facility RF1 Transitional RTF JCAHO 0949 01 013 56 per diem 837I/UB R R SR RE Y PSY N DOD

Residential Treatment Facility RF1 Transitional RTF JCAHO 0949 01 013 56 per diem 837I/UB R R P NA Y PSY N DOD

Residential Treatment Facility RF1 JCAHO 0154 01 013 56 per diem 837I/UB R R D DT Y PSY N DOD

Residential Treatment Facility RF1 JCAHO 0154 01 013 56 per diem 837I/UB R R SR RE Y PSY N DOD

Residential Treatment Facility RF1 JCAHO 0154 01 013 56 per diem 837I/UB R R P NA Y PSY N DOD

Residential Treatment Facility RF2 Transitional RTF JCAHO/Reserve Bed Day 0919 01 013 56 per diem 837I/UB R R D NA Y PSY N DOD

Residential Treatment Facility RF2 Transitional RTF JCAHO/Reserve Bed Day 0919 01 013 56 per diem 837I/UB R R SR NA Y PSY N DOD

Residential Treatment Facility RF2 JCAHO/Reserve Bed Day 0134 01 013 56 per diem 837I/UB R R D DT Y PSY N DOD

Residential Treatment Facility RF2 JCAHO/Reserve Bed Day 0134 01 013 56 per diem 837I/UB R R SR RE Y PSY N DOD

Residential Treatment Facility RF2 JCAHO/Reserve Bed Day 0134 01 013 56 per diem 837I/UB R R P NA Y PSY N DOD

Residential Treatment Facility RF3 Non-JCAHO/Comp (R&B) T2048 U7 56 560 56 per diem R R P NA Y PSY N DOD

Residential Treatment Facility RF4 Non-JCAHO TX Only H0019 SC 56 560 56 per diem R R P NA Y PSY N DOD

Residential Treatment Facility RF5 Non-JCAHO/Reserve Bed Day Comp (R&B) T2048 U3 56 560 56 per diem R R P NA Y PSY N DOD

Residential Treatment Facility RF6 Non-JCAHO/Reserve Bed Day Tx Only H0019 U4 56 560 56 per diem R R P NA Y PSY N DOD

Residential Treatment Facility DAS Accredited Diversion and Stabilization Unit 0911 01 013 56 per diem R R D NA Y PSY Y DOD

Residential Treatment Facility DAS Accredited Diversion and Stabilization Unit 0911 01 013 56 per diem R R SR NA Y PSY Y DOD

Residential Treatment Facility DAS Accredited Diversion and Stabilization Unit 0911 01 013 56 per diem R R P NA Y PSY Y DOD

Residential Treatment Facility LTR Long Term Structured Residential - Treatment H0037 11 110 99 per diem R R P NA Y PSY Y DOD

Residential Treatment Facility LTB Long Term Structured Residential - Room & Board T2048 HE 11 110 99 per diem R R P NA Y PSY Y DOD

Residential Treatment Facility RTF Non hospital residential treatment program H0018 11 110 99 per diem R P P NA Y PSY Y DOD

Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Moderate to High, at bedside 99255 09 103 21 110 min I I P NA N PSY N DOS

Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Moderate to High, at bedside 99255 09 103 21 110 min I I SA DA N SUB N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused exam; medical decision making that is straightforward or of low complexity 99231 U1 09 103 21 15 min I I PA NA N PSY N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused exam; medical decision making that is straightforward or of low complexity 99231 U1 09 103 21 15 min I I SA DA N SUB N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused exam; medical decision making of moderate complexity 99232 U1 09 103 21 25 min I I P NA N PSY N DOS



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Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused exam; medical decision making of moderate complexity 99232 U1 09 103 21 25 min I I SA DA N SUB N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: a detailed interval history; a detailed exam; medical decision making of high complexity 99233 U1 09 103 21 35 min I I P NA N PSY N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: a detailed interval history; a detailed exam; medical decision making of high complexity 99233 U1 09 103 21 35 min I I SA DA N SUB N DOS

Consultations CNSHome Visit for Eval & Mgmt of New Patient, Problem Low, face to face with the patient and/or family 99341 09 103 12 20 min I I P NA N PSY N DOD

Consultations CNSHome Visit for Eval & Mgmt of New Patient, Problem Low, face to face with the patient and/or family 99341 09 103 12 20 min I I SA NA N SUB N DOD

Consultations CNSome Visit for Eval & Mgmt of New Patient, Problem Moderate, face to face with the patient and/or family 99342 09 103 12 30 min I I P NA N PSY N DOD

Consultations CNSome Visit for Eval & Mgmt of New Patient, Problem Moderate, face to face with the patient and/or family 99342 09 103 12 30 min I I SA NA N SUB N DOD

Consultations CNSHome Visit for Eval & Mgmt of New Patient, Problem High, face to face with the patient and/or family 99343 09 103 12 45 min I I P NA N PSY N DOD

Consultations CNSHome Visit for Eval & Mgmt of New Patient, Problem High, face to face with the patient and/or family 99343 09 103 12 45 min I I SA NA N SUB N DOD

Consultations CNS

Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a detailed or comprehensive history; a detailed or comprehensive examination; and a medical decision making that is straightforward or of low complexity 99304 09 103 31 visit I I P NA N PSY N DOD

Consultations CNS


Consultations CNS

Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a detailed or comprehensive history; a detailed or comprehensive examination; and a medical decision making that is straightforward or of low complexity 99304 09 103 31 visit I I SA NA N SUB N DOD



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Consultations CNS


Consultations CNS

Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity 99305 09 103 31 visit I I P NA N PSY N DOD

Consultations CNS


Consultations CNS

Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity 99305 09 103 31 visit I I SA NA N SUB N DOD

Consultations CNS


Consultations CNS

Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity 99306 09 103 31 visit I I p NA N PSY N DOD

Consultations CNS


Consultations CNS

Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity 99306 09 103 31 visit I I SA NA N SUB N DOD

Consultations CNS




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Consultations CNS New Patient/Focused Examination 99201 31 339 21 per event I I P NA N PSY N DOD

Consultations CNS New Patient/Focused Examination 99201 31 339 21 per event I I SA DA N SUB N DOD

Consultations CNS New Patient/Expanded Examination 99202 31 339 21 per event I I P NA N PSY N DOD

Consultations CNS New Patient/Expanded Examination 99202 31 339 21 per event I I SA DA N SUB N DOD

Consultations CNS Office or Other Outpatient Visit for the 99203 31 339 21 per event I I P NA N PSY N DOD

Consultations CNS Office or Other Outpatient Visit for the 99203 31 339 21 per event I I SA DA N SUB N DOD

Consultations CNS New Patient/Comprehensive Examination 99204 31 339 21 per event I I P DA N PSY N DOD

Consultations CNS New Patient/Comprehensive Examination 99204 31 339 21 per event I I SA DA N SUB N DOD

Consultations CNS Established Patient/Evaluation 99211 31 339 21 per event I I P NA N PSY N DOD

Consultations CNS Established Patient/Evaluation 99211 31 339 21 per event I I SA DA N SUB N DOD

Consultations CNS Established Patient/Focused Examination 99212 31 339 21 per event I I PA NA N PSY N DOD

Consultations CNS Established Patient/Focused Examination 99212 31 339 21 per event I I SA DA N SUB N DOD

Consultations CNS Established Patient/Expanded Examination 99213 31 339 21 per event I I PA NA N PSY N DOD

Consultations CNS Established Patient/Expanded Examination 99213 31 339 21 per event I I SA DA N SUB N DOD

Consultations CNS Office or Other Outpatient Visit for the Eval 99214 31 339 21 per event I I PA NA N PSY N DOD

Consultations CNS Office or Other Outpatient Visit for the Eval 99214 31 339 21 per event I I SA DA N SUB N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem Low, at bedside 99221 U1 31 339 21 30 min I I P NA N PSY N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem Low, at bedside 99221 U1 31 339 21 30 min I I SA NA N SUB N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem Moderate, at bedside 99222 U1 31 339 21 50 min I I P NA N PSY N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem Moderate, at bedside 99222 U1 31 339 21 50 min I I SA NA N SUB N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem High, at bedside 99223 U1 31 339 21 70 min I I P NA N PSY N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem High, at bedside 99223 U1 31 339 21 70 min I I SA NA N SUB N DOD

Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Self Ltd or Minor, at bedside 99251 31 339 21 20 min I I P NA N PSY N DOS

Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Self Ltd or Minor, at bedside 99251 31 339 21 20 min I I SA DA N SUB N DOS





Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Low, at bedside 99252 31 339 21 40 min I I P NA N PSY N DOS

Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Low, at bedside 99252 31 339 21 40 min I I SA DA N SUB N DOS





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Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Moderate, at bedside 99253 31 339 21 55 min I I P NA N PSY N DOS

Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Moderate, at bedside 99253 31 339 21 55 min I I SA DA N SUB N DOS





Consultations CNSInitial Inpatient Consult for New or Established Patient, Problem Moderate to High, at bedside 99254 31 339 21 80 min I I PA NA N PSY N DOS












Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused exam; medical decision making that is straightforward or of low complexity 99231 U1 31 339 21 15 min I I PA NA N PSY N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused exam; medical decision making that is straightforward or of low complexity 99231 U1 31 339 21 15 min I I SA DA N SUB N DOS



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Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused exam; medical decision making of moderate complexity 99232 U1 31 339 21 25 min I I P NA N PSY N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused exam; medical decision making of moderate complexity 99232 U1 31 339 21 25 min I I SA DA N SUB N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: a detailed interval history; a detailed exam; medical decision making of high complexity 99233 U1 31 339 21 35 min I I P NA N PSY N DOS

Consultations CNS

Subsequent hospital care, per day, for eval & mgmt of a patient, which requires at least 2 of these 3 key components: a detailed interval history; a detailed exam; medical decision making of high complexity 99233 U1 31 339 21 35 min I I SA DA N SUB N DOS

Consultations CNSHome Visit for Eval & Mgmt of New Patient, Problem Low, face to face with the patient and/or family 99341 31 339 12 20 min I I P NA N PSY N DOD

Consultations CNSHome Visit for Eval & Mgmt of New Patient, Problem Low, face to face with the patient and/or family 99341 31 339 12 20 min I I SA NA N SUB N DOD

Consultations CNSome Visit for Eval & Mgmt of New Patient, Problem Moderate, face to face with the patient and/or family 99342 31 339 12 30 min I I P NA N PSY N DOD

Consultations CNSome Visit for Eval & Mgmt of New Patient, Problem Moderate, face to face with the patient and/or family 99342 31 339 12 30 min I I SA NA N SUB N DOD

Consultations CNSHome Visit for Eval & Mgmt of New Patient, Problem High, face to face with the patient and/or family 99343 31 339 12 45 min I I P NA N PSY N DOD

Consultations CNSHome Visit for Eval & Mgmt of New Patient, Problem High, face to face with the patient and/or family 99343 31 339 12 45 min I I SA NA N SUB N DOD

Consultations CNS


Consultations CNS




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Consultations CNS


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Consultations CNS


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Consultations CNS


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Consultations CNS




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Consultations CNS


Consultations CNS


Consultations CNS

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem focused interval history; a problem focused examination; straightforward medical decision making 99307 31 339 31 visit I I P NA N PSY N DOD

Consultations CNS


Consultations CNS

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem focused interval history; a problem focused examination; straightforward medical decision making 99307 31 339 31 visit I I SA NA N SUB N DOD

Consultations CNS


Consultations CNS

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity 99308 31 339 31 visit I I P NA N PSY N DOD

Consultations CNS




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Consultations CNS

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity 99308 31 339 31 visit I I SA NA N SUB N DOD

Consultations CNS


Consultations CNS

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a detailed interval history; a detailed examination; medical decision making of moderate complexity 99309 31 339 31 visit I I P NA N PSY N DOD

Consultations CNS


Consultations CNS

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a detailed interval history; a detailed examination; medical decision making of moderate complexity 99309 31 339 31 visit I I SA NA N SUB N DOD

Consultations CNS


Consultations CNS

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a comprehensive interval history; a comprehensive examination; medical decision making of high complexity 99310 31 339 31 visit I I P NA N PSY N DOD

Consultations CNS




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Consultations CNS

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a comprehensive interval history; a comprehensive examination; medical decision making of high complexity 99310 31 339 31 visit I I SA NA N SUB N DOD

Consultations CNS


Consultations CNS New Patient/Focused Examination 99201 09 103 21 per event I I P NA N PSY N DOD

Consultations CNS New Patient/Focused Examination 99201 09 103 21 per event I I SA DA N SUB N DOD

Consultations CNS New Patient/Expanded Examination 99202 09 103 21 per event I I P NA N PSY N DOD

Consultations CNS New Patient/Expanded Examination 99202 09 103 21 per event I I SA DA N SUB N DOD

Consultations CNS Office or Other Outpatient Visit for the 99203 09 103 21 per event I I P NA N PSY N DOD

Consultations CNS Office or Other Outpatient Visit for the 99203 09 103 21 per event I I SA DA N SUB N DOD

Consultations CNS New Patient/Comprehensive Examination 99204 09 103 21 per event I I P DA N PSY N DOD

Consultations CNS New Patient/Comprehensive Examination 99204 09 103 21 per event I I SA DA N SUB N DOD

Consultations CNS Established Patient/Evaluation 99211 09 103 21 per event I I P NA N PSY N DOD

Consultations CNS Established Patient/Evaluation 99211 09 103 21 per event I I SA DA N SUB N DOD

Consultations CNS Established Patient/Focused Examination 99212 09 103 21 per event I I PA NA N PSY N DOD

Consultations CNS Established Patient/Focused Examination 99212 09 103 21 per event I I SA DA N SUB N DOD

Consultations CNS Established Patient/Expanded Examination 99213 09 103 21 per event I I PA NA N PSY N DOD

Consultations CNS Established Patient/Expanded Examination 99213 09 103 21 per event I I SA DA N SUB N DOD

Consultations CNS Office or Other Outpatient Visit for the Eval 99214 09 103 21 per event I I PA NA N PSY N DOD

Consultations CNS Office or Other Outpatient Visit for the Eval 99214 09 103 21 per event I I SA DA N SUB N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem Low, at bedside 99221 U1 09 103 21 30 min I I P NA N PSY N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem Low, at bedside 99221 U1 09 103 21 30 min I I SA NA N SUB N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem Moderate, at bedside 99222 U1 09 103 21 50 min I I P NA N PSY N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem Moderate, at bedside 99222 U1 09 103 21 50 min I I SA NA N SUB N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem High, at bedside 99223 U1 09 103 21 70 min I I P NA N PSY N DOD

Consultations CNSInitial Hospital Care, per Day, for Eval & Mgmt of Patient, Problem High, at bedside 99223 U1 09 103 21 70 min I I SA NA N SUB N DOD







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Inpatient Physicians Services BED Initial Hosp Eval/Low 99221 31 339 21 30 min I I P NA Y PSY N DOD

Inpatient Physicians Services BED Initial Hosp Eval/Low 99221 31 339 21 30 min I I SA DA Y SUB N DOD

Inpatient Physicians Services BED Initial Hosp Eval/Mod 99222 31 339 21 50 min I I P NA Y PSY N DOD

Inpatient Physicians Services BED Initial Hosp Eval/Mod 99222 31 339 21 50 min I I SA DA Y SUB N DOD

Inpatient Physicians Services BED Initial Hosp Eval/High 99223 31 339 21 70 min I I P NA Y PSY N DOD

Inpatient Physicians Services BED Initial Hosp Eval/High 99223 31 339 21 70 min I I SA DA Y SUB N DOD

Inpatient Physicians Services BED Sub Hosp (15 min) 99231 31 339 21 15 min I I P NA Y PSY N DOD

Inpatient Physicians Services BED Sub Hosp (15 min) 99231 31 339 21 15 min I I SA DA Y SUB N DOD





Inpatient Physicians Services BED Hospital Discharge Day Mgmt, 30 minutes or less 99238 31 339 21 Visit I I P NA Y PSY N DOD

Inpatient Physicians Services BED Hospital Discharge Day Mgmt, 30 minutes or less 99238 31 339 21 Visit I I SA DA Y SUB N DOD

Inpatient Physicians Services BED Initial Hosp Eval/Low 99221 09 103 21 30 min I I P NA Y PSY N DOD

Inpatient Physicians Services BED Initial Hosp Eval/Low 99221 09 103 21 30 min I I SA DA Y SUB N DOD

Inpatient Physicians Services BED Initial Hosp Eval/Mod 99222 09 103 21 50 min I I P NA Y PSY N DOD

Inpatient Physicians Services BED Initial Hosp Eval/Mod 99222 09 103 21 50 min I I SA DA Y SUB N DOD

Inpatient Physicians Services BED Initial Hosp Eval/High 99223 09 103 21 70 min I I P NA Y PSY N DOD

Inpatient Physicians Services BED Initial Hosp Eval/High 99223 09 103 21 70 min I I SA DA Y SUB N DOD







Inpatient Physicians Services BED Hospital Discharge Day Mgmt, 30 minutes or less 99238 09 103 21 Visit I I P NA Y PSY N DOD

Inpatient Physicians Services BED Hospital Discharge Day Mgmt, 30 minutes or less 99238 09 103 21 Visit I I SA DA Y SUB N DOD

Outpatient Professional Services TXC Site Based Autism H0046 SC 08 340 12 15 min O O P NA Y PSY Y DOS




Outpatient Professional Services TXC Site Based Autism (Plus) H0046 HA 08 340 12 15 min WS O O P NA Y PSY Y DOS

Outpatient Professional Services TXC Site Based Autism (Plus) H0046 HA 08 340 99 15 min WS O O P NA Y PSY Y DOS

Outpatient Professional Services TI1 Family Psychotherapy (without the patient present) 90846 U1 31 339 11 15 min O O P NA Y PSY Y DOS

Outpatient Professional Services TI1 Family Psychotherapy (without the patient present) 90846 U1 31 339 11 15 min O O SA DA Y SUB Y DOS

Outpatient Professional Services TI1 Family Psychotherapy (without the patient present) 90846 08 110 12 15 min O O P NA Y PSY Y DOS





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Outpatient Professional Services PSS Peer Support Services H0038 08 076 12 15 min O O P NA N PSY Y DOS



















Outpatient Professional Services PSS Peer Support Services- Group H0038 U3 08 076 12 15 min O O P NA N PSY Y DOS




















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Outpatient Professional Services PSS Peer Support Out of County H0038 U4 08 076 12 15 min O O P NA N PSY Y DOS



















Outpatient Professional Services PSS Peer Support/Interactive Telecom Services H0038 GT 08 076 12 15 min O O P NA N PSY Y DOS



















Assessment & Assistance AAT Assess & Assist TSS worker less than 6 months exp. H2014 HA U1 31 548 12 15 min O W P NA N PSY Y DOS



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Assessment & Assistance AAT Assess & Assist TSS worker less than 6 months exp. H2014 HA U1 31 548 99 15 min O W P NA N PSY Y DOS

Assessment & Assistance AAT Assess & Assist TSS worker less than 6 months exp. H2014 HA 19 548 12 15 min O W P NA N PSY Y DOS


















Assessment & Assistance AAT Assess & Assist TSS worker more than 6 months exp. H2014 U1 31 548 12 15 min O W P NA N PSY Y DOS

Assessment & Assistance AAT Assess & Assist TSS worker more than 6 months exp. H2014 U1 31 548 99 15 min O W P NA N PSY Y DOS

Assessment & Assistance AAT Assess & Assist TSS worker more than 6 months exp. H2014 19 548 12 15 min O W P NA N PSY Y DOS








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Family Based Services FB1 Team member w/Consumer H0004 HE 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team member w/Consumer H0004 HE 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team member w/ Family of Consumer H0004 UK 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team member w/ Family of Consumer H0004 UK 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team Member w/Family H0004 U6 U4 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team Member w/Family H0004 U6 U4 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team Member w/Family H0004 HA 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team Member w/Family H0004 HA 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team w/Consumer H0004 UB U4 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team w/Consumer H0004 UB U4 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team Member w/Collateral T1016 U4 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team Member w/Collateral T1016 U4 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team w/Collateral T1016 U8 U4 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Enhanced Family Based Team w/Collateral T1016 U8 U4 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team member w/ Collateral T1016 UB UK 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team member w/ Collateral T1016 UB UK 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team w/consumer &/or Family H0004 HT 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team w/consumer &/or Family H0004 HT 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team w/ Collateral T1016 HT 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB1 Team w/ Collateral T1016 HT 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team member w/ Family H0004 U8 U9 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team member w/ Family H0004 U8 U9 11 115 99 15 min O IH P NA Y PSY Y DOS



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Family Based Services FB2 Enhanced Family Based Team member w/ consumer H0004 U9 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team member w/ consumer H0004 U9 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team Member w/ Collateral T1016 U9 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team Member w/ Collateral T1016 U9 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team w/ consumer H0004 U7 U9 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team w/ consumer H0004 U7 U9 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team w/ Collateral T1016 U7 U9 11 115 12 15 min O IH P NA Y PSY Y DOS

Family Based Services FB2 Enhanced Family Based Team w/ Collateral T1016 U7 U9 11 115 99 15 min O IH P NA Y PSY Y DOS

Family Based Services FB3 Enhanced Family Based 3rd Person T1016 U3 U9 11 115 12 15 min O IH P NA N PSY Y DOS

Family Based Services FB3 Enhanced Family Based 3rd Person T1016 U3 U9 11 115 99 15 min O IH P NA N PSY Y DOS

VBP - Family Based VB2 Family Based Initiative T1016 UA 11 115 12 O O P NA Y PSY Y DOS

VBP - Family Based VB2 Family Based Initiative T1016 UA 11 115 99 O O P NA Y PSY Y DOS

Base Service Unit BSP BSU Diagnostic Assessment 90791 U7 08 110 12 per event O O P NA N PSY Y DOS

Base Service Unit BSP BSU Diagnostic Assessment 90791 U7 08 110 49 per event O O P NA N PSY Y DOS

Base Service Unit DXA BSU Diagnostic Assessment H0031 11 110 31 15 min O O P NA N PSY Y DOS



Plan Assessments SPA SCA Service Plan Assessment H0001 U5 11 184 99 15 min O O SA DA N SUB Y DOS

Plan Assessments DAA Diagnostic Assessment - Level of Care Assessment H0001 11 184 99 15 min O O SA NA N SUB Y DOS

Plan Assessments DAA Diagnostic Assessment - Level of Care Assessment H0001 11 184 99 15 min O O SA DA N SUB Y DOS

Plan Assessments DAADiagnostic Assessment-Level of Care Assessment (mobile) H0001 U4 11 184 99 15 min O O SA NA N SUB Y DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate, face to face w/ patient and/or family (Eating disorder/Merck Unit) 99203 TU 08 110 49 30 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family (Eating disorder/Merck Unit) 99204 TU 08 110 49 45 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family (Eating disorder/Merck Unit) 99205 TU 08 110 49 60 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Self Ltd or Minor, face to face w/ patient and/or family (Eating disorder/Merck Unit) 99213 TU 08 110 49 15 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Low to Moderate, face to face w/ patient and/or family (Eating disorder/Merck Unit) 99214 TU 08 110 49 25 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family (Eating disorder/Merck Unit) 99215 TU 08 110 49 40 min O O P NA N PSY N DOS



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Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family (Eating disorder/Merck Unit) 99212 TU 08 110 49 10 min O O P NA N PSY N DOS

Medication Mgt. DXM

Office or other outpatient visit for the evaluation and management of a new patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) 99201 U7 31 339 11 15 min O O SA NA N SUB N DOS

Medication Mgt. DXM

Office or other outpatient visit for the evaluation and management of a new patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) 99201 U7 08 184 57 15 min O O SA NA N SUB N DOS

Medication Mgt. DXM

OV/OP Visit for Eval & Mgmt of New Patient, Problem Moderate to High, face to face w/ patient and/or family (Comprehensive Medical Exam & Eval) 99204 U7 31 339 11 45 min visit O O SA NA N SUB N DOS

Medication Mgt. DXM


Medication Mgt. DXM


Medication Mgt. DXM

Office or other outpatient visit for the evaluation and & management of an established patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) Nurse Medication 99211 HF 31 339 11 15 min O O SA NA N SUB N DOS

Medication Mgt. DXM

Office or other outpatient visit for the evaluation and & management of an established patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) Nurse Medication 99211 HF 08 184 57 15 min O O SA NA N SUB N DOS

Medication Mgt. DXM

Office or other outpatient visit for the evaluation and & management of an established patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) Nurse Medication 99211 U5 08 184 57 15 min FAY O O SA NA N SUB N DOS

Medication Mgt. DXM

Office or other outpatient visit for the evaluation and & management of an established patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) 99211 U7 31 339 11 15 min O O SA NA N SUB N DOS

Medication Mgt. DXM




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Medication Mgt. DXM


Medication Mgt. DXM

Office or other outpatient visit for the evaluation and & management of an established patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) 99215 U7 08 184 12 40 min visit O O SA NA N SUB N DOS

Medication Mgt. DXM

Office or other outpatient visit for the evaluation and & management of an established patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) 99215 U7 08 184 57 40 min visit O O SA NA N SUB N DOS

Medication Mgt. DXM

Office or other outpatient visit for the evaluation and management of a new patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) (Buprenorphine/Suboxone Best Practice) 99201 U6 08 184 57 15 min O O SA NA N SUB N DOS

Medication Mgt. DXM

Office or other outpatient visit for the evaluation and & management of an established patient (Chemotherapy clinic visit for administration and evaluation of drugs other than methadone or drugs for opiate detox) MD 99211 U6 08 184 57 15 min FAY O O SA NA N SUB N DOS

Medication Mgt. DXM

OV/OP Visit for Eval & Mgmt of New Patient, Problem Moderate to High, face to face w/ patient and/or family (Comprehensive Medical Exam & Eval) (Buprenorphine/Suboxone Best Practice) 99204 U6 08 184 12 45 min visit O O SA NA N SUB N DOS

Medication Mgt. DXM

OV/OP Visit for Eval & Mgmt of New Patient, Problem Moderate to High, face to face w/ patient and/or family (Comprehensive Medical Exam & Eval) (Buprenorphine/Suboxone Best Practice) 99204 U6 08 184 57 45 min visit O O SA NA N SUB N DOS

Medication Mgt. DXM

OV/OP Visit for Eval & Mgmt of Established Patient, Problem Moderate to High, face to face w/ patient and/or family (Comprehensive Medical Exam & Eval) (Buprenorphine/Suboxone Best Practice) 99215 U6 08 184 12 40 min visit O O SA NA N SUB N DOS

Medication Mgt. DXM

OV/OP Visit for Eval & Mgmt of Established Patient, Problem Moderate to High, face to face w/ patient and/or family (Comprehensive Medical Exam & Eval) (Buprenorphine/Suboxone Best Practice) 99215 U6 08 184 57 40 min visit O O SA NA N SUB N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Self Ltd or Minor, face to face with patient and/or family Co-Occurring 99201 TG 08 110 49 10 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Low to Moderate, face to face w/ patient and/or family Co-Occurring 99202 TG 08 110 49 20 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate, face to face w/ patient and/or family Co-Occurring 99203 TG 08 110 49 30 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family Co-Occurring 99204 TG 08 110 49 45 min O O P NA N PSY N DOS



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Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family Co-Occurring 99205 TG 08 110 49 60 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Self Ltd or Minor, face to face w/ patient and/or family Co-Occurring 99212 TG 08 110 49 10 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Low to Moderate, face to face w/ patient and/or family Co-Occurring 99213 TG 08 110 49 15 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family Co-Occurring 99214 TG 08 110 49 25 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family Co-Occurring 99215 TG 08 110 49 40 min O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Self Ltd or Minor, face to face with patient and/or family (signing psychiatrist) 99201 U5 08 110 49 10 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Low to Moderate, face to face w/ patient and/or family (signing psychiatrist) 99202 U5 08 110 49 20 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate, face to face w/ patient and/or family (signing psychiatrist) 99203 U5 08 110 49 30 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family (signing psychiatrist) 99204 U5 08 110 49 45 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family (signing psychiatrist) 99205 U5 08 110 49 60 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Self Ltd or Minor, face to face w/ patient and/or family (signing Psychiatrist) 99212 U5 08 110 49 10 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Low to Moderate, face to face w/ patient and/or family (signing Psychiatrist) 99213 U5 08 110 49 15 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family (signing Psychiatrist) 99214 U5 08 110 49 25 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family (signing Psychiatrist) 99215 U5 08 110 49 40 min WS O O P NA N PSY N DOS

Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Self Ltd or Minor, face to face with patient and/or family 99201 UB 31 339 11 10 min O O P NA N PSY N DOS

Medication Mgt. RXM




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Medication Mgt. RXM


Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Low to Moderate, face to face w/ patient and/or family 99202 UB 31 339 11 20 min O O P NA N PSY N DOS

Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate, face to face w/ patient and/or family 99203 UB 31 339 11 30 min O O P NA N PSY N DOS

Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family 99204 UB 31 339 11 45 min O O P NA N PSY N DOS

Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Low to Moderate, face to face w/ patient and/or family 99213 UB 31 339 11 15 min O O P NA N PSY N DOS

Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family 99214 UB 31 339 11 25 min O O P NA N PSY N DOS

Medication Mgt. RXM




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Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM

OV/OP Visit for Evaluation & Management of Established Patient, Problem Self Ltd or Minor, face to face w/ patient and/or family 99212 UB 31 339 11 10 min O O P NA N PSY N DOS

Medication Mgt. RXM


Medication Mgt. RXM


Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of Established Patient, Problem Self Ltd or Minor, face to face w/ patient and/or family 99212 GT 08 110 49 10 min O O P NA N PSY N DOS

Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of Established Patient, Problem Low to Moderate, face to face w/ patient and/or family 99213 GT 08 110 49 15 min O O P NA N PSY N DOS

Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family 99214 GT 08 110 49 25 min O O P NA N PSY N DOS

Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family 99215 GT 08 110 49 40 min O O P NA N PSY N DOS

Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of New Patient, Problem Self Ltd or Minor, face to face with patient and/or family 99201 GT 08 110 49 10 min O O P NA N PSY N DOS

Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of New Patient, Problem Low to Moderate, face to face w/ patient and/or family 99202 GT 08 110 49 20 min O O P NA N PSY N DOS

Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate, face to face w/ patient and/or family 99203 GT 08 110 49 30 min O O P NA N PSY N DOS

Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family 99204 GT 08 110 49 45 min O O P NA N PSY N DOS

Medication Mgt. RXM

Telepsychiatry OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family 99205 GT 08 110 49 60 min O O P NA N PSY N DOS

Medication Mgt. RXMOffice or other OP Visit for the EM of an Established Patient 99211 HE 08 110 49 Per Event WS O O P NA N PSY N DOS

Medication Mgt. RXMOffice Visit Established Patient (Nurse Medication Management) 99211 UB 31 339 11 15 min O O P, SA NA N PSY N DOS



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Medication Mgt. RXMOffice Visit Established Patient (Nurse Medication Management) 99211 UB 09 103 11 15 min O O P NA N PSY N DOS

Medication Mgt. RXMOffice Visit Established Patient (Nurse Medication Management) 99211 UB 08 110 49 15 min O O P NA N PSY N DOS

Medication Mgt. RXMTelepsychiatry Office Visit Established Patient (Nurse Medication Management) 99211 GT 08 110 49 15 min O O P NA N PSY N DOS

Evaluation EXM Psychiatric diagnostic Evaluation with Medical Services 90792 31 339 11 per occurrence O O P NA N PSY N DOS




Evaluation EXM Psychiatric diagnostic Evaluation with Medical Services 90792 08 184 12 per occurrence O O SA NA N SUB N DOS

Evaluation EXM Psychiatric diagnostic Evaluation with Medical Services 90792 08 184 57 per occurrence O O SA NA N SUB N DOS

Evaluation EXMPsychiatric Diagnostic Evaluation without Medical Services 90791 08 110 12 per occurrence O O P NA N PSY N DOS


Evaluation EXMPsychiatric Diagnostic Evaluation without Medical Services 90791 08 184 12 per occurrence O O SA NA N SUB N DOS

Evaluation EXMPsychiatric Diagnostic Evaluation without Medical Services 90791 08 184 57 per occurrence O O SA NA N SUB N DOS




Evaluation EXM Telepsych Diagnostic Interview - Therapist 90791 GT 08 110 12 per occurrence O O P NA N PSY N DOS

Evaluation EXM Telepsych Diagnostic Interview - Therapist 90791 GT 08 110 49 per occurrence O O P NA N PSY N DOS

Evaluation EXM Telepsych Diagnostic Interview 90791 U1 GT 08 110 12 per occurrence O O P NA N PSY N DOS

Evaluation EXM Telepsych Diagnostic Interview 90791 U1 GT 08 110 49 per occurrence O O P NA N PSY N DOS

Evaluation EXM Psychological Evaluation-Sex Offender Treatment 90791 AJ 19 190 11 per occurrence O O P NA N PSY N DOS




Evaluation EXM Victim Evaluation 90791 ST 11 112 31 per occurrence O O P NA N PSY N DOS






Evaluation EXMMD/DO Diagnostic Evaluation for Buprenorphine patients only 90791 HB 08 184 12 per occurrence O O SA NA N SUB N DOS



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Evaluation EXMMD/DO Diagnostic Evaluation for Buprenorphine patients only 90791 HB 08 184 57 per occurrence O O SA NA N SUB N DOS

Evaluation EXM

Psychiatric diagnostic evaluation with medical services (Psychiatric Eval, Exam & Eval of Patient) (Effective 02/20/20) 90791 U1 GT 08 184 57 per occurrence O O SA NA N SUB N DOS

Evaluation EXM Diagnostic Interview (Masters Level) H0031 AJ 11 112 31 15 min O O P NA N PSY N DOS



Evaluation EXMPsychiatric Diagnostic Evaluation without Medical Services (Eating Disorder/Merck Unit) 90791 TU 08 110 49 per occurrence O O P NA N PSY N DOS

Evaluation EXMPsychiatric diagnostic Evaluation with Medical Services (Eating disorder/Merck Unit) 90792 TU 08 110 49 per occurrence O O P NA N PSY N DOS

Evaluation EXMPsychiatric Diagnostic Evaluation without Medical Services (Eating Disorder/Merck Unit) 90791 TU 08 110 12 per occurrence O O P NA N PSY N DOS

Evaluation EXMPsychiatric diagnostic Evaluation with Medical Services (Eating disorder/Merck Unit) 90792 TU 08 110 12 per occurrence O O P NA N PSY N DOS

Evaluation AOS Adult Extended Assessment 90792 U7 08 110 12 per occurrenc WAS O O P NA Y PSY N DOS

Evaluation AOS Adult Extended Assessment 90792 U7 08 110 49 per occurrenc WAS O O P NA Y PSY N DOS

Therapy OUT Clinic Visit/Encounter, All-Inclusive T1015 HE 08 080 12 visit O O P NA N PSY N DOS














Therapy OUT Individual Activity Therapy (Music Therapy) G0176 UB 17 175 11 1 hour CM O O P NA N PSY Y DOS

Therapy OUT Group Activity Therapy (Music Therapy) G0176 U3 17 175 11 15 min CM O O P NA N PSY Y DOS

Therapy OUT Individual Psychotherapy 90832 08 110 12 30 min O O P NA N PSY N DOS


Therapy OUT Individual Psychotherapy 90832 U1 09 103 11 30 min O O P NA N PSY N DOS


Therapy OUT Individual Psychotherapy (Trauma Focused Services) 90832 ST 19 190 11 30 min O O P NA N PSY N DOS

Therapy OUT Individual Psychotherapy (Trauma Focused Services) 90832 ST 08 110 12 30 min O o p NA N PSY N DOS

Therapy OUT Individual Psychotherapy (Trauma Focused Services) 90832 ST 08 110 49 30 min O o p NA N PSY N DOS




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Therapy OUT Individual Therapy 90832 U5 08 110 12 30 min WS O O P NA N PSY N DOS






Therapy OUT Mobile Mental Health Treatment (MMHT) Individual 90832 U4 08 110 12 30 min O O P NA N PSY Y DOS




Therapy OUT Individual Psychotherapy, Interpreter 90832 U3 08 110 12 30 min O O P NA N PSY N DOS




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Therapy OUT Group Psychotherapy, Interpreter 90853 U4 UB 08 110 49 15 min O O P NA N PSY N DOS

Therapy OUT Family Psychotherapy, Interpreter 90847 U4 UB 08 110 12 15 min O O P NA N PSY N DOS

Therapy OUT Family Psychotherapy, Interpreter 90847 U4 UB 08 110 49 15 min O O P NA N PSY N DOS

Therapy OUTIndividual Psychotherapy, Interpreter, not covered by Medicare 90832 GX 08 110 12 30 min O O P NA N PSY N DOS






Therapy OUTGroup Psychotherapy, Interpreter, not covered by Medicare 90853 GX 08 110 49 15 min O O P NA N PSY N DOS

Therapy OUTFamily Psychotherapy, Interpreter, not covered by Medicare 90847 GX 08 110 12 15 min O O P NA N PSY N DOS

Therapy OUTFamily Psychotherapy, Interpreter, not covered by Medicare 90847 GX 08 110 49 15 min O O P NA N PSY N DOS

Therapy OUT Individual Therapy MD 90832 U1 31 339 11 30 min O O P NA N PSY N DOS



Therapy OUT Individual Psychotherapy (Masters Level) 90832 AJ 11 112 31 30 min O O P NA N PSY N DOS









Therapy OUT Group Psychotherapy 90853 U1 31 339 11 15 min O O P NA N PSY N DOS

Therapy OUT Group Psychotherapy 90853 08 110 49 15 min O O P NA N PSY N DOS

Therapy OUT Group Psychotherapy 90853 19 190 11 15 min O O P NA N PSY N DOS

Therapy OUT Group Psychotherapy 90853 U1 09 103 11 15 min O O P NA N PSY N DOS

Therapy OUT Group Therapy (Masters Level) 90853 AJ 11 112 31 15 min O O P NA N PSY N DOS



Therapy OUT Group Psychotherapy (Trauma Focused Services) 90853 ST 19 190 11 15 min O O P NA N PSY N DOS



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Therapy OUT Family Psychotherapy 90847 U1 31 339 11 15 min O O P NA N PSY N DOS

Therapy OUT Family Psychotherapy 90847 08 110 12 15 min O O P NA N PSY N DOS



Therapy OUT Family Psychotherapy 90847 U1 09 103 11 15 min O O P NA N PSY N DOS

Therapy OUT Family Psychotherapy (Masters Level) 90847 AJ 11 112 31 15 min O O P NA N PSY N DOS



Therapy OUT Family Psychotherapy (Trauma Focused Services) 90847 ST 19 190 11 15 min O O P NA N PSY N DOS






Therapy OUT Individual Psychotherapy (Eating disorder/Merck Unit) 90832 TU 08 110 12 30 min O O P NA N PSY N DOS






Therapy OUT Group Psychotherapy (Eating disorder/Merck Unit) 90853 TU 08 110 49 15 min O O P NA N PSY N DOS

Therapy OUT Family Psychotherapy (Eating disorder/Merck Unit) 90847 TU 08 110 12 15 min O O P NA N PSY N DOS

Therapy OUT Family Psychotherapy (Eating disorder/Merck Unit) 90847 TU 08 110 49 15 min O O P NA N PSY N DOS

Base Service Unit OUT

TeleHealth: Psychiatric diagnostic evaluation with medical services (Psychiatric Eval, Exam & Eval of Patient) (Effective 02/20/20) 90792 GT 08 110 49 per event O O P NA N PSY Y DOS

Therapy OUTTeleHealth: Psychotherapy, 30 minutes with patient and/or family member (Effective 02/20/20) 90832 GT 08 110 49 30 min O O P NA N PSY N DOS



Outpatient Professional Services OUTFamily Psychotherapy (without the patient present) (Effective 02/20/20) 90846 UB GT 08 110 49 15 min O O P NA Y PSY Y DOS

Outpatient Professional Services OUTFamily Psychotherapy (conjoint psychotherapy) w/ patient present (Effective 02/20/20) 90846 UB GT 08 110 49 15 min O O P NA Y PSY Y DOS

Therapy OUTTeleHealth: Psychotherapy, 30 minutes with patient and/or family member (Effective 02/20/20) 90832 GT 08 184 57 30 min O O SA NA N SUB N DOS



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Therapy OUTFamily Psychotherapy (conjoint psychotherapy) w/ patient present (Effective 02/20/20) 90847 UB GT 08 184 57 15 min O O SA DA N SUB N DOS

Therapy OPR DA Individual Psychotherapy 90832 HF 31 339 11 30 min O O SA NA N SUB N DOS









Therapy OPR DA Group Psychotherapy 90853 HF 31 339 11 15 min O O SA NA N SUB N DOS

Therapy OPR DA Group Psychotherapy 90853 HF 08 184 57 15 min O O SA NA N SUB N DOS

Therapy OPR DA Family Psychotherapy 90847 HF 31 339 11 15 min O O SA NA N SUB N DOS



Therapy OPR Evaluation Drug & Alcohol Intervention Services H0022 U5 11 184 99 Per Event O O SA NA N SUB Y DOS

Therapy OPR Drug & Alcohol Intervention Services H0022 U4 11 184 99 Per Event O O SA NA N SUB Y DOS

Therapy OPR Nurse Coordination with PCP H0047 U4 11 184 99 15 min O O SA NA N SUB Y DOS

Therapy RA1Individual Psychotherapy forReactive Attachment Disorder (RAD) 90832 HA 08 110 12 30 min O W P, SA NA Y PSY Y DOS



Therapy RA1Individual Psychotherapy forReactive Attachment Disorder (RAD) 90832 HA 19 190 11 30 min O W P NA Y PSY Y DOS












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Therapy RA1Family Psychotherapy forReactive Attachment Disorder (RAD) 90847 HA 08 110 12 15 min O W P NA Y PSY Y DOS





Therapy RA1Family Psychotherapy without the patient present forReactive Attachment Disorder (RAD) 90846 HA 08 110 12 15 min O W P NA Y PSY Y DOS





Therapy EMCUrgent Care Psychiatric Diagnostic Evaluation with Medical Services 90792 U8 08 110 49 per occurrenc CM O O P NA N PSY N DOS

Therapy EMCUrgent Care Psychiatric Diagnostic Evaluation with Medical Services 90792 U8 08 110 12 per occurrenc CM O O P NA N PSY N DOS

Therapy EMC

Urgent Care OV/OP Visit for Evaluation & Management of New Patient, Problem Self Ltd or Minor, face to face with patient and/or family 99201 U8 08 110 49 10 min CM O O P NA N PSY N DOS

Therapy EMC

Urgent Care OV/OP Visit for Evaluation & Management of New Patient, Problem Low to Moderate, face to face w/ patient and/or family 99202 U8 08 110 49 20 min CM O O P NA N PSY N DOS

Therapy EMC

Urgent Care OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate, face to face w/ patient and/or family 99203 U8 08 110 49 30 min CM O O P NA N PSY N DOS

Therapy EMC

Urgent Care OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family 99204 U8 08 110 49 45 min CM O O P NA N PSY N DOS

Therapy EMC

Urgent Care OV/OP Visit for Evaluation & Management of New Patient, Problem Moderate to High, face to face w/ patient and/or family 99205 U8 08 110 49 60 min CM O O P NA N PSY N DOS

Therapy EMC

Urgent Care OV/OP Visit for Evaluation & Management of Established Patient, Problem Low to Moderate, face to face w/ patient and/or family 99213 U8 08 110 49 15 min CM O O P NA N PSY N DOS



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Therapy EMC

Urgent Care OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family 99214 U8 08 110 49 25 min CM O O P NA N PSY N DOS

Therapy EMC

Urgent Care OV/OP Visit for Evaluation & Management of Established Patient, Problem Moderate to High, face to face w/ patient and/or family 99215 U8 08 110 49 40 min CM O O P NA N PSY N DOS

Therapy DAL DA OP in an Alternative Setting - Individual H0047 HA 11 184 03 15 min O O SA NA Y SUB Y DOS

Therapy DAL DA OP in an Alternative Setting - Individual H0047 HA 11 184 99 15 min O O SA NA Y SUB Y DOS

Therapy DAL DA OP in an Alternative Setting - Group H0047 U5 11 184 03 15 min O O SA NA Y SUB Y DOS

Therapy DAL DA OP in an Alternative Setting - Group H0047 U5 11 184 99 15 min O O SA NA Y SUB Y DOS

Therapy COT Co-Occurring Individual Therapy 90832 TG 08 110 12 30 min O O P NA Y PSY N DOS

Therapy COT Co-Occurring Individual Therapy 90832 TG 08 184 12 30 min O O SA NA Y SUB N DOS











Therapy COT Co-Occurring Group Therapy 90853 TG 08 110 49 15 min O O PA NA Y PSY N DOS

Therapy COT Co-Occurring Group Therapy 90853 TG 08 184 57 15 min O O SA NA Y SUB N DOS

Therapy COT Co-Occurring Family Therapy 90847 TG 08 110 12 15 min O O P NA Y PSY N DOS

Therapy COT Co-Occurring Family Therapy 90847 TG 08 184 12 15 min O O SA NA Y SUB N DOS

Therapy COT Co-Occurring Family Therapy 90847 TG 08 110 49 15 min O O P NA Y PSY N DOS

Therapy COT Co-Occurring Family Therapy 90847 TG 08 184 57 15 min O O SA NA Y SUB N DOS

Therapy PAS PASS Program week 1 & 2 H0004 UC 11 112 99 15 min CV O O P NA Y PSY Y DOS

Therapy PAS PASS Program H0004 AJ 11 112 99 15 min CV O O P NA Y PSY Y DOS

Therapy DRS DA Recovery Specialist H0047 U6 11 184 99 15 min O O SA NA N SUB Y DOS

Therapy DRS DA Recovery Group H0047 HQ 11 184 99 15 min O O SA NA N SUB Y DOS

Therapy DCC DA Case Coordination H0047 U7 11 184 99 15 min O O SA NA N SUB Y DOS

Therapy MMH Mobile Mental Health Diagnostic Interview 90791 HW 08 110 12 per occurrence O O P NA Y PSY Y DOS

Therapy MMH Mobile Mental Health Diagnostic Interview 90791 HW 08 110 49 per occurrence O O P NA Y PSY Y DOS

Therapy MMHPsychiatric diagnostic evaluation with medical services (Psychiatric Eval, Exam & Eval of Patient) 90792 HB 08 074 15 occurrence O O P NA Y PSY Y DOS

Therapy MMHPsychotherapy, 30 minutes with patient and/or family member 90832 HB 08 074 15 30 min O O P NA Y PSY Y DOS

Therapy MMH Mobile Mental Health Individual Therapy 90832 HW 08 110 12 30 min O O P NA Y PSY Y DOS





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Therapy MMH Family Psychotherapy (without the patient present) 90846 UB HB 08 074 15 15 min O O P NA Y PSY Y DOS

Therapy MMHFamily Psychotherapy (conjoint psychotherapy) w/ patient present 90847 UB HB 08 074 15 15 min O O P NA Y PSY Y DOS

Therapy MMHGroup Psychotherapy (other than of a multiple-family group) 90853 UB HB 08 074 15 15 min O O P NA Y PSY Y DOS

Therapy MMH

TeleHealth: Psychiatric diagnostic evaluation with medical services (Psychiatric Eval, Exam & Eval of Patient) (Effective 02/20/20) 90792 GT 08 074 15 occurrence O O P NA Y PSY Y DOS

Therapy MMH

TeleHealth: Psychotherapy, 30 minutes with patient and/or family member (Effective 02/20/20) 90832 GT 08 074 15 30 min O O P NA Y PSY Y DOS

Therapy MMH


Therapy MMH


Therapy MMHTeleHealth: Family Psychotherapy (without the patient present) (Effective 02/20/20) 90846 UB GT 08 074 15 15 min O O P NA Y PSY Y DOS

Therapy MMH

TeleHealth: Family Psychotherapy (conjoint psychotherapy) w/ patient present (Effective 02/20/20) 90847 UB GT 08 074 15 15 min O O P NA Y PSY Y DOS

Therapy PCTINDIVIDUAL THERAPY PARENT-CHILD INTERACTION THERAPY (PCIT) 90832 HR 08 110 12 30 min O O P NA N PSY N DOS









Therapy PCTFAMILY THERAPY PARENT-CHILD INTERACTION THERAPY (PCIT) 90847 HR 08 110 12 15 min O O P NA N PSY N DOS




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Therapy PCTGROUP THERAPY PARENT-CHILD INTERACTION THERAPY (PCIT) 90853 HR 08 110 49 15 min O O P NA N PSY N DOS







Therapy OS1Alcohol and/or other drug abuse service, not otherwise specified 90847 UB 08 184 12 15 min O O SA NA N SUB N DOS

Therapy OS1Alcohol and/or other drug abuse service, not otherwise specified 90847 UB 08 184 57 15 min O O SA DA N SUB N DOS

Therapy MDF Mobile Drug & Alcohol Family Therapy H0047 HW 11 184 99 15 min O O SA NA Y SUB Y DOS

Therapy OS2Alcohol and/or other drug abuse service, not otherwise specified H0047 U3 11 184 99 Weekly O O SA NA Y SUB N DOS

Therapy OS2Alcohol and/or other drug abuse service, not otherwise specified H0047 U3 11 184 99 Weekly O O SA DA Y SUB N DOS

Therapy OPM Expedited Evaluation - MD (Mobile Adult Outpatient) 90791 HE 08 110 12 per occurrence O O P NA Y PSY Y DOS

Therapy OPM Expedited Evaluation - MD (Mobile Adult Outpatient) 90791 HE 08 110 49 per occurrence O O P NA Y PSY Y DOS

Therapy OPM Intake Evaluation (Mobile Adult Outpatient) 90791 TS 08 110 12 per occurrence O O P NA Y PSY Y DOS

Therapy OPM Intake Evaluation (Mobile Adult Outpatient) 90791 TS 08 110 49 per occurrence O O P NA Y PSY Y DOS

Therapy OPM Individual Therapy (Mobile Adult Outpatient) 90832 HE 08 110 12 30 min O O P NA Y PSY Y DOS






Therapy SXEPsychological Evaluation (Sex Offender Assessment, including Testing & Clinical Interview) 90791 SE 19 190 11 per occurrence O O P NA N PSY N DOS






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Therapy SXE Individual Therapy- Sex Offender Treatment 90832 SE 19 190 11 30 min O O P NA N PSY N DOS












Therapy SXE Group Therapy- Sex Offender Treatment 90853 SE 19 190 11 15 min O O P NA N PSY N DOS




Therapy SXE Family Therapy- Sex Offender Treatment 90847 SE 19 190 11 15 min O O P NA N PSY N DOS




Clozapine Support CME Clozaril Monitor & Eval H0034 HK 08 110 49 15 min O O P NA Y PSY Y DOS

Clozapine Support CME Clozaril Monitor & Eval by MD/DO H0034 U1 08 110 49 15 min O O P NA Y PSY Y DOS

Clozapine Support CS1Comprehensive Medication Services (Clozapine Support Svc) H2010 U1 31 339 11 15 min O O P NA Y PSY Y DOS

Clozapine Support CS1Comprehensive Medication Services (Clozapine Support Svc) H2010 U1 31 339 12 15 min O O P NA Y PSY Y DOS

Clozapine Support CS2 Clozapine Support Serv H2010 HK 08 110 12 15 min O O P NA Y PSY Y DOS




Clozapine Support PRC Clozapine Support H2010 U4 08 110 12 15 min P O P NA Y PSY Y DOD

Clozapine Support PRC Clozapine Support H2010 U4 08 110 49 15 min P O P NA Y PSY Y DOD



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Testing TS1

Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities) by physician or other qualified health care professional, both face to face time with the patient and time interpreting test results and preparing the report, first hour (effective 08/19/19) 96116 08 074 15 hour O O P NA Y PSY N

Testing TS1

Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities) by physician or other qualified health care professional, both face to face time with the patient and time interpreting test results and preparing the report, first hour (Effective 02/20/20)

96116 GT 08 074 15 hour O O P NA Y PSY N DOS

Testing TS1each additional hour (List separately in addition to code for primary procedure 96116) effective 08/19/19 96121 08 074 15 hour O O P NA Y PSY N

Testing TS1

each additional hour (List separately in addition to code for primary procedure 96116) (Effective 02/20/20)


Testing TS1

Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback of the patient, family member(s) or caregiver(s), when performed; first hour (effective 08/19/19) 96130 08 074 15 hour O O P NA Y PSY N

Testing TS1

Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback of the patient, family member(s) or caregiver(s), when performed; first hour (Effective 02/20/20)



Testing TS1



Testing TS1

Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour (effective 08/19/19) 96132 08 074 15 hour O O P NA Y PSY N



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Testing TS1

Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour (Effective 02/20/20) 96132 GT 08 074 15 hour O O P NA Y PSY N DOS


Testing TS1



Testing TS1

Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities) by physician or other qualified health care professional, both face to face time with the patient and time interpreting test results and preparing the report, first hour (effective 08/19/19) 96116 08 184 12 hour O O P NA Y PSY N DOS

Testing TS1


Testing TS1



Testing TS1each additional hour (List separately in addition to code for primary procedure 96116) effective 08/19/19 96121 08 184 12 hour O O P NA Y PSY N DOS


Testing TS1





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Exem


Testing TS1

Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback of the patient, family member(s) or caregiver(s), when performed; first hour (effective 08/19/19) 96130 08 184 12 hour O O P NA Y PSY N DOS

Testing TS1


Testing TS1





Testing TS1



Testing TS1

Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour (effective 08/19/19) 96132 08 184 12 hour O O P NA Y PSY N DOS

Testing TS1




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Exem


Testing TS1




Testing TS1



Testing TS1


Testing TS1


Testing TS1





Testing TS1





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Testing TS1


Testing TS1


Testing TS1





Testing TS1



Testing TS1


Testing TS1




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Testing TS1




Testing TS1



Testing TS1


Testing TS1




Testing TS1




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Testing TS1




Testing TS1


Testing TS1




Testing TS1

Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team. effective 08/19/19 99484 31 339 11 Per procedure O O P NA Y PSY N



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Testing TS1

Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team. effective 08/19/19 99484 31 339 12 Per procedure O O P NA Y PSY N

Testing TS1

Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies. effective 08/19/19 99492 31 339 11 Per procedure O O P NA Y PSY N



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Testing TS1

Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies. effective 08/19/19 99492 31 339 12 Per procedure O O P NA Y PSY N

Testing TS1

Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidenced-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment. effective 08/19/19 99493 31 339 11 Per procedure O O P NA Y PSY N



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Exem


Testing TS1

Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidenced-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment. effective 08/19/19 99493 31 339 12 Per procedure O O P NA Y PSY N

Testing TS1

Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional (List separately in addition to code for primary procedure) effective 08/19/19 99494 31 339 11 Per procedure O O P NA Y PSY N

Testing TS1

Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional (List separately in addition to code for primary procedure) effective 08/19/19 99494 31 339 12 Per procedure O O P NA Y PSY N

Testing TS1




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Exem


Testing TS1


Testing TS1


Testing TS1






Testing TS1


Testing TS1




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Exem


Testing TS1


Testing TS1






Testing TS1


Testing TS1


Testing TS1




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Testing TS1






Testing TS1

Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities) by physician or other qualified health care professional, both face to face time with the patient and time interpreting test results and preparing the report, first hour (Comprehensive Neuropsychological Eval w/ Personality Assessment) 96116 11 113 12 hour O O P NA Y PSY N

Testing TS1


Testing TS1




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Testing TS1


Testing TS1


Testing TS1










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Testing TS1


Testing TS1


Testing TS1


Testing TS1


Testing TS1


Testing TS1






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Testing TS1


Testing TS1


Testing TS1


Testing TS1


Testing TS1




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Testing TS1








Testing TS1 Psychological Testing 96136 08 110 12 30 min O O P NA Y PSY N DOS








Testing TS1

TeleHealth: Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities) by physician or other qualified health care professional, both face to face time with the patient and time interpreting test results and preparing the report, first hour (Effective 02/20/20)




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Testing TS1

TeleHealth: Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities) by physician or other qualified health care professional, both face to face time with the patient and time interpreting test results and preparing the report, first hour (Effective 02/20/20)


Testing TS1

TeleHealth: each additional hour (List separately in addition to code for primary procedure 96116) (Effective 02/20/20) 96121 GT 11 113 52 hour O O P NA Y PSY N DOS

Testing TS1


Testing TS1

TeleHealth: Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback of the patient, family member(s) or caregiver(s), when performed; first hour (Effective 02/20/20)


Testing TS1

TeleHealth: Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback of the patient, family member(s) or caregiver(s), when performed; first hour (Effective 02/20/20)


Testing TS1


Testing TS1


Testing TS1

TeleHealth: Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour (Effective 02/20/20)




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Testing TS1

TeleHealth: Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour (Effective 02/20/20)


Testing TS1


Testing TS1


Electroconvulsive Therapy EC1 ECT Therapy/single seizure 90870 01 183 22 1tx O O P NA Y PSY N DOS

Electroconvulsive Therapy EC1 ECT Therapy/single seizure 90870 08 110 49 1tx O O P NA Y PSY N DOS

Electroconvulsive Therapy EC2 ECT Therapy/single seizure/physician services 90870 AM 31 339 11 1 treatment O O P NA Y PSY N DOS



Electroconvulsive Therapy IET ECT/Inpt 0901 01 010 21 occur 837/UB I I PP NA Y PSY N DOD

Electroconvulsive Therapy IET ECT/Inpt 0901 01 011 21 occur 837/UB I I PP NA Y PSY N DOD

Electroconvulsive Therapy IET ECT/Inpt 0901 01 022 21 occur 837I/UB I I PP NA Y PSY N DOD

Electroconvulsive Therapy ANE Anesthesia 00104 U1 31 339 11 O O P NA N PSY N DOS



Physician Wraparound Y96CCASBE Psychological or Psychiatric Re-Evaluation (child/adolescent) 90791 UC 08 110 11 per occurrence O W P NA Y PSY N DOS













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Physician Wraparound YT1Community-based Wraparound Services TSS in Home & Community H2021 EP 08 800 12 15 min O W P NA Y PSY Y DOS
















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Physician Wraparound YT1Community-based Wraparound Services TSS in Home & Community H2021 EP U1 31 548 12 15 min O W P NA Y PSY Y DOS



Physician Wraparound YT1 Community-based Wraparound Svcs (TSS), Interpreter H2021 U5 08 800 12 15 min O W P NA Y PSY Y DOS










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Physician Wraparound YT2Physician Wraparound-TSS (Authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Physician Wraparound YT3Community Based Wrap Around Services TSS in School H2021 U3 08 800 99 15 min O W P NA Y PSY Y DOS









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Physician Wraparound AB3Community Based Wrap Around Services TSS-ASD/ABA TSS in School H2021 U4 08 800 99 15 min O W P NA Y PSY Y DOS











Physician Wraparound AS1 TSS-ASD without ABA in Home and Community H2021 U6 08 800 12 15 min O W P NA Y PSY Y DOS






















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Physician Wraparound AS2 TSS ASD without ABA in School H2021 U7 08 800 99 15 min O W P NA Y PSY Y DOS










Physician Wraparound AB6TSS-ASD/ABA - School - Act 62 (Authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Physician Wraparound YT4 TSS in School (Authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Physician Wraparound YT5 School - Act 62 (Authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Physician Wraparound YT6Home & Community - Act 62 (Authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Physician Wraparound AB2

Community Based Wrap Around Services TSS-ASD/ABATSS in Home and Community H2021 TG 08 800 12 15 min O W P NA Y PSY Y DOS















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Physician Wraparound AB5TSS-ASD/ABA - Home/Community - Act 62 (Authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Physician Wraparound ITM Interagency Service Planning Team Mtg 98966 11 115 99 per occurrence O W P NA Y PSY Y DOS























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Physician Wraparound TXSCCASBE Psychological or Psychiatric Evaluation (Child/Adolescent) (Independent Evaluator) 90791 U4 08 110 11 per occurrence O W P NA Y PSY N DOS






Physician Wraparound TXSCCASBE Psychological or Psychiatric Evaluation in the school (Child/Adolescent) Independent Evaluator 90791 AH 19 190 11 per occurrence O W P NA Y PSY N DOS







Physician Wraparound AEV CCASBE Addendum to Evaluation 90791 U5 19 190 11 per occurrence O W P NA Y PSY N DOS



Physician Wraparound AEV CCASBE Addendum to Evaluation 90791 U5 08 110 11 per occurrence O W P NA Y PSY Y DOD




Physician Wraparound CMP Summer Therapeutic Activities Program (STAP) H2015 HA 11 445 99 15 min O W P NA Y PSY Y DOS






MST MS1 Multi-Systemic Therapy H2033 U4 08 340 12 Weekly O W P NA N PSY Y DOS





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MST MS2 Multi-Systemic Therapy H2033 U5 08 340 12 15 min O W P NA Y PSY Y DOS




MST MS4 Multi-Systemic Therapy H2033 U3 U9 08 340 12 15 min BVR, FAY O W P NA Y PSY Y DOS

MST MS4 Multi-Systemic Therapy H2033 U3 U9 08 340 99 15 min BVR, FAY O W P NA Y PSY Y DOS

MST MS4 Multi-Systemic Therapy H2033 U3 U9 11 340 12 15 min O W P NA Y PSY Y DOS

MST MS4 Multi-Systemic Therapy H2033 U3 U9 11 340 99 15 min O W P NA Y PSY Y DOS

MST MS5 Multi-Systemic Therapy H2033 08 340 12 15 min O O P NA Y PSY Y (S8) DOS




BHRS BS1 Behavioral Specialist Consultant (Doctoral Level) H0032 HP U1 31 559 11 15 min O W P NA Y PSY Y DOS




BHRS BS1 Behavioral Specialist Consultant (Doctoral Level) H0032 HP 08 802 12 15 min O W P NA Y PSY Y DOS


























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BHRS BS1Behavioral Specialist Consultant, (Doctoral Level) Interpreter H0032 U5 08 802 12 15 min O W P NA Y PSY Y DOS


















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BHRS BS1 Behavioral Specialist Consultant (Master's Level) H0032 HO U1 31 559 11 15 min O W P NA Y PSY Y DOS




BHRS BS1 Behavioral Specialist Consultant (Master's Level) H0032 HO 08 802 12 15 min O W P NA Y PSY Y DOS








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BHRS ASDBehavior Specialist Consultant for Children with Autism Spectrum Disorder BSC-ASD-Doctoral level H0046 HP 08 558 12 15 min O W P NA Y PSY Y DOS





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BHRS ASDBehavior Specialist Consultant for children with Autism Spectrum Disorder BSC-ASD-Masters Level H0046 HO 11 558 11 15 min O W P NA Y PSY Y DOS






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BHRS AB1Behavioral Specialist Consultant ABA (BSC-ABA) Masters Level H0046 TM 08 558 11 15 min O W P NA Y PSY Y DOS



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BHRS AB1Behavioral Specialist Consultant ABA BSC-ASD Doctoral Level with Applied Behavior Analysis H0046 AH 08 558 11 15 min O W P NA Y PSY Y DOS




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BHRS AB4BSC-ASD/ABA Master’s/Doctoral Level - Act 62 (Authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

BHRS EAC ExACT (Doctoral Level) H0032 U7 08 802 12 15 min O W P NA Y PSY Y DOS










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BHRS EAC ExACT (Masters Level) H0032 U8 08 802 12 15 min O W P NA Y PSY Y DOS















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BHRS BS2BHRS Services - BSC ACT 62 (authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

BHRS FBAFunctional Behavioral Assessment (FBA) BSC Doctoral Level H0032 U4 08 802 12 15 min O W P NA Y PSY Y DOS













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BHRS FBAFunctional Behavioral Assessment (FBA) BSC Doctoral level H0032 U4 31 559 11 15 min O W P NA Y PSY Y DOS




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BHRS FBAFunctional Behavioral Assessment (FBA) BSC Masters Level H0032 U6 08 802 12 15 min O W P NA Y PSY Y DOS



























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BHRS FBAFunctional Behavioral Assessment (FBA) BSC Masters level H0032 U6 31 559 11 15 min O W P NA Y PSY Y DOS




BHRS FB4Functional Behavioral Assessment (FBA) BSC Masters Level ASD H0032 TM 11 558 11 15 min O W P NA Y PSY Y DOS














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BHRS FB4Functional Behavioral Assessment (FBA) BSC Masters level ASD H0032 TM 31 558 11 15 min O W P NA Y PSY Y DOS




BHRS FB4Functional Behavioral Assessment (FBA) BSC Doctoral Level ASD H0032 AH 19 558 11 15 min O W P NA Y PSY Y DOS

























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BHRS ASXComprehensive Community Support Svcs (After School Program) H2015 08 340 12 15 min O W P NA Y PSY Y DOS




Mobile BHRS Services MT1 Therapeutic Behavioral Services MT (Licensed) H2019 U1 31 549 12 15 min O W P NA Y PSY Y DOS

Mobile BHRS Services MT1 Therapeutic Behavioral Services MT (Licensed) H2019 U1 31 549 99 15 min O W P NA Y PSY Y DOS

Mobile BHRS Services MT1 Therapeutic Behavioral Svcs MT (Licensed) H2019 08 801 12 15 min O W P NA Y PSY Y DOS




















Mobile BHRS Services MT1 Therapeutic Behavioral Svcs MT, Interpreter H2019 U5 08 801 12 15 min O W P NA Y PSY Y DOS














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Mobile BHRS Services MT1 Therapeutic Behavioral Svcs MT (Non-licensed) H2019 U4 U1 31 549 12 15 min O W P NA Y PSY Y DOS

Mobile BHRS Services MT1 Therapeutic Behavioral Svcs MT (Non-licensed) H2019 U4 U1 31 549 99 15 min O W P NA Y PSY Y DOS

Mobile BHRS Services MT1 Therapeutic Behavioral Svcs MT (Non-licensed) H2019 U4 08 801 12 15 min O W P NA Y PSY Y DOS




















Mobile BHRS Services MT2 BHRS Services - Mobile Therapy n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Mobile BHRS Services TMT Targeted/Enhanced Non Licensed Masters Level MT H2019 HO 08 801 12 15 min O W P NA Y PSY Y DOS










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Mobile BHRS Services TMT Targeted/Enhanced Licensed Masters Level MT H2019 UB 08 801 12 15 min O W P NA Y PSY Y DOS


















Mobile BHRS Services TMT Targeted/Enhanced Licensed Psychologist Level MT H2019 UA 08 801 12 15 min O W P NA Y PSY Y DOS





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Mobile BHRS Services ASC After School Program for Youth with ASD H2015 SC 08 340 12 15 min O W P NA Y PSY Y DOS




Mobile BHRS Services PEPTherapeutic Behavioral Services (SBBH-Master's Level Individual Therapy) H2019 SC 08 340 99 15 min O O P NA NA Y PSY Y DOS

Mobile BHRS Services PEPTherapeutic Behavioral Services (SBBH-Master's Level Individual Therapy) H2019 SC 11 340 99 15 min O O P NA NA Y PSY Y DOS

Mobile BHRS Services PEPTherapeutic Behavioral Services (SBBH-Master's Level Group Therapy) H2019 TJ 08 340 99 15 min O O P NA NA Y PSY Y DOS

Mobile BHRS Services PEPTherapeutic Behavioral Services (SBBH-Master's Level Group Therapy) H2019 TJ 11 340 99 15 min O O P NA NA Y PSY Y DOS

Mobile BHRS Services PEPCommunity-based Wraparound Svcs (SBBH- Bachelor's Level Individual Svcs) H2021 HA SC 08 340 99 15 min O O P NA NA Y PSY Y DOS

Mobile BHRS Services PEPCommunity-based Wraparound Svcs (SBBH- Bachelor's Level Individual Svcs) H2021 HA SC 11 340 99 15 min O O P NA NA Y PSY Y DOS

Mobile BHRS Services PEPCommunity Baed Wraparound Svcs (SBBH-Bachelor's Level Group Svcs) H2021 TJ 08 340 99 15 min O O P NA NA Y PSY Y DOS

Mobile BHRS Services PEPCommunity Baed Wraparound Svcs (SBBH-Bachelor's Level Group Svcs) H2021 TJ 11 340 99 15 min O O P NA NA Y PSY Y DOS

Mobile BHRS Services PEP School Based Program Individual H0046 TJ 08 340 99 15 min O O P NA NA Y PSY Y DOS




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Mobile BHRS Services PEP School Based Program Group H0046 HQ 08 340 99 15 min O O P NA NA Y PSY Y DOS






Mobile BHRS Services FB9Act 62 Functional Behavioral Assessment (Authorization purposes only) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Mobile BHRS Services GRC Group Home R &B H0019 U3 52 523 12 per diem O W P NA Y PSY Y DOS

Mobile BHRS Services GRTTx Services Chd & Adol/Group Home -- -- Host Home Therapeutic Foster Care (TX only) H0019 U5 HQ 52 523 12 per diem O W P NA Y PSY Y DOS

IBHS PDE

Psychiatric diagnostic evaluation (Psychological Evaluation) (Effective 01/17/20)

90791 U8 11 590 11 30 min O O P NA N PSY N DOS

IBHS PDE



IBHS PDE



IBHS PDE



IBHS PDE



IBHS PDE



IBHS PDE



IBHS PDE



IBHS PDE





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IBHS ABT

Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessment and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan (Behavior Consultation - ABA) (Effective 01/17/20)

97151 11 592 03 15 min O W P NA Y PSY Y DOS

IBHS ABT



IBHS ABT



IBHS BA1

Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessment and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan (Behavior Analytic) (Effective 01/17/20)

97151 U7 11 592 03 15 min O W P NA Y PSY Y DOS



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IBHS BA1



IBHS BA1



IBHS BH1

Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes (Behavior Health Technician - ABA) (Effective 01/17/20)


IBHS BH1



IBHS BH1



IBHS BC1

Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes (Assistant Behavior Consultation - ABA) (Effective 01/17/20)




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IBHS BC1



IBHS BC1



IBHS BH1

Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes (Behavior Health Technician - ABA) (Effective 01/17/20) 97153 11 592 03 15 min O W P NA Y PSY Y DOS

IBHS BH1


IBHS BH1


IBHS BC1

Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes (Assistant Behavior Consultation - ABA) (Effective 01/17/20)


IBHS BC1





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IBHS BC1



IBHS ATG

Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes (up to 3 group members) (Effective 01/17/20) 97154 U6 11 592 03 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes (up to 3 group members) (Effective 01/17/20) 97154 U6 11 592 99 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes (4 to 6 group members) (Effective 01/17/20) 97154 U5 11 592 03 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes (4 to 6 group members) (Effective 01/17/20) 97154 U5 11 592 99 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes (7 to 12 group members) (Effective 01/17/20) 97154 11 592 03 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes (7 to 12 group members) (Effective 01/17/20) 97154 11 592 99 15 min O W P NA Y PSY Y DOS

IBHS ABT

Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous directions of technician, face-to-face with one patient, each 15 minutes (Behavior Consultation - ABA) (Effective 01/17/20) 97155 11 592 03 15 min O W P NA Y PSY Y DOS



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IBHS ABT


IBHS ABT


IBHS BA1

Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous directions of technician, face-to-face with one patient, each 15 minutes (Behavior Analytic) (Effective 01/17/20)


IBHS BA1



IBHS BA1



IBHS ABT

Family adaptive behavior treatment guidance,administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian (s)/caregiver(s), each15 minutes (Behavior Consultation—ABA) 97156 11 592 12 15 min O W P NA Y PSY Y DOS

IBHS ABT

Family adaptive behavior treatment guidance,administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian (s)/caregiver(s), each15 minutes (Behavior Consultation—ABA) 97156 11 592 99 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment with protocol modification,administered by physician or other qualified health care professional, face-toface with multiple patients, each 15 minutes (up to 3 group members) 97158 U6 11 592 03 15 min O W P NA Y PSY Y DOS



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IBHS ATG

Group adaptive behavior treatment with protocol modification,administered by physician or other qualified health care professional, face-toface with multiple patients, each 15 minutes (up to 3 group members) 97158 U6 11 592 99 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-tofacewith multiple patients, each 15 minutes (4 to 6 group members) 97158 U5 11 592 03 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-tofacewith multiple patients, each 15 minutes (4 to 6 group members) 97158 U5 11 592 99 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-toface with multiple patients, each 15 minutes (7 to 12 group members) 97158 11 592 03 15 min O W P NA Y PSY Y DOS

IBHS ATG

Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-toface with multiple patients, each 15 minutes (7 to 12 group members) 97158 11 592 99 15 min O W P NA Y PSY Y DOS

IBHS MH1Mental health assessment by non-physician (other licensed Practitioner) H0031 UB 11 590 11 30 min O O P NA N PSY N DOS









IBHS MH1Mental health assessment by non-physician (licensed practitioner) H0031 U9 11 590 11 30 min O O P NA N PSY N DOS







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IBHS BCSMental health service plan development by nonphysician (Behavior Consultation—Unlicensed Practitioner) H0032 UB 11 590 03 15 min O W P NA Y PSY Y DOS



IBHS BCSMental health service plan development by nonphysician (Behavior Consultation— Licensed Practitioner) H0032 U9 11 590 03 15 min O W P NA Y PSY Y DOS



IBHS TDS Skills Training and Development (Onsite Supervision) H2014 UB 11 590 03 15 min O W P NA N PSY Y DOS



IBHS TBSTherapeutic Behavioral Services(Mobile Therapy—Unlicensed Practitioner) H2019 U7 11 590 03 15 min O W P NA Y PSY Y DOS



IBHS TBSTherapeutic Behavioral Services(Mobile Therapy—Licensed Practitioner) H2019 U9 11 590 03 15 min O W P NA Y PSY Y DOS



IBHS FF2Therapeutic Behavioral Services(Functional Family Therapy) H2019 U8 HA 11 590 03 15 min O W P NA Y PSY Y DOS



IBHS BHTCommunity-Based Wraparound Services(Behavioral Health Technician) H2021 11 590 03 15 min O W P NA Y PSY Y DOS




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IBHS CBWCommunity-Based Wraparound Services(Group Service—4 to 8 group members) H2021 HQ U6 11 591 03 15 min O W P NA Y PSY Y DOS



IBHS CBWCommunity-Based Wraparound Services(Group Service—9 to 12 group members) H2021 U8 HQ 11 591 03 15 min O W P NA Y PSY Y DOS






IBHS MS5Multisystemic therapy for juveniles,per 15 minutes H2033 11 590 03 15 min O O P NA Y PSY Y (S8) DOS



IBHS BA2

Family adaptive behavior treatment guidance,administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian (s)/caregiver(s), each15 minutes (Behavior Analytic) 97156 U7 11 592 12 15 min O W P NA Y PSY Y DOS

IBHS BA2

Family adaptive behavior treatment guidance,administered by physician or other qualified health care professional (with orwithout the patient present), face-to-face with guardian (s)/caregiver(s), each15 minutes (Behavior Analytic) 97156 U7 11 592 99 15 min O W P NA Y PSY Y DOS

Mental Health - Partial Psych HospitalizationPRT Licensed Adult Psych Partial Hosp/Adult H0035 11 114 52 1 hour P O P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationPRT Licensed Adult Psych Partial Hosp/Child H0035 HA 11 114 52 1 hour P O P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationPRT Psych Partial/Non-covered Medicare/Adult H0035 U2 11 114 52 1 hour P O P NA Y PSY Y DOS

Mental Health - Partial Psych HospitalizationPRT Enhanced School Based Partial Level 1 H0035 U7 11 113 52 1 hour WS P O P NA Y PSY Y DOS

Mental Health - Partial Psych HospitalizationPRT Enhanced School Based Partial Level 2 H0035 U8 11 113 52 1 hour WS P O P NA Y PSY Y DOS

Mental Health - Partial Psych HospitalizationPRT Psych Partial/Non-covered Medicare/Child (0-14) H0035 U4 11 113 52 1 hour P O P NA Y PSY Y DOS

Mental Health - Partial Psych HospitalizationPRT Licensed Child Psych Partial Hosp/Adult H0035 HB UA 11 113 52 1 hour P O P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationPRT Licensed Child Psych Partial Hosp/Child H0035 UB UA 11 113 52 1 hour P O P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationPRT Licensed Child Psych Partial Hosp/Child (15 to 20 yrs) H0035 UA 11 113 52 1 hour P O P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationAPH Adult Acute Partial H0035 U5 11 114 52 1 hour P P P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationAPH Adult Acute Partial (Non-covered Medicare) H0035 U3 11 114 52 1 hour P P P NA Y PSY Y DOS

Mental Health - Partial Psych HospitalizationAPH Child/Adol Acute Partial (Non-covered Medicare) H0035 HE 11 113 52 1 hour P P P NA Y PSY Y DOS



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Mental Health - Partial Psych HospitalizationNPH Sleep Over Partial H0035 HK 11 113 52 1 hour P P P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationNPH Acute Partial H0035 U6 11 113 52 1 hour P P P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationNPH Non-Covered Acute Partial H0035 GX 11 113 52 1 hour P P P NA Y PSY Y DOS

Mental Health - Partial Psych HospitalizationCOO Acute Partial Hospitalization Co-Occurring H0035 TG 11 114 52 1 hour P P P NA Y PSY N DOS

Mental Health - Partial Psych HospitalizationAPD Adult Acute Partial Hospitalization H0035 UC 11 114 52 per hour P P P NS N PSY N DOS

Mental Health/Substance Abuse - Supplem DAP D & A Partial H2035 11 129 99 per hour P O SP PD Y SUB Y DOS

Mental Health/Substance Abuse - Supplem DAP Enhanced D & A Partial H2035 U4 11 129 99 per hour P O SP PD Y SUB Y DOS

Crisis Intervention CR0 Crisis Block Payment - Not for use by providers W9700 11 118 11 O O P NA N PSY Y

Crisis Intervention CR0 Crisis Block Payment - Not for use by providers W9700 11 118 15 O O P NA N PSY Y

Crisis Intervention CR0Blended Case Management Block Payment - Not for use by providers W9701 21 222 11 O O P NA N PSY Y





Crisis Intervention CBPDA Case Management Block Payment- Not for use by provider W9702 11 184 99 O O S NA N SUB Y

BHRS VB1 BHRS VBP Initiative T2026 BS1 n/a 99 FA O O P NA Y PSY Y DOS

Crisis Intervention CR1 Telephone Crisis H0030 11 118 11 15 min O O P NA N PSY Y DOS

Crisis Intervention CR1 Telephone Crisis H0030 11 118 11 15 min O O SA DA N SUB Y DOS

Crisis Intervention CR1 Child Urgent Response Telephone Crisis H0030 U4 11 118 11 15 min FA O O P NA N PSY Y DOS

Crisis Intervention CR1 Child Urgent Response Telephone Crisis H0030 U4 11 118 11 15 min FA O O SA DA N SUB Y DOS

Crisis Intervention CR2 Crisis Intervention Svs Walk-In Crisis H2011 11 118 11 15 min O O P NA N PSY Y DOS

Crisis Intervention CR2 Crisis Intervention Svs Walk-In Crisis H2011 11 118 11 15 min O O SA DA N SUB Y DOS

Crisis Intervention CR2 Child Urgent Response Walk In H2011 U4 11 118 11 15 min FA O O P NA N PSY Y DOS

Crisis Intervention CR2 Child Urgent Response Walk In H2011 U4 11 118 11 15 min FA O O SA DA N SUB Y DOS

Crisis Intervention CR3 Crisis Intervention Svcs Mobile/Individual Delivered H2011 HE 11 118 15 15 min O O P NA N PSY Y DOS

Crisis Intervention CR3 Crisis Intervention Svcs Mobile/Individual Delivered H2011 HE 11 118 15 15 min O O SA DA N SUB Y DOS

Crisis Intervention CR3 Mobile Crisis Follow-Up H2011 U7 11 118 15 15 min O O O NA N PSY Y DOS

Crisis Intervention CR3 Mobile Crisis Follow-Up H2011 U7 11 118 15 15 min O O O DA N SUB Y DOS

Crisis Intervention CR3 Child Urgent Response Mobile Crisis- Individual H2011 U5 11 118 15 15 min FA O O P NA N PSY Y DOS

Crisis Intervention CR3 Child Urgent Response Mobile Crisis- Individual H2011 U5 11 118 15 15 min FA O O SA DA N SUB Y DOS

Crisis Intervention CR4 Crisis Intervention Svcs Mobile/Team Delivered H2011 HT 11 118 15 15 min O O P NA N PSY Y DOS

Crisis Intervention CR4 Crisis Intervention Svcs Mobile/Team Delivered H2011 HT 11 118 15 15 min O O SA DA N SUB Y DOS

Crisis Intervention CR4 Child Urgent Response Mobile Crisis- Team H2011 U6 11 118 15 15 min FA O O P NA N PSY Y DOS

Crisis Intervention CR4 Child Urgent Response Mobile Crisis- Team H2011 U6 11 118 15 15 min FA O O P DA N SUB Y DOS

Crisis Intervention CR5 Crisis In-Home Support S9484 11 118 12 per hour O O P NA N PSY Y DOS

Crisis Intervention CR5 Crisis In-Home Support S9484 11 118 99 per hour O O SA DA N SUB Y DOS

Crisis Intervention CR6 Crisis Intervention Svcs- Medical Mobile/Team H2011 HK 11 118 15 15 min O O P NA N PSY Y DOS

Crisis Intervention CR6 Crisis Intervention Svcs- Medical Mobile/Team H2011 HK 11 118 15 15 min O O SA DA N SUB Y DOS



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Crisis Intervention CR7 Crisis Residential S9485 11 118 12 per diem O O P NA N PSY Y DOS

Crisis Intervention CR7 Crisis Residential S9485 11 118 12 per diem O O SA DA N SUB Y DOS

Crisis Intervention CR7 Residential Treatment Facility - Adult (RTFA) H0019 HB 11 110 99 per diem O O P NA N PSY Y DOS

Crisis Intervention CR7 Residential Treatment Facility - Adult (RTFA) H0019 HB 11 110 99 per diem O O SA DA N SUB Y DOS

Crisis Intervention CR8 Crisis Residential S9485 U3 11 118 12 per diem O O P NA Y PSY Y DOS

Crisis Intervention CR8 Crisis Residential S9485 U3 11 118 12 per diem O O SA DA Y SUB Y DOS

Crisis Intervention ACD Adult Diversion and Stabilization H0046 TF 11 119 31 15 min SW6, NW3 O O P NA N PSY Y DOD



Methadone Maintenance MM1 Methadone Maintenance H0020 UB 08 084 57 daily O O SA DA Y SUB Y DOS

Methadone Maintenance MM1 Methadone Maintenance H0020 U3 08 084 57 daily O O SA DA Y SUB Y DOS

Methadone Maintenance MM1 Methadone Maintenance (clinic encounter) T1015 HG 08 084 57 weekly O O SA DA Y SUB Y DOS

Methadone Maintenance MM1 Methadone Maintenance (clinic encounter) T1015 U3 08 084 57 weekly O O SA DA Y SUB Y DOS

Methadone Maintenance MM1METHADONE-RECOVERY INITIATION & STABLIZATION PHASE 1 T1015 U4 08 084 57 weekly O O SA DA Y SUB Y DOS

Methadone Maintenance MM1METHADONE-RECOVERY INITIATION & STABLIZATION PHASE 1 H0020 U4 08 084 57 daily O O SA DA Y SUB Y DOS

Methadone Maintenance MM1METHADONE-EARLY RECOVERY & REHABILITATION PHASE 2 T2015 U5 08 084 57 weekly O O SA DA Y SUB Y DOS

Methadone Maintenance MM1METHADONE-EARLY RECOVERY & REHABILITATION PHASE 2 H0020 U5 08 084 57 daily O O SA DA Y SUB Y DOS

Methadone Maintenance MM1 METHADONE-RECOVERY MAINTENANCE- PHASE 3 T1015 U6 08 084 57 weekly O O SA DA Y SUB Y DOS

Methadone Maintenance MM1 METHADONE-RECOVERY MAINTENANCE- PHASE 3 H0020 U6 08 084 57 daily O O SA DA Y SUB Y DOS

Methadone Maintenance MM1METHADONE-LONG TERM SUSTAINED RECOVERY- PHASE 4 T1015 U7 08 084 57 weekly O O SA DA Y SUB Y DOS

Methadone Maintenance MM1METHADONE-LONG TERM SUSTAINED RECOVERY- PHASE 4 H0020 U7 08 084 57 daily O O SA DA Y SUB Y DOS

Methadone Maintenance MM1 Methadone-Women who are pregnant T1015 TH 08 084 57 weekly O O SA DA Y SUB Y DOS

Methadone Maintenance MM1 Methadone-Women who are pregnant H0020 TH 08 084 57 daily O O SA DA Y SUB Y DOS

Methadone Maintenance MM1Alcohol and/or Drug Svcs: Methadone Administration and/or Svc (take-home) H0020 HG 08 084 57 daily SW6, NW3 O O SA DA Y SUB Y DOS

Other RSPAdolescent Diversion & Acute Stabilization Unit (Includes Partial Hospitalization Programming) H0019 HA 08 340 12 per diem R R UD RE Y PSY Y DOD



Other RSPAdolescent Diversion & Acute Stabilization Unit (without partial hospitalization) H0019 U7 08 340 12 per diem R R UD RE Y PSY Y DOD

Other RSPAdolescent Diversion & Acute Stabilization Unit (without partial hospitalization) H0019 U7 11 340 12 per diem R R UD RE Y PSY Y DOD

Other IND Intensive outpt D & A H0015 11 128 99 15 min N O SA DA Y SUB Y DOS

Other INP Intensive outpt Psych H2012 SC 08 110 49 per hour N O P NA Y PSY Y DOS

Other INP Co-Occurring Intensive Outpatient H2012 TG 08 110 49 per hour N O P NA Y PSY Y DOS

Other SMKSmoking and tobacco use cessation counseling visit; intensive, greater than 10 min. 99407 01 370 22 per visit N O SA NA N SUB N DOS



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Other SMKSmoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes 99407 19 370 11 per visit N O SA NA N SUB N DOS















Other PRS Psych Rehab-Site Based H0036 11 123 15 15 min O O P NA Y PSY Y DOS





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Other PRS Transition Site Based Psych Rehab H0036 U4 11 123 15 15 min O O P NA Y PSY Y DOS




Other PRS Psych Rehab Site Based Group H0036 HQ 11 123 15 15 min O O P NA Y PSY Y DOS




Other PRM Psych Rehab-Mobile H0036 HB 11 123 15 15 min O O P NA Y PSY Y DOS




Other PRM Psych Rehab Mobile Group H0036 U5 11 123 15 15 min O O P NA Y PSY Y DOS




Other PRM Psych Rehab-Mobile by ASL Cert. Signing Therapist H0036 U3 11 123 15 15 min O O O NA Y PSY Y DOS




Other CLB Psych Rehab Clubhouse H2030 11 123 99 15 min O O P NA Y PSY Y DOS

Other CLB Psych Rehab Clubhouse Group H2030 HQ 11 123 99 15 min O O P NA Y PSY Y DOS

Other CRR Community Res Rehab H0018 HB 11 110 99 per diem O R P NA Y PSY Y DOS

Other CRO Community Residential Services - Other T2048 U5 52 523 12 per diem O R P NA Y PSY Y DOS

Other CTA CTT Assessment H0039 HK 11 111 31 Event O O P NA N PSY Y DOS



Other CTT Community Tx Teams H0039 HB 11 111 31 15 min O O P NA Y PSY Y DOS



Other CTT Assertive Community Tx Team (ACT) Group H0039 U3 11 111 31 15 min O O P NA Y PSY Y DOS



Other CTT Transitions Program H0046 HE 11 119 31 15 min CW,ME,VE,BT O O P NA Y PSY Y DOS



Other CMM Community Mental Health/Other (Mobile Meds) H0046 HW 11 119 31 15 min O O P NA Y PSY Y DOS




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Other CMM Community Mental Health/Other (Mobile Meds) H0046 HW 11 119 31 15 min O O SA DA Y SUB Y DOS



Other CMM Mobile Meds Travel H0046 U4 11 119 31 15 min O O P NA Y PSY Y DOS



Other CMM Mobile Meds Nurse Extender H0046 HK 11 119 31 15 min O O P NA Y PSY Y DOS



Other MMF Mobile Meds Follow Up H0046 U5 11 119 31 15 min O O P NA N PSY Y DOS



Other INS Interpreter Services All Ages H0046 UB 11 119 31 15 min O O P NA N PSY Y DOS

Other INS Interpreter Services All Ages H0046 UB 11 119 31 15 min O O SA DA N SUB Y DOS





Other FFAAdult Family Focused Solutions Based Services- Individual H0046 HB 11 119 31 15 min O W P NA Y PSY Y DOS



Other FFA Adult Family Focused Solutions Based Services- Team H0046 U6 11 119 31 15 min O W P NA Y PSY Y DOS



Other FDP Forensic Diversion Program (APA) H2033 HB 11 119 31 Weekly O O P NA Y PSY Y DOS

Other FDP Forensic Diversion Program (APA) H2033 HB 11 119 31 Weekly O O SA NA Y SUB Y DOS





Other FDE Forensic Diversion Encounter Data (APA) H2033 U7 11 119 31 15 min O O P NA N PSY Y DOS

Other FDE Forensic Diversion Encounter Data (APA) H2033 U7 11 119 31 15 min O O SA NA N SUB Y DOS





Other FFSChild Family Focused Solutions Based Services- Individual H0046 U2 U9 08 340 12 15 min O W P NA Y PSY Y DOS



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Other FFS Child Family Focused Solutions Based Services- Team H0046 U3 U9 08 340 12 15 min O W P NA Y PSY Y DOS




Other FF1 Functional Family Therapy H2019 HA U9 08 340 12 15 min O O P NA Y PSY Y (S8) DOS




Other FF1 Functional Family Therapy - Collateral H2019 U6 U9 08 340 12 15 min O O P NA Y PSY Y (S8) DOS




Other PT1 Project Transitions 24/7 Program H0046 T1 11 119 31 15 min AI, WAS O O P NA Y PSY Y DOS



Other PT2 Project Transitions Level 1 H0046 TG 11 119 31 15 min AI, WAS O O P NA Y PSY Y DOS



Other PT2 Project Transitions Level 2 H0046 HX 11 119 31 15 min AI, WAS O O P NA Y PSY Y DOS



Other PT2 Project Transitions Level 3 H0046 TS 11 119 31 15 min AI, WAS O O P NA Y PSY Y DOS



Other DTT Dual Diagnosis Treatment Team H0046 HI 11 119 31 15 min SW6/NW3 BVR/FAY O O P NA Y PSY Y DOS



Other AUT Non-emergency Transportation A0080 n/a n/a n/a Per Trip BVR O O O NA Y DOS

Case Management CM1 MH/MR Case Management (ICM) T1017 UB 21 222 11 15 min O O P NA Y PSY Y DOS



Case Management CM1 MH Services During Psych Inpatient Admission (ICM) T1017 HK 21 222 21 15 min I O P NA Y PSY Y DOS

Case Management CM1MH Services During Non-Psych Inpatient Admission (ICM) T1017 HE HK 21 222 21 15 min I O P NA Y PSY Y DOS



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Case Management CM1 MH Services During Psych Inpatient Admission H0004 HK 21 222 21 15 min I O P NA Y PSY Y DOS

Case Management CM1 MH Services During Non-Psych Inpatient Admission H0004 U4 21 222 21 15 min I O P NA Y PSY Y DOS



Case Management CM1 Child Urgent Response Team BCM T1017 HA 21 222 11 15 min O O O NA Y PSY Y DOS



Case Management CM1 MH Intensive Case Management Svc. T1017 UC 21 222 11 15 min O O P NA Y PSY Y DOS



Case Management TM1 Blended Case Management - Encounter T1017 UD 21 222 11 15 min O O P NA N PSY Y DOS



Case Management TM1 TCM Auto-Payment T1017 U7 21 222 11 15 min O O P NA N PSY Y DOS



Case Management TM1 Advanced MH-BCM T1017 HO 21 222 11 15 min CW, ME, VE O O P NA N PSY Y DOS



Case Management TM1 MDFT Case Management H0047 11 184 99 15 min O O SA NA N SUB Y DOS

Case Management RC1 Resource Coordination T1017 TF 21 221 11 15 min O O PM MN N PSY Y DOS



Case Management RC1 MH Services During Psych Inpatient Admission (RC) T1017 TS 21 221 21 15 min I O PM MN N PSY Y DOS

Case Management RC1MH Services During Non-Psych Inpatient Admission (RC) T1017 ST 21 221 21 15 min I O PM MN N PSY Y DOS



Case Management RC2 Resource Coordination D & A H0006 TF 21 138 99 15 min O O SA DA N SUB Y DOS

Case Management RC2 D &A ICM H0006 21 138 99 15 min O O SA DA N SUB Y DOS

Case Management DCM D &A ICM T1017 HF 21 138 99 15 min O O SA DA N SUB Y DOS

Other COE D & A CM - Center of Excellence G9012 21 138 99 O O SA NA N SUB Y DOS

Other COEOther specified case management services not elsewhere classified, effective 07/01/19 G9012 01 022 99 per month N O SA NA N SUB N DOS




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Case Management ER2 2nd vst/24 hours 99283 SC 31 339 23 visit N/A N/A P NA N PSY N DOS

Case Management ER2 2nd vst/24 hours 99283 SC 09 103 23 visit N/A N/A P NA N PSY N DOS

Autism Center of Excellence (ACE) ACE

OV/OP Visit for Evaluation &Management of New Patient, ProblemSelf Ltd or Minor, face to face withpatient and/or family (ACE) 99201 SC 08 110 49 10 min SW6, NW3 O O P NA N PSY N DOS



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OV/OP Visit for Evaluation &Management of New Patient, ProblemLow to Moderate, face to face w/patient and/or family (ACE) 99202 SC 08 110 49 20 min SW6, NW3 O O P NA N PSY N DOS


OV/OP Visit for Evaluation &Management of New Patient, ProblemModerate, face to face w/ patientand/or family (ACE) 99203 SC 08 110 49 30 min SW6, NW3 O O P NA N PSY N DOS


OV/OP Visit for Evaluation &Management of New Patient, ProblemModerate to High, face to face w/patient and/or family (ACE) 99204 SC 08 110 49 45 min SW6, NW3 O O P NA N PSY N DOS


OV/OP Visit for Evaluation &Management of New Patient, ProblemModerate to High, face to face w/patient and/or family (ACE) 99205 SC 08 110 49 60 min SW6, NW3 O O P NA N PSY N DOS


OV/OP Visit for Evaluation &Management of Established Patient,Problem Self Ltd or Minor, face toface w/ patient and/or family (ACE) 99212 SC 08 110 49 10 min SW6, NW3 O O P NA N PSY N DOS


OV/OP Visit for Evaluation &Management of Established Patient,Problem Low to Moderate, face toface w/ patient and/or family (ACE) 99213 SC 08 110 49 15 min SW6, NW3 O O P NA N PSY N DOS


OV/OP Visit for Evaluation &Management of Established Patient,Problem Moderate to High, face toface w/ patient and/or family (ACE) 99214 SC 08 110 49 25 min SW6, NW3 O O P NA N PSY N DOS


OV/OP Visit for Evaluation &Management of Established Patient,Problem Moderate to High, face toface w/ patient and/or family (ACE) 99215 SC 08 110 49 40 min SW6, NW3 O O P NA N PSY N DOS

Laboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHO 70450 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHO 70450 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BR 70470 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BR 70470 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD MAGNETIC RESONANCE (EG, PROTON) IMAGING, BR 70551 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD MAGNETIC RESONANCE (EG, PROTON) IMAGING, BR 70551 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD MAGNETIC RESONANCE (EG, PROTON) IMAGING, BR 70553 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD MAGNETIC RESONANCE (EG, PROTON) IMAGING, BR 70553 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEA 93000 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEA 93000 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEA 93005 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEA 93005 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEA 93010 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEA 93010 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIM 93307 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIM 93307 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD Doppler echocardiography, pulsed wave and/or continuou 93320 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD Doppler echocardiography, pulsed wave and/or continuou 93320 01 183 22 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD Electroencephalogram (EEG); including recording awake 95816 28 280 81 N/A N/A P N PSY / SUB N DOSLaboratory Studies/Dianostic/Radiology/Medical Diagnostic Orderd by BH Physicians RAD Electroencephalogram (EEG); including recording awake 95816 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Basic metabolic panel (Calcium, ionized) 80047 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Basic metabolic panel (Calcium, ionized) 80047 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Basic metabolic panel (Calcium, total) 80048 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Basic metabolic panel (Calcium, total) 80048 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB General health panel 80050 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB General health panel 80050 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABElectrolyte panel (carbon dioxide, chloride, potassium, sodium) 80051 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABElectrolyte panel (carbon dioxide, chloride, potassium, sodium) 80051 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Comprehensive metabolic panel 80053 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Comprehensive metabolic panel 80053 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB Obstetric blood test panel 80055 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Obstetric blood test panel 80055 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Lipid panel (Cholesterol, Lipoprotein, Triglycerides) 80061 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Lipid panel (Cholesterol, Lipoprotein, Triglycerides) 80061 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Kidney function blood test panel 80069 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Kidney function blood test panel 80069 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Acute hepatitis panel 80074 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Acute hepatitis panel 80074 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Liver function blood test panel 80076 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Liver function blood test panel 80076 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Obstetric panel (includes HIV testing) (cbc, differential wbc count, hepatitis b, hiv, rubella, syphilis, antibody screening, rbc, blood typing) 80081 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Obstetric panel (includes HIV testing) (cbc, differential wbc count, hepatitis b, hiv, rubella, syphilis, antibody screening, rbc, blood typing) 80081 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMIKACIN 80150 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMIKACIN 80150 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Caffeine 80155 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Caffeine 80155 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBAMAZEPINE; TOTAL 80156 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBAMAZEPINE; TOTAL 80156 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBAMAZEPINE; FREE 80157 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBAMAZEPINE; FREE 80157 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYCLOSPORINE 80158 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYCLOSPORINE 80158 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clozapine 80159 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clozapine 80159 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Digoxin; total 80162 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Digoxin; total 80162 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Digoxin; free 80163 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Digoxin; free 80163 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Valproic acid (dipropylacetic acid); total 80164 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Valproic acid (dipropylacetic acid); total 80164 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Valproic acid (dipropylacetic acid); free 80165 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Valproic acid (dipropylacetic acid); free 80165 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ETHOSUXIMIDE 80168 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ETHOSUXIMIDE 80168 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Everolimus 80169 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Everolimus 80169 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GENTAMICIN 80170 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GENTAMICIN 80170 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Gabapentin, whole blood, serum, or plasma 80171 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB Gabapentin, whole blood, serum, or plasma 80171 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HALOPERIDOL 80173 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HALOPERIDOL 80173 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Lamotrigine 80175 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Lamotrigine 80175 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LIDOCAINE 80176 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LIDOCAINE 80176 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Levetiracetam 80177 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Levetiracetam 80177 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LITHIUM 80178 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LITHIUM 80178 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Mycophenolate (mycophenolic acid) 80180 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Mycophenolate (mycophenolic acid) 80180 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Oxcarbazepine 80183 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Oxcarbazepine 80183 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENOBARBITAL 80184 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENOBARBITAL 80184 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENYTOIN; TOTAL 80185 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENYTOIN; TOTAL 80185 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENYTOIN; FREE 80186 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENYTOIN; FREE 80186 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PRIMIDONE 80188 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PRIMIDONE 80188 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROCAINAMIDE; 80190 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROCAINAMIDE; 80190 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPROCAINAMIDE; WITH METABOLITES (EG, N-ACETYL PROCAINAMIDE) 80192 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPROCAINAMIDE; WITH METABOLITES (EG, N-ACETYL PROCAINAMIDE) 80192 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB QUINIDINE 80194 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB QUINIDINE 80194 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SIROLIMUS 80195 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SIROLIMUS 80195 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TACROLIMUS 80197 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TACROLIMUS 80197 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THEOPHYLLINE 80198 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THEOPHYLLINE 80198 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Tiagabine 80199 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Tiagabine 80199 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TOBRAMYCIN 80200 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TOBRAMYCIN 80200 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TOPIRAMATE 80201 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB TOPIRAMATE 80201 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VANCOMYCIN 80202 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VANCOMYCIN 80202 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Zonisamide 80203 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Zonisamide 80203 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Quantitation of therapeutic drug, not elsewhere specified 80299 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Quantitation of therapeutic drug, not elsewhere specified 80299 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Testing for presence of drug 80305 28 280 81 N/A N/A P N PSY / SUB N DOS






Laboratory LAB Alcohols 80320 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alcohols 80320 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alcohol biomarkers; 1 or 2 80321 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alcohol biomarkers; 1 or 2 80321 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alcohol biomarkers; 3 or more 80322 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alcohol biomarkers; 3 or more 80322 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Amphetamines; 1 or 2 80324 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LAB Amphetamines; 5 or more 80326 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Amphetamines; 5 or more 80326 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Anabolic steroids; 1 or 2 80327 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Anabolic steroids; 1 or 2 80327 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Anabolic steroids; 3 or more 80328 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Anabolic steroids; 3 or more 80328 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analgesics, non-opioid; 1 or 2 80329 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analgesics, non-opioid; 1 or 2 80329 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analgesics, non-opioid; 3-5 80330 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analgesics, non-opioid; 3-5 80330 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analgesics, non-opioid; 6 or more 80331 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analgesics, non-opioid; 6 or more 80331 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Antidepressants, tricyclic and other cyclicals; 1 or 2 80335 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Antidepressants, tricyclic and other cyclicals; 1 or 2 80335 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Antidepressants, tricyclic and other cyclicals; 3-5 80336 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Antidepressants, tricyclic and other cyclicals; 3-5 80336 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB Antidepressants, tricyclic and other cyclicals; 6 or more 80337 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Antidepressants, tricyclic and other cyclicals; 6 or more 80337 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Antipsychotics, not otherwise specified; 1-3 80342 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LAB Antipsychotics, not otherwise specified; 7 or more 80344 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Antipsychotics, not otherwise specified; 7 or more 80344 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Barbiturates 80345 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Barbiturates 80345 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Benzodiazepines; 1-12 80346 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Benzodiazepines; 1-12 80346 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Benzodiazepines; 13 or more 80347 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Benzodiazepines; 13 or more 80347 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Buprenorphine 80348 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Buprenorphine 80348 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Cannabinoids, natural 80349 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Cannabinoids, natural 80349 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Cocaine 80353 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Cocaine 80353 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Fentanyl 80354 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Fentanyl 80354 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Methadone 80358 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Methadone 80358 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Opiates, 1 or more 80361 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Opiates, 1 or more 80361 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Opioids and opiate analogs; 1 or 2 80362 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LAB Opioids and opiate analogs; 5 or more 80364 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Opioids and opiate analogs; 5 or more 80364 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Oxycodone 80365 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Oxycodone 80365 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Skeletal muscle relaxants; 1 or 2 80369 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Skeletal muscle relaxants; 1 or 2 80369 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Skeletal muscle relaxants; 3 or more 80370 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Skeletal muscle relaxants; 3 or more 80370 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABDrug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3 80375 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LABDrug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3 80375 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHormonal panel for adrenal gland assessment (adrenal gland insufficiency) 80400 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHormonal panel for adrenal gland assessment (adrenal gland insufficiency) 80400 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHormone panel for adrenal gland assessment (21 hydroxylase deficiency) 80402 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHormone panel for adrenal gland assessment (21 hydroxylase deficiency) 80402 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHormone panel adrenal gland assessment (3 beta-hydroxydehydrogenase deficiency) 80406 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHormone panel adrenal gland assessment (3 beta-hydroxydehydrogenase deficiency) 80406 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Aldosterone suppression evaluation panel 80408 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Aldosterone suppression evaluation panel 80408 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Calcitonin stimulation panel 80410 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Calcitonin stimulation panel 80410 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Adrenal gland stimulation panel 80412 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Adrenal gland stimulation panel 80412 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Reproductive hormone panel (testosterone) 80414 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Reproductive hormone panel (testosterone) 80414 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Reproductive hormone panel (estradiol) 80415 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Reproductive hormone panel (estradiol) 80415 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Renal vein renin (kidney enzyme) stimulation panel 80416 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Renal vein renin (kidney enzyme) stimulation panel 80416 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Peripheral vein renin (kidney enzyme) stimulation panel 80417 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Peripheral vein renin (kidney enzyme) stimulation panel 80417 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Anterior pituitary gland evaluation panel 80418 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Anterior pituitary gland evaluation panel 80418 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Dexamethasone suppression panel, 48 hour 80420 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Dexamethasone suppression panel, 48 hour 80420 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGlucagon (hormone) tolerance panel to evaluate for insulinoma (pancreatic tumor) 80422 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGlucagon (hormone) tolerance panel to evaluate for insulinoma (pancreatic tumor) 80422 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGlucagon (hormone) tolerance panel to evaluate for pheochromocytoma (adrenal gland tumor) 80424 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGlucagon (hormone) tolerance panel to evaluate for pheochromocytoma (adrenal gland tumor) 80424 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGonadotropin releasing hormone (reproductive hormone) panel 80426 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGonadotropin releasing hormone (reproductive hormone) panel 80426 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Growth hormone stimulation panel 80428 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Growth hormone stimulation panel 80428 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB Growth hormone suppression panel 80430 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Growth hormone suppression panel 80430 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Insulin-induced C-peptide (protein) suppression panel 80432 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Insulin-induced C-peptide (protein) suppression panel 80432 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABInsulin tolerance panel for ACTH (adrenal gland hormone) insufficiency 80434 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABInsulin tolerance panel for ACTH (adrenal gland hormone) insufficiency 80434 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Insulin tolerance panel for growth hormone deficiency 80435 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Insulin tolerance panel for growth hormone deficiency 80435 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Metyrapone (hormone antibody) panel 80436 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Metyrapone (hormone antibody) panel 80436 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABThyrotropin releasing hormone (TRH) (hypothalamus hormone) stimulation panel, 1 hour 80438 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LAB

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; NON-AUTOMATED, WITH MICROSCOPY 81000 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; NON-AUTOMATED, WITH MICROSCOPY 81000 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITH MICROSCOPY 81001 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITH MICROSCOPY 81001 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy 81002 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy 81002 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITHOUT MICROSCOPY 81003 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITHOUT MICROSCOPY 81003 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABURINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS 81005 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABURINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS 81005 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABURINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE OR DIPSTICK 81007 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABURINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE OR DIPSTICK 81007 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB URINALYSIS; MICROSCOPIC ONLY 81015 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB URINALYSIS; MICROSCOPIC ONLY 81015 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urinalysis, 2 or 3 glass test 81020 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urinalysis, 2 or 3 glass test 81020 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABURINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS 81025 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABURINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS 81025 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (Human Platelet Antigen 1) for common variant 81105 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (Human Platelet Antigen 1) for common variant 81105 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

DMD (DYSTROPHIN) (EG, DUCHENNE/BECKER MUSCULAR DYSTROPHY) DELETION ANALYSIS, AND DUPLICATION ANALYSIS, IF PERFORMED 81161 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

DMD (DYSTROPHIN) (EG, DUCHENNE/BECKER MUSCULAR DYSTROPHY) DELETION ANALYSIS, AND DUPLICATION ANALYSIS, IF PERFORMED 81161 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements) 81162 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements) 81162 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis 81163 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis 81163 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) 81164 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) 81164 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis 81165 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis 81165 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) 81166 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB


Laboratory LAB


Laboratory LAB


Laboratory LABGene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase) 81170 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase) 81170 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

ASPA (ASPARTOACYLASE) (EG, CANAVAN DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, E285A, Y231X) 81200 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

ASPA (ASPARTOACYLASE) (EG, CANAVAN DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, E285A, Y231X) 81200 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (adenomatous polyposis coli), full gene sequence 81201 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (adenomatous polyposis coli), full gene sequence 81201 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (adenomatous polyposis coli), known familial variants 81202 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (adenomatous polyposis coli), known familial variants 81202 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (adenomatous polyposis coli), duplication or deletion variants 81203 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (adenomatous polyposis coli), duplication or deletion variants 81203 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRAF (V-RAF MURINE SARCOMA VIRAL ONCOGENE HOMOLOG B1) (EG, COLON CANCER), GENE ANALYSIS, V600E VARIANT 81210 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRAF (V-RAF MURINE SARCOMA VIRAL ONCOGENE HOMOLOG B1) (EG, COLON CANCER), GENE ANALYSIS, V600E VARIANT 81210 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1, BRCA2 (BREAST CANCER 1 AND 2) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; FULL SEQUENCE ANALYSIS AND COMMON DUPLICATION/DELETION VARIANTS IN BRCA1 (IE, EXON 13 DEL 3.835KB, EXON 13 DUP 6KB, EXON 14-20 DEL 26KB, EXON 22 DEL 510BP, 81211 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1, BRCA2 (BREAST CANCER 1 AND 2) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; FULL SEQUENCE ANALYSIS AND COMMON DUPLICATION/DELETION VARIANTS IN BRCA1 (IE, EXON 13 DEL 3.835KB, EXON 13 DUP 6KB, EXON 14-20 DEL 26KB, EXON 22 DEL 510BP, 81211 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (breast cancer 1 and 2) for 185delAG, 5385insC, 6174delT variants 81212 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (breast cancer 1 and 2) for 185delAG, 5385insC, 6174delT variants 81212 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1, BRCA2 (BREAST CANCER 1 AND 2) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; UNCOMMON DUPLICATION/DELETION VARIANTS 81213 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1, BRCA2 (BREAST CANCER 1 AND 2) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; UNCOMMON DUPLICATION/DELETION VARIANTS 81213 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BRCA1 (BREAST CANCER 1) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; FULL SEQUENCE ANALYSIS AND COMMON DUPLICATION/DELETION VARIANTS (IE, EXON 13 DEL 3.835KB, EXON 13 DUP 6KB, EXON 14-20 DEL 26KB, EXON 22 DEL 510BP, EXON 8-9 DEL 7.1KB) 81214 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

BRCA1 (BREAST CANCER 1) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; FULL SEQUENCE ANALYSIS AND COMMON DUPLICATION/DELETION VARIANTS (IE, EXON 13 DEL 3.835KB, EXON 13 DUP 6KB, EXON 14-20 DEL 26KB, EXON 22 DEL 510BP, EXON 8-9 DEL 7.1KB) 81214 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (breast cancer 1) for known familial variant 81215 28 280 81 N/A N/A P N PSY / SUB N DOS


Laboratory LAB Gene analysis (breast cancer 2) of full sequence 81216 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Gene analysis (breast cancer 2) of full sequence 81216 01 183 22 N/A N/A P N PSY / SUB N DOS



Laboratory LAB

Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence (eg, acute myeloid leukemia), full gene sequence 81218 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence (eg, acute myeloid leukemia), full gene sequence 81218 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMMON VARIANTS (EG, ACMG/ACOG GUIDELINES) 81220 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMMON VARIANTS (EG, ACMG/ACOG GUIDELINES) 81220 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (epidermal growth factor receptor) (eg, non-small cell lung cancer), common variants (eg, exon 19 LREA deletion, L858R, T790 M, G719A, G719S, L861Q) 81235 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (epidermal growth factor receptor) (eg, non-small cell lung cancer), common variants (eg, exon 19 LREA deletion, L858R, T790 M, G719A, G719S, L861Q) 81235 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (prothrombin, coagulation factor II) A variant 81240 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (prothrombin, coagulation factor II) A variant 81240 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

F5 (COAGULATION FACTOR V) (EG, HEREDITARY HYPERCOAGULABILITY) GENE ANALYSIS, LEIDEN VARIANT 81241 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

F5 (COAGULATION FACTOR V) (EG, HEREDITARY HYPERCOAGULABILITY) GENE ANALYSIS, LEIDEN VARIANT 81241 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILE X MENTAL RETARDATION) GENE ANALYSIS; EVALUATION TO DETECT ABNORMAL (EG, EXPANDED) ALLELES 81243 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILE X MENTAL RETARDATION) GENE ANALYSIS; EVALUATION TO DETECT ABNORMAL (EG, EXPANDED) ALLELES 81243 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (fragile X mental retardation 1) for characterization of alleles (eg, expanded size and promoter methylation status) 81244 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (fragile X mental retardation 1) for characterization of alleles (eg, expanded size and promoter methylation status) 81244 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FLT3 (FMS-RELATED TYROSINE KINASE 3) (EG, ACUTE MYELOID LEUKEMIA), GENE ANALYSIS; INTERNAL TANDEM DUPLICATION (ITD) VARIANTS (IE, EXONS 14, 15) 81245 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FLT3 (FMS-RELATED TYROSINE KINASE 3) (EG, ACUTE MYELOID LEUKEMIA), GENE ANALYSIS; INTERNAL TANDEM DUPLICATION (ITD) VARIANTS (IE, EXONS 14, 15) 81245 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEXA (HEXOSAMINIDASE A [ALPHA POLYPEPTIDE]) (EG, TAY-SACHS DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, 1278INSTATC, 1421+1G>C, G269S) 81255 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEXA (HEXOSAMINIDASE A [ALPHA POLYPEPTIDE]) (EG, TAY-SACHS DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, 1278INSTATC, 1421+1G>C, G269S) 81255 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HFE (HEMOCHROMATOSIS) (EG, HEREDITARY HEMOCHROMATOSIS) GENE ANALYSIS, COMMON VARIANTS (EG, C282Y, H63D) 81256 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HFE (HEMOCHROMATOSIS) (EG, HEREDITARY HEMOCHROMATOSIS) GENE ANALYSIS, COMMON VARIANTS (EG, C282Y, H63D) 81256 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant 81257 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant 81257 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein) (eg, familial dysautonomia)common variants 81260 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein) (eg, familial dysautonomia)common variants 81260 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IGH@ (IMMUNOGLOBULIN HEAVY CHAIN LOCUS) (EG, LEUKEMIAS AND LYMPHOMAS, B-CELL), GENE REARRANGEMENT ANALYSIS TO DETECT ABNORMAL CLONAL POPULATION(S); AMPLIFIED METHODOLOGY (EG, POLYMERASE CHAIN REACTION) 81261 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

IGH@ (IMMUNOGLOBULIN HEAVY CHAIN LOCUS) (EG, LEUKEMIAS AND LYMPHOMAS, B-CELL), GENE REARRANGEMENT ANALYSIS TO DETECT ABNORMAL CLONAL POPULATION(S); AMPLIFIED METHODOLOGY (EG, POLYMERASE CHAIN REACTION) 81261 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IGH@ (IMMUNOGLOBULIN HEAVY CHAIN LOCUS) (EG, LEUKEMIAS AND LYMPHOMAS, B-CELL), GENE REARRANGEMENT ANALYSIS TO DETECT ABNORMAL CLONAL POPULATION(S); DIRECT PROBE METHODOLOGY (EG, SOUTHERN BLOT) 81262 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IGH@ (IMMUNOGLOBULIN HEAVY CHAIN LOCUS) (EG, LEUKEMIAS AND LYMPHOMAS, B-CELL), GENE REARRANGEMENT ANALYSIS TO DETECT ABNORMAL CLONAL POPULATION(S); DIRECT PROBE METHODOLOGY (EG, SOUTHERN BLOT) 81262 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene rearrangement analysis (immunoglobulin heavy chain locus) (eg, leukemia and lymphoma, B-cell) variable region somatic mutation analysis 81263 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene rearrangement analysis (immunoglobulin heavy chain locus) (eg, leukemia and lymphoma, B-cell) variable region somatic mutation analysis 81263 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IGK@ (IMMUNOGLOBULIN KAPPA LIGHT CHAIN LOCUS) (EG, LEUKEMIA AND LYMPHOMA, B-CELL), GENE REARRANGEMENT ANALYSIS, EVALUATION TO DETECT ABNORMAL CLONAL POPULATION(S) 81264 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IGK@ (IMMUNOGLOBULIN KAPPA LIGHT CHAIN LOCUS) (EG, LEUKEMIA AND LYMPHOMA, B-CELL), GENE REARRANGEMENT ANALYSIS, EVALUATION TO DETECT ABNORMAL CLONAL POPULATION(S) 81264 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

JAK2 (JANUS KINASE 2) (EG, MYELOPROLIFERATIVE DISORDER) GENE ANALYSIS, P.VAL617PHE (V617F) VARIANT 81270 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

JAK2 (JANUS KINASE 2) (EG, MYELOPROLIFERATIVE DISORDER) GENE ANALYSIS, P.VAL617PHE (V617F) VARIANT 81270 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), targeted sequence (eg, exons 8, 11, 13, 17, 18) 81272 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), targeted sequence (eg, exons 8, 11, 13, 17, 18) 81272 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis) D816 variant(s) 81273 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis) D816 variant(s) 81273 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

KRAS (V-KI-RAS2 KIRSTEN RAT SARCOMA VIRAL ONCOGENE) (EG, CARCINOMA) GENE ANALYSIS, VARIANTS IN CODONS 12 AND 13 81275 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

KRAS (V-KI-RAS2 KIRSTEN RAT SARCOMA VIRAL ONCOGENE) (EG, CARCINOMA) GENE ANALYSIS, VARIANTS IN CODONS 12 AND 13 81275 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (Kirsten rat sarcoma viral oncogene homolog), additional variants (eg, codon 61, codon 146) 81276 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (Kirsten rat sarcoma viral oncogene homolog), additional variants (eg, codon 61, codon 146) 81276 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABMGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme) promoter methylation analysis 81287 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABMGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme) promoter methylation analysis 81287 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis 81292 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis 81292 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis; known familial variants 81293 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis; known familial variants 81293 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2)(eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis;full sequence analysis; duplication/deletion variants 81294 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2)(eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis;full sequence analysis; duplication/deletion variants 81294 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis 81295 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis 81295 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABGene analysis (mutS homolog 2, colon cancer, nonpolyposis type 1) known familial variants 81296 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (mutS homolog 2, colon cancer, nonpolyposis type 1) known familial variants 81296 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (mutS homolog 2, colon cancer, nonpolyposis type 1) duplication or deletion variants 81297 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (mutS homolog 2, colon cancer, nonpolyposis type 1) duplication or deletion variants 81297 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MSH6 (MUTS HOMOLOG 6 [E. COLI]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; FULL SEQUENCE ANALYSIS 81298 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MSH6 (MUTS HOMOLOG 6 [E. COLI]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; FULL SEQUENCE ANALYSIS 81298 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MSH6 (MUTS HOMOLOG 6 [E. COLI]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; KNOWN FAMILIAL VARIANTS 81299 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MSH6 (MUTS HOMOLOG 6 [E. COLI]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; KNOWN FAMILIAL VARIANTS 81299 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MSH6 (MUTS HOMOLOG 6 [E. COLI]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS 81300 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MSH6 (MUTS HOMOLOG 6 [E. COLI]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS 81300 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MICROSATELLITE INSTABILITY ANALYSIS (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) OF MARKERS FOR MISMATCH REPAIR DEFICIENCY (EG, BAT25, BAT26), INCLUDES COMPARISON OF NEOPLASTIC AND NORMAL TISSUE, IF PERFORMED 81301 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MICROSATELLITE INSTABILITY ANALYSIS (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) OF MARKERS FOR MISMATCH REPAIR DEFICIENCY (EG, BAT25, BAT26), INCLUDES COMPARISON OF NEOPLASTIC AND NORMAL TISSUE, IF PERFORMED 81301 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MECP2 (METHYL CPG BINDING PROTEIN 2) (EG, RETT SYNDROME) GENE ANALYSIS; FULL SEQUENCE ANALYSIS 81302 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MECP2 (METHYL CPG BINDING PROTEIN 2) (EG, RETT SYNDROME) GENE ANALYSIS; FULL SEQUENCE ANALYSIS 81302 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

MECP2 (METHYL CPG BINDING PROTEIN 2) (EG, RETT SYNDROME) GENE ANALYSIS; KNOWN FAMILIAL VARIANT 81303 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MECP2 (METHYL CPG BINDING PROTEIN 2) (EG, RETT SYNDROME) GENE ANALYSIS; KNOWN FAMILIAL VARIANT 81303 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MECP2 (METHYL CPG BINDING PROTEIN 2) (EG, RETT SYNDROME) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS 81304 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MECP2 (METHYL CPG BINDING PROTEIN 2) (EG, RETT SYNDROME) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS 81304 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABNPM1 (NUCLEOPHOSMIN) (EG, ACUTE MYELOID LEUKEMIA) GENE ANALYSIS, EXON 12 VARIANTS 81310 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABNPM1 (NUCLEOPHOSMIN) (EG, ACUTE MYELOID LEUKEMIA) GENE ANALYSIS, EXON 12 VARIANTS 81310 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, cocon 61) 81311 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, cocon 61) 81311 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [GIST]), targeted sequence analysis (eg, exons 12, 18) 81314 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [GIST]), targeted sequence analysis (eg, exons 12, 18) 81314 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PML/RARALPHA, (T(15;17)), (PROMYELOCYTIC LEUKEMIA/RETINOIC ACID RECEPTOR ALPHA) (EG, PROMYELOCYTIC LEUKEMIA) TRANSLOCATION ANALYSIS; COMMON BREAKPOINTS (EG, INTRON 3 AND INTRON 6), QUALITATIVE OR QUANTITATIVE 81315 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PML/RARALPHA, (T(15;17)), (PROMYELOCYTIC LEUKEMIA/RETINOIC ACID RECEPTOR ALPHA) (EG, PROMYELOCYTIC LEUKEMIA) TRANSLOCATION ANALYSIS; COMMON BREAKPOINTS (EG, INTRON 3 AND INTRON 6), QUALITATIVE OR QUANTITATIVE 81315 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PML/RARALPHA, (T(15;17)), (PROMYELOCYTIC LEUKEMIA/RETINOIC ACID RECEPTOR ALPHA) (EG, PROMYELOCYTIC LEUKEMIA) TRANSLOCATION ANALYSIS; SINGLE BREAKPOINT (EG, INTRON 3, INTRON 6 OR EXON 6), QUALITATIVE OR QUANTITATIVE 81316 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

PML/RARALPHA, (T(15;17)), (PROMYELOCYTIC LEUKEMIA/RETINOIC ACID RECEPTOR ALPHA) (EG, PROMYELOCYTIC LEUKEMIA) TRANSLOCATION ANALYSIS; SINGLE BREAKPOINT (EG, INTRON 3, INTRON 6 OR EXON 6), QUALITATIVE OR QUANTITATIVE 81316 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PMS2 (POSTMEIOTIC SEGREGATION INCREASED 2 [S. CEREVISIAE]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; FULL SEQUENCE ANALYSIS 81317 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PMS2 (POSTMEIOTIC SEGREGATION INCREASED 2 [S. CEREVISIAE]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; FULL SEQUENCE ANALYSIS 81317 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PMS2 (POSTMEIOTIC SEGREGATION INCREASED 2 [S. CEREVISIAE]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; KNOWN FAMILIAL VARIANTS 81318 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PMS2 (POSTMEIOTIC SEGREGATION INCREASED 2 [S. CEREVISIAE]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; KNOWN FAMILIAL VARIANTS 81318 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PMS2 (POSTMEIOTIC SEGREGATION INCREASED 2 [S. CEREVISIAE]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS 81319 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PMS2 (POSTMEIOTIC SEGREGATION INCREASED 2 [S. CEREVISIAE]) (EG, HEREDITARY NON-POLYPOSIS COLORECTAL CANCER, LYNCH SYNDROME) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS 81319 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (peripheral myelin protein 22), duplication or deletion analysis 81324 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (peripheral myelin protein 22), duplication or deletion analysis 81324 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (peripheral myelin protein 22), full sequence analysis 81325 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (peripheral myelin protein 22), full sequence analysis 81325 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (peripheral myelin protein 22), known familial variant 81326 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGene analysis (peripheral myelin protein 22), known familial variant 81326 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SMN1 (survival of motor neuron 1, telomeric) (eg, spinal m 81329 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SMN1 (survival of motor neuron 1, telomeric) (eg, spinal m 81329 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (sphingomyelin phosphodiesterase 1, acid lysosomal)(eg, Niemann-Pick disease, Type A) common variants (eg, R496L, L302P, fsP330) 81330 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

Gene analysis (sphingomyelin phosphodiesterase 1, acid lysosomal)(eg, Niemann-Pick disease, Type A) common variants (eg, R496L, L302P, fsP330) 81330 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SNRPN/UBE3A (SMALL NUCLEAR RIBONUCLEOPROTEIN POLYPEPTIDE N AND UBIQUITIN PROTEIN LIGASE E3A) (EG, PRADER-WILLI SYNDROME AND/OR ANGELMAN SYNDROME), METHYLATION ANALYSIS 81331 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SNRPN/UBE3A (SMALL NUCLEAR RIBONUCLEOPROTEIN POLYPEPTIDE N AND UBIQUITIN PROTEIN LIGASE E3A) (EG, PRADER-WILLI SYNDROME AND/OR ANGELMAN SYNDROME), METHYLATION ANALYSIS 81331 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1)(eg, alpha-1-antitrypsin deficiency) common variants (eg, *S and *Z) 81332 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Gene analysis (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1)(eg, alpha-1-antitrypsin deficiency) common variants (eg, *S and *Z) 81332 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; full gene sequence 81336 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; full gene sequence 81336 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; known familial sequence variant(s) 81337 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; known familial sequence variant(s) 81337 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHLA class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1 81370 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHLA class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1 81370 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and -DRB1 (eg, verification typing) 81371 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and -DRB1 (eg, verification typing) 81371 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); COMPLETE (IE, HLA-A, -B, AND -C) 81372 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); COMPLETE (IE, HLA-A, -B, AND -C) 81372 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); ONE LOCUS (EG, HLA-A, -B, OR -C), EACH 81373 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

HLA CLASS I TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); ONE LOCUS (EG, HLA-A, -B, OR -C), EACH 81373 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA class I typing, low resolution one antigen equivalent 81374 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA class I typing, low resolution one antigen equivalent 81374 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS II TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); HLA-DRB1/3/4/5 AND -DQB1 81375 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS II TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); HLA-DRB1/3/4/5 AND -DQB1 81375 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA class II typing low resolution one locus 81376 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA class II typing low resolution one locus 81376 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS II TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); ONE ANTIGEN EQUIVALENT, EACH 81377 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS II TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); ONE ANTIGEN EQUIVALENT, EACH 81377 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHLA class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C, and -DRB1 81378 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHLA class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C, and -DRB1 81378 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); COMPLETE (IE, HLA-A, -B, AND -C) 81379 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); COMPLETE (IE, HLA-A, -B, AND -C) 81379 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); ONE LOCUS (EG, HLA-A, -B, OR -C), EACH 81380 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); ONE LOCUS (EG, HLA-A, -B, OR -C), EACH 81380 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); ONE ALLELE OR ALLELE GROUP (EG, B*57:01P), EACH 81381 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS I TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); ONE ALLELE OR ALLELE GROUP (EG, B*57:01P), EACH 81381 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA class II typing high resolution one locus 81382 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA class II typing high resolution one locus 81382 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS II TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); ONE ALLELE OR ALLELE GROUP (EG, HLA-DQB1*06:02P), EACH 81383 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HLA CLASS II TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); ONE ALLELE OR ALLELE GROUP (EG, HLA-DQB1*06:02P), EACH 81383 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Test for detecting genes associated with heart disease 81413 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 81420 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 81420 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Hereditary colon cancer syndromes (eg, Lynch syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include analysis of at least 7 genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, and PMS2 81435 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Hereditary colon cancer syndromes (eg, Lynch syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include analysis of at least 7 genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, and PMS2 81435 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Hereditary colon cancer syndromes (eg, Lynch syndrome, familial adenomatosis polyposis); duplication/deletion gene analysis panel, must include analysis of at least 8 genes, including APC, MLH1, MSH2, MSH6, PMS2, EPCAM, CHEK2, and MUTYH 81436 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Hereditary colon cancer syndromes (eg, Lynch syndrome, familial adenomatosis polyposis); duplication/deletion gene analysis panel, must include analysis of at least 8 genes, including APC, MLH1, MSH2, MSH6, PMS2, EPCAM, CHEK2, and MUTYH 81436 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores 81504 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores 81504 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy 81507 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy 81507 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score 81511 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score 81511 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Fetal congenital abnormalities, biochemical assays of five analytes (afp, ue3, total hcg, hyperglycosylated hcg, dia) utilizing maternal serum, algorithm reported as a risk score 81512 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Fetal congenital abnormalities, biochemical assays of five analytes (afp, ue3, total hcg, hyperglycosylated hcg, dia) utilizing maternal serum, algorithm reported as a risk score 81512 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score 81519 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score 81519 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and NMP3) and fecal hemoglobin, utilizing stool, algorithm reported as positive or negative resul 81528 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and NMP3) and fecal hemoglobin, utilizing stool, algorithm reported as positive or negative resul 81528 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroin 81596 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroin 81596 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABKETONE BODY(S) (EG, ACETONE, ACETOACETIC ACID, BETA-HYDROXYBUTYRATE); QUALITATIVE 82009 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABKETONE BODY(S) (EG, ACETONE, ACETOACETIC ACID, BETA-HYDROXYBUTYRATE); QUALITATIVE 82009 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABKETONE BODY(S) (EG, ACETONE, ACETOACETIC ACID, BETA-HYDROXYBUTYRATE); QUANTITATIVE 82010 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABKETONE BODY(S) (EG, ACETONE, ACETOACETIC ACID, BETA-HYDROXYBUTYRATE); QUANTITATIVE 82010 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ACETYLCHOLINESTERASE 82013 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ACETYLCHOLINESTERASE 82013 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ADRENOCORTICOTROPIC HORMONE (ACTH) 82024 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ADRENOCORTICOTROPIC HORMONE (ACTH) 82024 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Adenosine, 5-monophosphate, cyclic (cyclic AMP) level 82030 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Adenosine, 5-monophosphate, cyclic (cyclic AMP) level 82030 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD 82040 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD 82040 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urine microalbumin (protein) level 82043 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urine microalbumin (protein) level 82043 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABALBUMIN; URINE, (eg, microalbumin), SEMIQUANTITATIVE (eg, reagent strip assay) 82044 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABALBUMIN; URINE, (eg, microalbumin), SEMIQUANTITATIVE (eg, reagent strip assay) 82044 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALBUMIN; ISCHEMIA MODIFIED 82045 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALBUMIN; ISCHEMIA MODIFIED 82045 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALDOLASE 82085 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALDOLASE 82085 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALDOSTERONE 82088 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALDOSTERONE 82088 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALPHA-1-ANTITRYPSIN; TOTAL 82103 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALPHA-1-ANTITRYPSIN; TOTAL 82103 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALPHA-1-ANTITRYPSIN; PHENOTYPE 82104 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALPHA-1-ANTITRYPSIN; PHENOTYPE 82104 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alpha-fetoprotein (AFP) level, serum 82105 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alpha-fetoprotein (AFP) level, serum 82105 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alpha-fetoprotein (AFP); serum; amniotic fluid 82106 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Alpha-fetoprotein (AFP); serum; amniotic fluid 82106 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABALPHA-FETOPROTEIN (AFP); AFP-L3 FRACTION ISOFORM AND TOTAL AFP (INCLUDING RATIO) 82107 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABALPHA-FETOPROTEIN (AFP); AFP-L3 FRACTION ISOFORM AND TOTAL AFP (INCLUDING RATIO) 82107 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALUMINUM 82108 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ALUMINUM 82108 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABAMINO ACIDS; SINGLE, QUALITATIVE, EACH SPECIMEN 82127 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABAMINO ACIDS; SINGLE, QUALITATIVE, EACH SPECIMEN 82127 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB Amino acids, multiple qualitative, each specimen 82128 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Amino acids, multiple qualitative, each specimen 82128 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABAMINO ACIDS; SINGLE, QUANTITATIVE, EACH SPECIMEN 82131 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABAMINO ACIDS; SINGLE, QUANTITATIVE, EACH SPECIMEN 82131 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMINOLEVULINIC ACID, DELTA (ALA) 82135 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMINOLEVULINIC ACID, DELTA (ALA) 82135 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABAmino acids, 2 to 5 amino acids, quantitative, each specimen 82136 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABAmino acids, 2 to 5 amino acids, quantitative, each specimen 82136 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABAmino acids, 6 or more amino acids, quantitative, each specimen 82139 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABAmino acids, 6 or more amino acids, quantitative, each specimen 82139 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMMONIA 82140 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMMONIA 82140 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMNIOTIC FLUID SCAN (SPECTROPHOTOMETRIC) 82143 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMNIOTIC FLUID SCAN (SPECTROPHOTOMETRIC) 82143 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMYLASE 82150 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB AMYLASE 82150 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANDROSTANEDIOL GLUCURONIDE 82154 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANDROSTANEDIOL GLUCURONIDE 82154 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANDROSTENEDIONE 82157 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANDROSTENEDIONE 82157 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANDROSTERONE 82160 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANDROSTERONE 82160 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANGIOTENSIN II 82163 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANGIOTENSIN II 82163 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANGIOTENSIN I - CONVERTING ENZYME (ACE) 82164 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANGIOTENSIN I - CONVERTING ENZYME (ACE) 82164 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB APOLIPOPROTEIN, EACH 82172 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB APOLIPOPROTEIN, EACH 82172 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Ascorbic acid (Vitamin C), blood 82180 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Ascorbic acid (Vitamin C), blood 82180 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BETA-2 MICROGLOBULIN 82232 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BETA-2 MICROGLOBULIN 82232 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILE ACIDS; TOTAL 82239 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILE ACIDS; TOTAL 82239 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILE ACIDS; CHOLYLGLYCINE 82240 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILE ACIDS; CHOLYLGLYCINE 82240 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILIRUBIN; TOTAL 82247 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILIRUBIN; TOTAL 82247 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB BILIRUBIN; DIRECT 82248 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILIRUBIN; DIRECT 82248 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILIRUBIN; FECES, QUALITATIVE 82252 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILIRUBIN; FECES, QUALITATIVE 82252 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, CONSECUTIVE COLLECTED SPECIMENS WITH SINGLE DETERMINATION, FOR COLORECTAL NEOPLASM SCREENING (IE, PATIENT WAS PROVIDED THREE CARDS OR SINGLE TRIPLE CARD FOR CONSECUTIVE COLLECTIO 82270 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, CONSECUTIVE COLLECTED SPECIMENS WITH SINGLE DETERMINATION, FOR COLORECTAL NEOPLASM SCREENING (IE, PATIENT WAS PROVIDED THREE CARDS OR SINGLE TRIPLE CARD FOR CONSECUTIVE COLLECTIO 82270 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABBLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOURCES 82271 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABBLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOURCES 82271 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS, PERFORMED FOR OTHER THAN COLORECTAL NEOPLASM SCREENING 82272 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS, PERFORMED FOR OTHER THAN COLORECTAL NEOPLASM SCREENING 82272 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS 82274 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS 82274 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CADMIUM 82300 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CADMIUM 82300 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABVITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED 82306 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABVITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED 82306 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCITONIN 82308 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCITONIN 82308 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCIUM; TOTAL 82310 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCIUM; TOTAL 82310 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCIUM; IONIZED 82330 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB CALCIUM; IONIZED 82330 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCIUM; URINE QUANTITATIVE, TIMED SPECIMEN 82340 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCIUM; URINE QUANTITATIVE, TIMED SPECIMEN 82340 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCULUS; QUALITATIVE ANALYSIS 82355 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCULUS; QUALITATIVE ANALYSIS 82355 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCULUS; QUANTITATIVE ANALYSIS, CHEMICAL 82360 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCULUS; QUANTITATIVE ANALYSIS, CHEMICAL 82360 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCULUS; INFRARED SPECTROSCOPY 82365 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCULUS; INFRARED SPECTROSCOPY 82365 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCULUS; X-RAY DIFFRACTION 82370 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALCULUS; X-RAY DIFFRACTION 82370 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBOHYDRATE DEFICIENT TRANSFERRIN 82373 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBOHYDRATE DEFICIENT TRANSFERRIN 82373 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBON DIOXIDE (BICARBONATE) 82374 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBON DIOXIDE (BICARBONATE) 82374 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBOXYHEMOGLOBIN; QUANTITATIVE 82375 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBOXYHEMOGLOBIN; QUANTITATIVE 82375 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBOXYHEMOGLOBIN; QUALITATIVE 82376 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARBOXYHEMOGLOBIN; QUALITATIVE 82376 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARCINOEMBRYONIC ANTIGEN (CEA) 82378 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CARCINOEMBRYONIC ANTIGEN (CEA) 82378 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CAROTENE 82380 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CAROTENE 82380 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CATECHOLAMINES; TOTAL URINE 82382 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CATECHOLAMINES; TOTAL URINE 82382 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CATECHOLAMINES; BLOOD 82383 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CATECHOLAMINES; BLOOD 82383 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CATECHOLAMINES; FRACTIONATED 82384 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CATECHOLAMINES; FRACTIONATED 82384 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CATHEPSIN-D 82387 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CATHEPSIN-D 82387 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CERULOPLASMIN 82390 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CERULOPLASMIN 82390 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORAMPHENICOL 82415 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORAMPHENICOL 82415 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORIDE; BLOOD 82435 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORIDE; BLOOD 82435 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORIDE; URINE 82436 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORIDE; URINE 82436 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORIDE; OTHER SOURCE 82438 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB CHLORIDE; OTHER SOURCE 82438 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORINATED HYDROCARBONS, SCREEN 82441 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHLORINATED HYDROCARBONS, SCREEN 82441 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL 82465 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL 82465 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Cholinesterase; serum 82480 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Cholinesterase; serum 82480 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHOLINESTERASE; RBC 82482 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHOLINESTERASE; RBC 82482 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHROMIUM 82495 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHROMIUM 82495 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COPPER 82525 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COPPER 82525 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CORTICOSTERONE 82528 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CORTICOSTERONE 82528 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CORTISOL; FREE 82530 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CORTISOL; FREE 82530 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CORTISOL; TOTAL 82533 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CORTISOL; TOTAL 82533 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Column chromatography, includes mass spectrometry (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified; quantitative, each specimen 82542 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Column chromatography, includes mass spectrometry (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified; quantitative, each specimen 82542 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATINE KINASE (CK), (CPK); TOTAL 82550 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATINE KINASE (CK), (CPK); TOTAL 82550 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATINE KINASE (CK), (CPK); ISOENZYMES 82552 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATINE KINASE (CK), (CPK); ISOENZYMES 82552 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCREATINE KINASE (CK), (CPK); MB FRACTION ONLY 82553 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCREATINE KINASE (CK), (CPK); MB FRACTION ONLY 82553 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATININE; BLOOD 82565 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATININE; BLOOD 82565 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATININE; OTHER SOURCE 82570 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATININE; OTHER SOURCE 82570 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATININE; CLEARANCE 82575 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CREATININE; CLEARANCE 82575 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CRYOFIBRINOGEN 82585 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB CRYOFIBRINOGEN 82585 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCRYOGLOBULIN, QUALITATIVE OR SEMI-QUANTITATIVE (EG, CRYOCRIT) 82595 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCRYOGLOBULIN, QUALITATIVE OR SEMI-QUANTITATIVE (EG, CRYOCRIT) 82595 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYANIDE 82600 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYANIDE 82600 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYANOCOBALAMIN (VITAMIN B-12); 82607 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYANOCOBALAMIN (VITAMIN B-12); 82607 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCYANOCOBALAMIN (VITAMIN B-12); UNSATURATED BINDING CAPACITY 82608 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCYANOCOBALAMIN (VITAMIN B-12); UNSATURATED BINDING CAPACITY 82608 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYSTATIN C 82610 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYSTATIN C 82610 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCYSTINE AND HOMOCYSTINE, URINE, QUALITATIVE 82615 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCYSTINE AND HOMOCYSTINE, URINE, QUALITATIVE 82615 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DEHYDROEPIANDROSTERONE (DHEA) 82626 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DEHYDROEPIANDROSTERONE (DHEA) 82626 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S) 82627 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S) 82627 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Desoxycorticosterone, 11- 82633 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Desoxycorticosterone, 11- 82633 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Desoxycortisol, 11- (hormone) level 82634 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Desoxycortisol, 11- (hormone) level 82634 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DIBUCAINE NUMBER 82638 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DIBUCAINE NUMBER 82638 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABDihydroxyvitamin D, 1, 25 level, includes fraction(s), if performed 82652 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABDihydroxyvitamin D, 1, 25 level, includes fraction(s), if performed 82652 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DOXEPIN 82656 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DOXEPIN 82656 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ERYTHROPOIETIN 82668 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ERYTHROPOIETIN 82668 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTRADIOL 82670 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTRADIOL 82670 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTROGENS; FRACTIONATED 82671 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTROGENS; FRACTIONATED 82671 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTROGENS; TOTAL 82672 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTROGENS; TOTAL 82672 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTRIOL 82677 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB ESTRIOL 82677 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTRONE 82679 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ESTRONE 82679 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ETIOCHOLANOLONE 82696 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ETIOCHOLANOLONE 82696 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FAT OR LIPIDS, FECES; QUALITATIVE 82705 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FAT OR LIPIDS, FECES; QUALITATIVE 82705 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FAT OR LIPIDS, FECES; QUANTITATIVE 82710 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FAT OR LIPIDS, FECES; QUANTITATIVE 82710 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FAT DIFFERENTIAL, FECES, QUANTITATIVE 82715 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FAT DIFFERENTIAL, FECES, QUANTITATIVE 82715 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FATTY ACIDS, NONESTERIFIED 82725 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FATTY ACIDS, NONESTERIFIED 82725 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VERY LONG CHAIN FATTY ACIDS 82726 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VERY LONG CHAIN FATTY ACIDS 82726 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FERRITIN 82728 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FERRITIN 82728 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS, SEMI-QUANTITATIVE 82731 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS, SEMI-QUANTITATIVE 82731 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FLUORIDE 82735 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FLUORIDE 82735 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FOLIC ACID; SERUM 82746 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FOLIC ACID; SERUM 82746 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FOLIC ACID; RBC 82747 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FOLIC ACID; RBC 82747 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FRUCTOSE, SEMEN 82757 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FRUCTOSE, SEMEN 82757 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GALACTOKINASE, RBC 82759 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GALACTOKINASE, RBC 82759 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GALACTOSE 82760 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GALACTOSE 82760 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; QUANTITATIVE 82775 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; QUANTITATIVE 82775 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GALECTIN-3 82777 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GALECTIN-3 82777 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH 82784 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH 82784 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE 82785 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE 82785 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GAMMAGLOBULIN (IMMUNOGLOBULIN); IMMUNOGLOBULIN SUBCLASSES (EG, IGG1, 2, 3, OR 4), EACH 82787 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GAMMAGLOBULIN (IMMUNOGLOBULIN); IMMUNOGLOBULIN SUBCLASSES (EG, IGG1, 2, 3, OR 4), EACH 82787 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GASES, BLOOD, PH ONLY 82800 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GASES, BLOOD, PH ONLY 82800 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED O2 SATURATION); 82803 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED O2 SATURATION); 82803 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED O2 SATURATION); WITH O2 SATURATION, BY DIRECT MEASUREMENT, EXCEPT PULSE OXIMETRY 82805 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED O2 SATURATION); WITH O2 SATURATION, BY DIRECT MEASUREMENT, EXCEPT PULSE OXIMETRY 82805 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGases, blood, 02 saturation only, by direct meaurement, except pulses oximetry 82810 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGases, blood, 02 saturation only, by direct meaurement, except pulses oximetry 82810 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGASTRIC ACID ANALYSIS, INCLUDES PH IF PERFORMED, EACH SPECIMEN 82930 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGASTRIC ACID ANALYSIS, INCLUDES PH IF PERFORMED, EACH SPECIMEN 82930 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GASTRIN AFTER SECRETIN STIMULATION 82938 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GASTRIN AFTER SECRETIN STIMULATION 82938 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GASTRIN 82941 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GASTRIN 82941 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCAGON 82943 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCAGON 82943 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCOSE, BODY FLUID, OTHER THAN BLOOD 82945 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCOSE, BODY FLUID, OTHER THAN BLOOD 82945 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCAGON TOLERANCE TEST 82946 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCAGON TOLERANCE TEST 82946 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP) 82947 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP) 82947 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCOSE; BLOOD, REAGENT STRIP 82948 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCOSE; BLOOD, REAGENT STRIP 82948 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABGLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE) 82950 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE) 82950 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE; TOLERANCE TEST (GTT), THREE SPECIMENS (INCLUDES GLUCOSE) 82951 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE; TOLERANCE TEST (GTT), THREE SPECIMENS (INCLUDES GLUCOSE) 82951 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 82952 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 82952 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITATIVE 82955 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITATIVE 82955 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); SCREEN 82960 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); SCREEN 82960 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE 82962 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE 82962 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCOSIDASE, BETA 82963 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUCOSIDASE, BETA 82963 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUTAMATE DEHYDROGENASE 82965 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUTAMATE DEHYDROGENASE 82965 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUTAMYLTRANSFERASE, GAMMA (GGT) 82977 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUTAMYLTRANSFERASE, GAMMA (GGT) 82977 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUTATHIONE 82978 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUTATHIONE 82978 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUTATHIONE REDUCTASE, RBC 82979 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLUTATHIONE REDUCTASE, RBC 82979 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLYCATED PROTEIN 82985 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GLYCATED PROTEIN 82985 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGonadotropin, follicle stimulating (reproductive hormone) level 83001 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGonadotropin, follicle stimulating (reproductive hormone) level 83001 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Gonadotropin, luteinizing (reproductive hormone) level 83002 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Gonadotropin, luteinizing (reproductive hormone) level 83002 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN) 83003 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LABGROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN) 83003 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGrowth stimulation expressed gene 2 (ST2, Interleukin 1 receptor like-1) 83006 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGrowth stimulation expressed gene 2 (ST2, Interleukin 1 receptor like-1) 83006 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HELICOBACTER PYLORI, BLOOD TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13) 83009 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HELICOBACTER PYLORI, BLOOD TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13) 83009 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HAPTOGLOBIN; QUANTITATIVE 83010 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HAPTOGLOBIN; QUANTITATIVE 83010 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HAPTOGLOBIN; PHENOTYPES 83012 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HAPTOGLOBIN; PHENOTYPES 83012 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13) 83013 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13) 83013 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); SCREEN 83015 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); SCREEN 83015 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); QUANTITATIVE, EACH 83018 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); QUANTITATIVE, EACH 83018 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C, AND/OR F) 83020 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C, AND/OR F) 83020 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMATOGRAPHY (EG, A2, S, C, AND/OR F) 83021 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMATOGRAPHY (EG, A2, S, C, AND/OR F) 83021 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; F (FETAL), CHEMICAL 83030 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; F (FETAL), CHEMICAL 83030 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; F (FETAL), QUALITATIVE 83033 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; F (FETAL), QUALITATIVE 83033 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; GLYCOSYLATED (A1C) 83036 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; GLYCOSYLATED (A1C) 83036 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; METHEMOGLOBIN, QUALITATIVE 83045 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB HEMOGLOBIN; METHEMOGLOBIN, QUALITATIVE 83045 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; METHEMOGLOBIN, QUANTITATIVE 83050 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; METHEMOGLOBIN, QUANTITATIVE 83050 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; PLASMA 83051 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; PLASMA 83051 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; SULFHEMOGLOBIN, QUANTITATIVE 83060 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOGLOBIN; SULFHEMOGLOBIN, QUANTITATIVE 83060 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOSIDERIN; QUALITATIVE 83070 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOSIDERIN; QUALITATIVE 83070 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HISTAMINE 83088 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HISTAMINE 83088 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HOMOCYSTINE 83090 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HOMOCYSTINE 83090 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HOMOVANILLIC ACID (HVA) 83150 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HOMOVANILLIC ACID (HVA) 83150 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Hydroxycorticosteroids, 17 (adrenal gland hormone) level 83491 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Hydroxycorticosteroids, 17 (adrenal gland hormone) level 83491 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HYDROXYINDOLACETIC ACID, 5-(HIAA) 83497 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HYDROXYINDOLACETIC ACID, 5-(HIAA) 83497 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Hydroxyprogesterone, 17-D (synthetic hormone) level 83498 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Hydroxyprogesterone, 17-D (synthetic hormone) level 83498 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HYDROXYPROLINE; FREE 83500 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HYDROXYPROLINE; FREE 83500 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HYDROXYPROLINE; TOTAL 83505 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HYDROXYPROLINE; TOTAL 83505 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INSULIN; TOTAL 83525 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INSULIN; TOTAL 83525 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INSULIN; FREE 83527 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INSULIN; FREE 83527 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INTRINSIC FACTOR 83528 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INTRINSIC FACTOR 83528 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IRON 83540 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IRON 83540 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IRON BINDING CAPACITY 83550 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IRON BINDING CAPACITY 83550 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ISOCITRIC DEHYDROGENASE (IDH) 83570 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ISOCITRIC DEHYDROGENASE (IDH) 83570 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB KETOGENIC STEROIDS, FRACTIONATION 83582 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB KETOGENIC STEROIDS, FRACTIONATION 83582 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Ketosteroids, 17 (hormone) measurement 83586 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LAB LACTATE (LACTIC ACID) 83605 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LACTATE (LACTIC ACID) 83605 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LACTATE DEHYDROGENASE (LD), (LDH); 83615 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LACTATE DEHYDROGENASE (LD), (LDH); 83615 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION AND QUANTITATION 83625 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION AND QUANTITATION 83625 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LACTOFERRIN, FECAL; QUALITATIVE 83630 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LACTOFERRIN, FECAL; QUALITATIVE 83630 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LACTOFERRIN, FECAL; QUANTITATIVE 83631 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LACTOFERRIN, FECAL; QUANTITATIVE 83631 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLACTOGEN, HUMAN PLACENTAL (HPL) HUMAN CHORIONIC SOMATOMAMMOTROPIN 83632 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLACTOGEN, HUMAN PLACENTAL (HPL) HUMAN CHORIONIC SOMATOMAMMOTROPIN 83632 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LEAD 83655 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LEAD 83655 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL LUNG MATURITY ASSESSMENT; LECITHIN SPHINGOMYELIN (L/S) RATIO 83661 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL LUNG MATURITY ASSESSMENT; LECITHIN SPHINGOMYELIN (L/S) RATIO 83661 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL LUNG MATURITY ASSESSMENT; FOAM STABILITY TEST 83662 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL LUNG MATURITY ASSESSMENT; FOAM STABILITY TEST 83662 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL LUNG MATURITY ASSESSMENT; FLUORESCENCE POLARIZATION 83663 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL LUNG MATURITY ASSESSMENT; FLUORESCENCE POLARIZATION 83663 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL LUNG MATURITY ASSESSMENT; LAMELLAR BODY DENSITY 83664 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFETAL LUNG MATURITY ASSESSMENT; LAMELLAR BODY DENSITY 83664 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LEUCINE AMINOPEPTIDASE (LAP) 83670 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LEUCINE AMINOPEPTIDASE (LAP) 83670 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LIPASE 83690 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LIPASE 83690 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LIPOPROTEIN (A) 83695 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LIPOPROTEIN (A) 83695 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2, (LP-PLA2) 83698 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LABLIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2, (LP-PLA2) 83698 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPARATION AND QUANTITATION 83700 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPARATION AND QUANTITATION 83700 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION AND QUANTITATION OF LIPOPROTEINS INCLUDING LIPOPROTEIN SUBCLASSES WHEN PERFORMED (EG, ELECTROPHORESIS, ULTRACENTRIFUGATION) 83701 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION AND QUANTITATION OF LIPOPROTEINS INCLUDING LIPOPROTEIN SUBCLASSES WHEN PERFORMED (EG, ELECTROPHORESIS, ULTRACENTRIFUGATION) 83701 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) 83718 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) 83718 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN, DIRECT MEASUREMENT; VLDL CHOLESTEROL 83719 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN, DIRECT MEASUREMENT; VLDL CHOLESTEROL 83719 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL 83721 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL 83721 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLipoprotein, direct measurement; small dense LDL cholesterol 83722 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLipoprotein, direct measurement; small dense LDL cholesterol 83722 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LUTEINIZING RELEASING FACTOR (LRH) 83727 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB LUTEINIZING RELEASING FACTOR (LRH) 83727 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MAGNESIUM 83735 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MAGNESIUM 83735 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MALATE DEHYDROGENASE 83775 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MALATE DEHYDROGENASE 83775 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MERCURY, QUANTITATIVE 83825 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MERCURY, QUANTITATIVE 83825 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB METANEPHRINES 83835 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB METANEPHRINES 83835 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB METHEMALBUMIN 83857 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB METHEMALBUMIN 83857 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MUCOPOLYSACCHARIDES, ACID; QUANTITATIVE 83864 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MUCOPOLYSACCHARIDES, ACID; QUANTITATIVE 83864 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MUCIN, SYNOVIAL FLUID (ROPES TEST) 83872 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MUCIN, SYNOVIAL FLUID (ROPES TEST) 83872 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB Myelin basic protein (nerve protein) level, spinal fluid 83873 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Myelin basic protein (nerve protein) level, spinal fluid 83873 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MYOGLOBIN 83874 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MYOGLOBIN 83874 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NATRIURETIC PEPTIDE 83880 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NATRIURETIC PEPTIDE 83880 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NICKEL 83885 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NICKEL 83885 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Nucleotidase 5' (enzyme) level 83915 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Nucleotidase 5' (enzyme) level 83915 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OLIGOCLONAL IMMUNE (OLIGOCLONAL BANDS) 83916 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OLIGOCLONAL IMMUNE (OLIGOCLONAL BANDS) 83916 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABORGANIC ACIDS; TOTAL, QUANTITATIVE, EACH SPECIMEN 83918 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABORGANIC ACIDS; TOTAL, QUANTITATIVE, EACH SPECIMEN 83918 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN 83919 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN 83919 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ORGANIC ACID, SINGLE, QUANTITATIVE 83921 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ORGANIC ACID, SINGLE, QUANTITATIVE 83921 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSMOLALITY; BLOOD 83930 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSMOLALITY; BLOOD 83930 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSMOLALITY; URINE 83935 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSMOLALITY; URINE 83935 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSTEOCALCIN (BONE G1A PROTEIN) 83937 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSTEOCALCIN (BONE G1A PROTEIN) 83937 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OXALATE 83945 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OXALATE 83945 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ONCOPROTEIN; HER-2/NEU 83950 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ONCOPROTEIN; HER-2/NEU 83950 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABONCOPROTEIN; DES-GAMMA-CARBOXY-PROTHROMBIN (DCP) 83951 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABONCOPROTEIN; DES-GAMMA-CARBOXY-PROTHROMBIN (DCP) 83951 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PARATHORMONE (PARATHYROID HORMONE) 83970 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PARATHORMONE (PARATHYROID HORMONE) 83970 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PH; BODY FLUID, NOT OTHERWISE SPECIFIED 83986 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PH; BODY FLUID, NOT OTHERWISE SPECIFIED 83986 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PH; EXHALED BREATH CONDENSATE 83987 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PH; EXHALED BREATH CONDENSATE 83987 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENCYCLIDINE (PCP) 83992 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENCYCLIDINE (PCP) 83992 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB CALPROTECTIN, FECAL 83993 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CALPROTECTIN, FECAL 83993 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Phenylalanine, PKU (amino acid) level 84030 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Phenylalanine, PKU (amino acid) level 84030 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENYLKETONES, QUALITATIVE 84035 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHENYLKETONES, QUALITATIVE 84035 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHATASE, ACID; TOTAL 84060 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHATASE, ACID; TOTAL 84060 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Phosphatase, prostatic (prostate enzyme) level 84066 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Phosphatase, prostatic (prostate enzyme) level 84066 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHATASE, ALKALINE; 84075 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHATASE, ALKALINE; 84075 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHATIDYLGLYCEROL 84081 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHATIDYLGLYCEROL 84081 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHOHEXOSE ISOMERASE 84087 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHOHEXOSE ISOMERASE 84087 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHORUS INORGANIC (PHOSPHATE); 84100 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHORUS INORGANIC (PHOSPHATE); 84100 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHORUS INORGANIC (PHOSPHATE); URINE 84105 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHORUS INORGANIC (PHOSPHATE); URINE 84105 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PORPHOBILINOGEN, URINE; QUALITATIVE 84106 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PORPHOBILINOGEN, URINE; QUALITATIVE 84106 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PORPHOBILINOGEN, URINE; QUANTITATIVE 84110 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PORPHOBILINOGEN, URINE; QUANTITATIVE 84110 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PORPHYRINS, URINE; QUALITATIVE 84119 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PORPHYRINS, URINE; QUALITATIVE 84119 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPORPHYRINS, URINE; QUANTITATION AND FRACTIONATION 84120 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPORPHYRINS, URINE; QUANTITATION AND FRACTIONATION 84120 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD 84132 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD 84132 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB POTASSIUM; URINE 84133 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB POTASSIUM; URINE 84133 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PREALBUMIN 84134 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PREALBUMIN 84134 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PREGNANEDIOL 84135 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PREGNANEDIOL 84135 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PREGNANETRIOL 84138 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PREGNANETRIOL 84138 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PREGNENOLONE 84140 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB PREGNENOLONE 84140 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB 17-HYDROXYPREGNENOLONE 84143 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB 17-HYDROXYPREGNENOLONE 84143 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROGESTERONE 84144 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROGESTERONE 84144 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROCALCITONIN (PCT) 84145 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROCALCITONIN (PCT) 84145 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROLACTIN 84146 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROLACTIN 84146 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROSTAGLANDIN, EACH 84150 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROSTAGLANDIN, EACH 84150 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPROSTATE SPECIFIC ANTIGEN (PSA); COMPLEXED (DIRECT MEASUREMENT) 84152 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPROSTATE SPECIFIC ANTIGEN (PSA); COMPLEXED (DIRECT MEASUREMENT) 84152 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL 84153 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL 84153 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROSTATE SPECIFIC ANTIGEN (PSA); FREE 84154 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROSTATE SPECIFIC ANTIGEN (PSA); FREE 84154 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Total protein level, blood 84155 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Total protein level, blood 84155 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Total protein level, urine 84156 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Total protein level, urine 84156 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Total protein level, body fluid 84157 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Total protein level, body fluid 84157 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPROTEIN, TOTAL, BY REFRACTOMETRY, ANY SOURCE 84160 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPROTEIN, TOTAL, BY REFRACTOMETRY, ANY SOURCE 84160 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A) 84163 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A) 84163 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABProtein; electrophoretic fractionation and quatitation, serum 84165 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABProtein; electrophoretic fractionation and quatitation, serum 84165 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABProtein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF) 84166 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABProtein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF) 84166 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY FLUID 84181 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY FLUID 84181 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY FLUID, IMMUNOLOGICAL PROBE FOR BAND IDENTIFICATION, EACH 84182 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY FLUID, IMMUNOLOGICAL PROBE FOR BAND IDENTIFICATION, EACH 84182 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROTOPORPHYRIN, RBC; QUANTITATIVE 84202 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROTOPORPHYRIN, RBC; QUANTITATIVE 84202 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROTOPORPHYRIN, RBC; SCREEN 84203 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROTOPORPHYRIN, RBC; SCREEN 84203 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROINSULIN 84206 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PROINSULIN 84206 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PYRIDOXAL PHOSPHATE (VITAMIN B-6) 84207 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PYRIDOXAL PHOSPHATE (VITAMIN B-6) 84207 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PYRUVATE 84210 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PYRUVATE 84210 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PYRUVATE KINASE 84220 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PYRUVATE KINASE 84220 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RECEPTOR ASSAY; ESTROGEN 84233 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RECEPTOR ASSAY; ESTROGEN 84233 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RECEPTOR ASSAY; PROGESTERONE 84234 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RECEPTOR ASSAY; PROGESTERONE 84234 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

RECEPTOR ASSAY; ENDOCRINE, OTHER THAN ESTROGEN OR PROGESTERONE (SPECIFY HORMONE) 84235 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

RECEPTOR ASSAY; ENDOCRINE, OTHER THAN ESTROGEN OR PROGESTERONE (SPECIFY HORMONE) 84235 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABRECEPTOR ASSAY; NON-ENDOCRINE (SPECIFY RECEPTOR) 84238 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABRECEPTOR ASSAY; NON-ENDOCRINE (SPECIFY RECEPTOR) 84238 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RENIN 84244 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RENIN 84244 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RIBOFLAVIN (VITAMIN B-2) 84252 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RIBOFLAVIN (VITAMIN B-2) 84252 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SEROTONIN 84260 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SEROTONIN 84260 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SEX HORMONE BINDING GLOBULIN (SHBG) 84270 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SEX HORMONE BINDING GLOBULIN (SHBG) 84270 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SIALIC ACID 84275 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB SIALIC ACID 84275 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SILICA 84285 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SILICA 84285 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SODIUM; SERUM, PLASMA OR WHOLE BLOOD 84295 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SODIUM; SERUM, PLASMA OR WHOLE BLOOD 84295 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SODIUM; URINE 84300 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SODIUM; URINE 84300 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SODIUM; OTHER SOURCE 84302 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SODIUM; OTHER SOURCE 84302 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SOMATOMEDIN 84305 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SOMATOMEDIN 84305 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SOMATOSTATIN 84307 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SOMATOSTATIN 84307 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS, CHROMATOGRAPHIC, TLC OR PAPER CHROMATOGRAPHY 84375 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS, CHROMATOGRAPHIC, TLC OR PAPER CHROMATOGRAPHY 84375 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUALITATIVE, EACH SPECIMEN 84376 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUALITATIVE, EACH SPECIMEN 84376 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); MULTIPLE QUALITATIVE, EACH SPECIMEN 84377 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); MULTIPLE QUALITATIVE, EACH SPECIMEN 84377 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUANTITATIVE, EACH SPECIMEN 84378 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUANTITATIVE, EACH SPECIMEN 84378 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); MULTIPLE QUANTITATIVE, EACH SPECIMEN 84379 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); MULTIPLE QUANTITATIVE, EACH SPECIMEN 84379 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TESTOSTERONE; FREE 84402 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TESTOSTERONE; FREE 84402 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TESTOSTERONE; TOTAL 84403 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TESTOSTERONE; TOTAL 84403 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THALLIUM, BLOOD OR URINE 84410 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THALLIUM, BLOOD OR URINE 84410 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THIAMINE (VITAMIN B-1) 84425 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB THIAMINE (VITAMIN B-1) 84425 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THIOCYANATE 84430 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THIOCYANATE 84430 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTHROMBOXANE METABOLITE(S), INCLUDING THROMBOXANE IF PERFORMED, URINE 84431 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTHROMBOXANE METABOLITE(S), INCLUDING THROMBOXANE IF PERFORMED, URINE 84431 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROGLOBULIN 84432 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROGLOBULIN 84432 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROXINE; TOTAL 84436 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROXINE; TOTAL 84436 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROXINE; REQUIRING ELUTION (EG, NEONATAL) 84437 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROXINE; REQUIRING ELUTION (EG, NEONATAL) 84437 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROXINE; FREE 84439 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROXINE; FREE 84439 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROXINE BINDING GLOBULIN (TBG) 84442 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROXINE BINDING GLOBULIN (TBG) 84442 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood test, thyroid stimulating hormone (TSH) 84443 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood test, thyroid stimulating hormone (TSH) 84443 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROID STIMULATING IMMUNE GLOBULINS (TSI) 84445 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROID STIMULATING IMMUNE GLOBULINS (TSI) 84445 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TOCOPHEROL ALPHA (VITAMIN E) 84446 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TOCOPHEROL ALPHA (VITAMIN E) 84446 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TRANSCORTIN (CORTISOL BINDING GLOBULIN) 84449 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TRANSCORTIN (CORTISOL BINDING GLOBULIN) 84449 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Liver enzyme (SGOT), level 84450 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Liver enzyme (SGOT), level 84450 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Liver enzyme (SGPT), level 84460 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Liver enzyme (SGPT), level 84460 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TRANSFERRIN 84466 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TRANSFERRIN 84466 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TRIGLYCERIDES 84478 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TRIGLYCERIDES 84478 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTHYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR) 84479 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTHYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR) 84479 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Thyroid hormone, T3 measurement 84480 28 280 81 N/A N/A P N PSY / SUB N DOS







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Laboratory LAB TROPONIN, QUANTITATIVE 84484 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TROPONIN, QUANTITATIVE 84484 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTrypsin (pancreatic enzyme) measurement, intestinal fluid 84485 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTrypsin (pancreatic enzyme) measurement, intestinal fluid 84485 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Trypsin (pancreatic enzyme) analysis, stool 84488 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Trypsin (pancreatic enzyme) analysis, stool 84488 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABStool trypsin (pancreatic enzyme) analysis, 24-hour collection 84490 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABStool trypsin (pancreatic enzyme) analysis, 24-hour collection 84490 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TYROSINE 84510 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB TYROSINE 84510 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB UREA NITROGEN; QUANTITATIVE 84520 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB UREA NITROGEN; QUANTITATIVE 84520 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB UREA NITROGEN, CLEARANCE 84545 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB UREA NITROGEN, CLEARANCE 84545 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Uric acid level, blood 84550 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Uric acid level, blood 84550 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB URIC ACID; OTHER SOURCE 84560 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB URIC ACID; OTHER SOURCE 84560 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urobilinogen, feces, quantitative 84577 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urobilinogen, feces, quantitative 84577 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urobilinogen, urine, qualitative 84578 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urobilinogen, urine, qualitative 84578 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urobilinogen, urine; quantitative, timed specimen 84580 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urobilinogen, urine; quantitative, timed specimen 84580 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urobilinogen, urine; semiquantitative 84583 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Urobilinogen, urine; semiquantitative 84583 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VANILLYLMANDELIC ACID (VMA), URINE 84585 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VANILLYLMANDELIC ACID (VMA), URINE 84585 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VASOACTIVE INTESTINAL PEPTIDE (VIP) 84586 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VASOACTIVE INTESTINAL PEPTIDE (VIP) 84586 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VASOPRESSIN (ANTIDIURETIC HORMONE, ADH) 84588 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VASOPRESSIN (ANTIDIURETIC HORMONE, ADH) 84588 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VITAMIN A 84590 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VITAMIN A 84590 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABXYLOSE ABSORPTION TEST, BLOOD AND/OR URINE 84620 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABXYLOSE ABSORPTION TEST, BLOOD AND/OR URINE 84620 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ZINC 84630 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB ZINC 84630 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB C-PEPTIDE 84681 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB C-PEPTIDE 84681 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Gonadotropin, chorionic (reproductive hormone) level 84702 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Gonadotropin, chorionic (reproductive hormone) level 84702 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE 84703 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE 84703 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABGonadotropin, chorionic (reproductive hormone) measurement 84704 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABGonadotropin, chorionic (reproductive hormone) measurement 84704 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLEEDING TIME 85002 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLEEDING TIME 85002 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABBLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT 85004 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABBLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT 85004 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC COUNT 85007 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC COUNT 85007 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITHOUT MANUAL DIFFERENTIAL WBC COUNT 85008 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITHOUT MANUAL DIFFERENTIAL WBC COUNT 85008 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABBLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT, BUFFY COAT 85009 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABBLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT, BUFFY COAT 85009 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLOOD COUNT; SPUN MICROHEMATOCRIT 85013 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLOOD COUNT; SPUN MICROHEMATOCRIT 85013 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLOOD COUNT; HEMATOCRIT (HCT) 85014 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLOOD COUNT; HEMATOCRIT (HCT) 85014 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLOOD COUNT; HEMOGLOBIN (HGB) 85018 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLOOD COUNT; HEMOGLOBIN (HGB) 85018 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Complete (CBC), automated test (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85025 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Complete (CBC), automated test (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85025 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABComplete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 85027 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LABComplete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 85027 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD COUNT; MANUAL CELL COUNT (ERYTHROCYTE, LEUKOCYTE, OR PLATELET) EACH 85032 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD COUNT; MANUAL CELL COUNT (ERYTHROCYTE, LEUKOCYTE, OR PLATELET) EACH 85032 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Red blood cell count, automated test 85041 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Red blood cell count, automated test 85041 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Red blood count, manual test 85044 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Red blood count, manual test 85044 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Red blood count, automated test 85045 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Red blood count, automated test 85045 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Red blood count automated, with additional calculations 85046 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Red blood count automated, with additional calculations 85046 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED 85048 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED 85048 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Platelet count, automated test 85049 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Platelet count, automated test 85049 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RETICULATED PLATELET ASSAY 85055 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RETICULATED PLATELET ASSAY 85055 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Bone marrow, smear interpretation 85097 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Bone marrow, smear interpretation 85097 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clot retraction 85170 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clot retraction 85170 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clot lysis time, whole blood dilution 85175 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clot lysis time, whole blood dilution 85175 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clotting factor II prothrombin, measurement 85210 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clotting factor II prothrombin, measurement 85210 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clotting factor V (AcG or proaccelerin) measurement 85220 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clotting factor V (AcG or proaccelerin) measurement 85220 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clotting factor VII (proconvertin, stable factor) 85230 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Clotting factor VII (proconvertin, stable factor) 85230 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR VIII (AHG), ONE STAGE 85240 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR VIII (AHG), ONE STAGE 85240 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR VIII RELATED ANTIGEN 85244 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR VIII RELATED ANTIGEN 85244 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; FACTOR VIII, VW FACTOR, RISTOCETIN COFACTOR 85245 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LABCLOTTING; FACTOR VIII, VW FACTOR, RISTOCETIN COFACTOR 85245 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR VIII, VW FACTOR ANTIGEN 85246 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR VIII, VW FACTOR ANTIGEN 85246 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; FACTOR VIII, VON WILLEBRAND FACTOR, MULTIMETRIC ANALYSIS 85247 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; FACTOR VIII, VON WILLEBRAND FACTOR, MULTIMETRIC ANALYSIS 85247 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR IX (PTC OR CHRISTMAS) 85250 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR IX (PTC OR CHRISTMAS) 85250 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR X (STUART-PROWER) 85260 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR X (STUART-PROWER) 85260 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR XI (PTA) 85270 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR XI (PTA) 85270 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR XII (HAGEMAN) 85280 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR XII (HAGEMAN) 85280 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR XIII (FIBRIN STABILIZING) 85290 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CLOTTING; FACTOR XIII (FIBRIN STABILIZING) 85290 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; FACTOR XIII (FIBRIN STABILIZING), SCREEN SOLUBILITY 85291 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; FACTOR XIII (FIBRIN STABILIZING), SCREEN SOLUBILITY 85291 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; PREKALLIKREIN ASSAY (FLETCHER FACTOR ASSAY) 85292 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; PREKALLIKREIN ASSAY (FLETCHER FACTOR ASSAY) 85292 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; HIGH MOLECULAR WEIGHT KININOGEN ASSAY (FITZGERALD FACTOR ASSAY) 85293 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING; HIGH MOLECULAR WEIGHT KININOGEN ASSAY (FITZGERALD FACTOR ASSAY) 85293 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ACTIVITY 85300 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ACTIVITY 85300 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ANTIGEN ASSAY 85301 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ANTIGEN ASSAY 85301 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Protein C, (clotting inhibitor) activity 85302 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Protein C, (clotting inhibitor) activity 85302 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ACTIVITY 85303 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ACTIVITY 85303 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, TOTAL 85305 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, TOTAL 85305 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, FREE 85306 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, FREE 85306 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ACTIVATED PROTEIN C (APC) RESISTANCE ASSAY 85307 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ACTIVATED PROTEIN C (APC) RESISTANCE ASSAY 85307 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FACTOR INHIBITOR TEST 85335 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FACTOR INHIBITOR TEST 85335 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COAGULATION TIME; LEE AND WHITE 85345 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COAGULATION TIME; LEE AND WHITE 85345 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COAGULATION TIME; ACTIVATED 85347 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COAGULATION TIME; ACTIVATED 85347 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COAGULATION TIME; OTHER METHODS 85348 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COAGULATION TIME; OTHER METHODS 85348 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB EUGLOBULIN LYSIS 85360 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB EUGLOBULIN LYSIS 85360 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); AGGLUTINATION SLIDE, SEMIQUANTITATIVE 85362 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); AGGLUTINATION SLIDE, SEMIQUANTITATIVE 85362 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); PARACOAGULATION 85366 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); PARACOAGULATION 85366 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); QUANTITATIVE 85370 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); QUANTITATIVE 85370 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRIN DEGRADATION PRODUCTS, D-DIMER; QUALITATIVE OR SEMIQUANTITATIVE 85378 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRIN DEGRADATION PRODUCTS, D-DIMER; QUALITATIVE OR SEMIQUANTITATIVE 85378 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE 85379 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE 85379 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FIBRIN DEGRADATION PRODUCTS, D-DIMER; ULTRASENSITIVE (EG, FOR EVALUATION FOR VENOUS THROMBOEMBOLISM), QUALITATIVE OR SEMIQUANTITATIVE 85380 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FIBRIN DEGRADATION PRODUCTS, D-DIMER; ULTRASENSITIVE (EG, FOR EVALUATION FOR VENOUS THROMBOEMBOLISM), QUALITATIVE OR SEMIQUANTITATIVE 85380 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FIBRINOGEN; ACTIVITY 85384 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FIBRINOGEN; ACTIVITY 85384 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB FIBRINOGEN; ANTIGEN 85385 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB FIBRINOGEN; ANTIGEN 85385 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT 85390 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT 85390 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day 85396 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day 85396 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

COAGULATION AND FIBRINOLYSIS, FUNCTIONAL ACTIVITY, NOT OTHERWISE SPECIFIED (EG, ADAMTS-13), EACH ANALYTE 85397 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

COAGULATION AND FIBRINOLYSIS, FUNCTIONAL ACTIVITY, NOT OTHERWISE SPECIFIED (EG, ADAMTS-13), EACH ANALYTE 85397 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; PLASMIN 85400 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; PLASMIN 85400 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; ALPHA-2 ANTIPLASMIN 85410 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; ALPHA-2 ANTIPLASMIN 85410 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN ACTIVATOR 85415 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN ACTIVATOR 85415 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, EXCEPT ANTIGENIC ASSAY 85420 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, EXCEPT ANTIGENIC ASSAY 85420 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, ANTIGENIC ASSAY 85421 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, ANTIGENIC ASSAY 85421 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEINZ BODIES; DIRECT 85441 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEINZ BODIES; DIRECT 85441 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEINZ BODIES; INDUCED, ACETYL PHENYLHYDRAZINE 85445 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEINZ BODIES; INDUCED, ACETYL PHENYLHYDRAZINE 85445 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; DIFFERENTIAL LYSIS (KLEIHAUER-BETKE) 85460 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; DIFFERENTIAL LYSIS (KLEIHAUER-BETKE) 85460 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABHEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; ROSETTE 85461 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; ROSETTE 85461 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOLYSIN, ACID 85475 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOLYSIN, ACID 85475 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPARIN ASSAY 85520 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPARIN ASSAY 85520 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPARIN NEUTRALIZATION 85525 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPARIN NEUTRALIZATION 85525 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPARIN-PROTAMINE TOLERANCE TEST 85530 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPARIN-PROTAMINE TOLERANCE TEST 85530 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IRON STAIN, PERIPHERAL BLOOD 85536 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IRON STAIN, PERIPHERAL BLOOD 85536 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLEUKOCYTE ALKALINE PHOSPHATASE WITH COUNT 85540 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLEUKOCYTE ALKALINE PHOSPHATASE WITH COUNT 85540 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MECHANICAL FRAGILITY, RBC 85547 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MECHANICAL FRAGILITY, RBC 85547 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MURAMIDASE 85549 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MURAMIDASE 85549 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSMOTIC FRAGILITY, RBC; UNINCUBATED 85555 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSMOTIC FRAGILITY, RBC; UNINCUBATED 85555 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSMOTIC FRAGILITY, RBC; INCUBATED 85557 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB OSMOTIC FRAGILITY, RBC; INCUBATED 85557 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPLATELET; AGGREGATION (IN VITRO), EACH AGENT 85576 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPLATELET; AGGREGATION (IN VITRO), EACH AGENT 85576 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHOLIPID NEUTRALIZATION; PLATELET 85597 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PHOSPHOLIPID NEUTRALIZATION; PLATELET 85597 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPHOSPHOLIPID NEUTRALIZATION; HEXAGONAL PHOSPHOLIPID 85598 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPHOSPHOLIPID NEUTRALIZATION; HEXAGONAL PHOSPHOLIPID 85598 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood test, clotting time 85610 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LABRUSSELL VIPER VENOM TIME (INCLUDES VENOM); UNDILUTED 85612 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABRUSSELL VIPER VENOM TIME (INCLUDES VENOM); UNDILUTED 85612 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABRUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED 85613 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABRUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED 85613 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB REPTILASE TEST 85635 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB REPTILASE TEST 85635 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABRed blood cell sedimentation rate, erythrocyte; non-automated 85651 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABRed blood cell sedimentation rate, erythrocyte; non-automated 85651 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABRed blood cell sedimentation rate, erythrocyte; automated 85652 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABRed blood cell sedimentation rate, erythrocyte; automated 85652 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SICKLING OF RBC, REDUCTION 85660 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SICKLING OF RBC, REDUCTION 85660 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Thrombin time, plasma 85670 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Thrombin time, plasma 85670 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Thrombin time, titer 85675 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Thrombin time, titer 85675 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THROMBOPLASTIN INHIBITION; TISSUE 85705 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THROMBOPLASTIN INHIBITION; TISSUE 85705 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTHROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD 85730 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTHROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD 85730 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTHROMBOPLASTIN TIME, PARTIAL (PTT); SUBSTITUTION, PLASMA FRACTIONS, EACH 85732 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTHROMBOPLASTIN TIME, PARTIAL (PTT); SUBSTITUTION, PLASMA FRACTIONS, EACH 85732 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VISCOSITY 85810 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB VISCOSITY 85810 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINE TYPHUS, Q FEVER, ROCKY MOUNTAIN SPOTTED FEVER, SCRUB TYPHUS), EACH ANTIGEN 86000 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINE TYPHUS, Q FEVER, ROCKY MOUNTAIN SPOTTED FEVER, SCRUB TYPHUS), EACH ANTIGEN 86000 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN 86001 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN 86001 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Measurement of antibody (lgE) to allergic substance 86003 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Measurement of antibody (lgE) to allergic substance 86003 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Measurement of antibody (lgE) to allergia substance 86008 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Measurement of antibody (lgE) to allergia substance 86008 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LABANTIBODY IDENTIFICATION; LEUKOCYTE ANTIBODIES 86021 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY IDENTIFICATION; LEUKOCYTE ANTIBODIES 86021 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY IDENTIFICATION; PLATELET ANTIBODIES 86022 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY IDENTIFICATION; PLATELET ANTIBODIES 86022 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY IDENTIFICATION; PLATELET ASSOCIATED IMMUNOGLOBULIN ASSAY 86023 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY IDENTIFICATION; PLATELET ASSOCIATED IMMUNOGLOBULIN ASSAY 86023 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTINUCLEAR ANTIBODIES (ANA); 86038 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTINUCLEAR ANTIBODIES (ANA); 86038 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTINUCLEAR ANTIBODIES (ANA); TITER 86039 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTINUCLEAR ANTIBODIES (ANA); TITER 86039 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTISTREPTOLYSIN 0; TITER 86060 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTISTREPTOLYSIN 0; TITER 86060 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTISTREPTOLYSIN 0; SCREEN 86063 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTISTREPTOLYSIN 0; SCREEN 86063 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MATCH AND/OR EVALUATION OF IRREGULAR ANTIBODY(S), INTERPRETATION AND WRITTEN REPORT 86077 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MATCH AND/OR EVALUATION OF IRREGULAR ANTIBODY(S), INTERPRETATION AND WRITTEN REPORT 86077 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD BANK PHYSICIAN SERVICES; INVESTIGATION OF TRANSFUSION REACTION INCLUDING SUSPICION OF TRANSMISSIBLE DISEASE, INTERPRETATION AND WRITTEN REPORT 86078 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD BANK PHYSICIAN SERVICES; INVESTIGATION OF TRANSFUSION REACTION INCLUDING SUSPICION OF TRANSMISSIBLE DISEASE, INTERPRETATION AND WRITTEN REPORT 86078 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD BANK PHYSICIAN SERVICES; AUTHORIZATION FOR DEVIATION FROM STANDARD BLOOD BANKING PROCEDURES (EG, USE OF OUTDATED BLOOD, TRANSFUSION OF RH INCOMPATIBLE UNITS), WITH WRITTEN REPORT 86079 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

BLOOD BANK PHYSICIAN SERVICES; AUTHORIZATION FOR DEVIATION FROM STANDARD BLOOD BANKING PROCEDURES (EG, USE OF OUTDATED BLOOD, TRANSFUSION OF RH INCOMPATIBLE UNITS), WITH WRITTEN REPORT 86079 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB C-REACTIVE PROTEIN; 86140 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB C-REACTIVE PROTEIN; 86140 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP) 86141 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP) 86141 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BETA 2 GLYCOPROTEIN I ANTIBODY, EACH 86146 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BETA 2 GLYCOPROTEIN I ANTIBODY, EACH 86146 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS 86147 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS 86147 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COLD AGGLUTININ; SCREEN 86156 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COLD AGGLUTININ; SCREEN 86156 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COLD AGGLUTININ; TITER 86157 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COLD AGGLUTININ; TITER 86157 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COMPLEMENT; ANTIGEN, EACH COMPONENT 86160 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COMPLEMENT; ANTIGEN, EACH COMPONENT 86160 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCOMPLEMENT; FUNCTIONAL ACTIVITY, EACH COMPONENT 86161 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCOMPLEMENT; FUNCTIONAL ACTIVITY, EACH COMPONENT 86161 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COMPLEMENT; TOTAL HEMOLYTIC (CH50) 86162 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COMPLEMENT; TOTAL HEMOLYTIC (CH50) 86162 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COMPLEMENT FIXATION TESTS, EACH ANTIGEN 86171 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COMPLEMENT FIXATION TESTS, EACH ANTIGEN 86171 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY 86200 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY 86200 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DEOXYRIBONUCLEASE, ANTIBODY 86215 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB DEOXYRIBONUCLEASE, ANTIBODY 86215 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABDEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED 86225 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABDEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED 86225 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABDEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; SINGLE STRANDED 86226 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABDEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; SINGLE STRANDED 86226 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EACH ANTIBODY 86235 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EACH ANTIBODY 86235 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH ANTIBODY 86255 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH ANTIBODY 86255 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABFLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER, EACH ANTIBODY 86256 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER, EACH ANTIBODY 86256 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GROWTH HORMONE, HUMAN (HGH), ANTIBODY 86277 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB GROWTH HORMONE, HUMAN (HGH), ANTIBODY 86277 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMAGGLUTINATION INHIBITION TEST (HAI) 86280 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMAGGLUTINATION INHIBITION TEST (HAI) 86280 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29) 86300 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29) 86300 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9 86301 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9 86301 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125 86304 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125 86304 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HUMAN EPIDIDYMIS PROTEIN 4 (HE4) 86305 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HUMAN EPIDIDYMIS PROTEIN 4 (HE4) 86305 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HETEROPHILE ANTIBODIES; SCREENING 86308 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HETEROPHILE ANTIBODIES; SCREENING 86308 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HETEROPHILE ANTIBODIES; TITER 86309 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HETEROPHILE ANTIBODIES; TITER 86309 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HETEROPHILE ANTIBODIES; TITERS AFTER ABSORPTION WITH BEEF CELLS AND GUINEA PIG KIDNEY 86310 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HETEROPHILE ANTIBODIES; TITERS AFTER ABSORPTION WITH BEEF CELLS AND GUINEA PIG KIDNEY 86310 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IMMUNOASSAY FOR TUMOR ANTIGEN; OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4, 549), EACH 86316 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IMMUNOASSAY FOR TUMOR ANTIGEN; OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4, 549), EACH 86316 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPECIFIED 86317 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPECIFIED 86317 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUALITATIVE OR SEMIQUANTITATIVE, SINGLE STEP METHOD (EG, REAGENT STRIP) 86318 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUALITATIVE OR SEMIQUANTITATIVE, SINGLE STEP METHOD (EG, REAGENT STRIP) 86318 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IMMUNOELECTROPHORESIS; SERUM 86320 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IMMUNOELECTROPHORESIS; SERUM 86320 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, URINE, CEREBROSPINAL FLUID) WITH CONCENTRATION 86325 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, URINE, CEREBROSPINAL FLUID) WITH CONCENTRATION 86325 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOELECTROPHORESIS; CROSSED (2-DIMENSIONAL ASSAY) 86327 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOELECTROPHORESIS; CROSSED (2-DIMENSIONAL ASSAY) 86327 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IMMUNODIFFUSION; NOT ELSEWHERE SPECIFIED 86329 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IMMUNODIFFUSION; NOT ELSEWHERE SPECIFIED 86329 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE (OUCHTERLONY), EACH ANTIGEN OR ANTIBODY 86331 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE (OUCHTERLONY), EACH ANTIGEN OR ANTIBODY 86331 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IMMUNE COMPLEX ASSAY 86332 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IMMUNE COMPLEX ASSAY 86332 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IMMUNOFIXATION ELECTROPHORESIS; SERUM 86334 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB IMMUNOFIXATION ELECTROPHORESIS; SERUM 86334 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOFIXATION ELECTROPHORESIS; OTHER FLUIDS WITH CONCENTRATION (EG, URINE, CSF) 86335 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOFIXATION ELECTROPHORESIS; OTHER FLUIDS WITH CONCENTRATION (EG, URINE, CSF) 86335 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INSULIN ANTIBODIES 86337 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INSULIN ANTIBODIES 86337 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INTRINSIC FACTOR ANTIBODIES 86340 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB INTRINSIC FACTOR ANTIBODIES 86340 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ISLET CELL ANTIBODY 86341 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ISLET CELL ANTIBODY 86341 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CELLULAR FUNCTION ASSAY INVOLVING STIMULATION (EG, MITOGEN OR ANTIGEN) AND DETECTION OF BIOMARKER (EG, ATP) 86352 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CELLULAR FUNCTION ASSAY INVOLVING STIMULATION (EG, MITOGEN OR ANTIGEN) AND DETECTION OF BIOMARKER (EG, ATP) 86352 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

LYMPHOCYTE TRANSFORMATION, MITOGEN (PHYTOMITOGEN) OR ANTIGEN INDUCED BLASTOGENESIS 86353 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

LYMPHOCYTE TRANSFORMATION, MITOGEN (PHYTOMITOGEN) OR ANTIGEN INDUCED BLASTOGENESIS 86353 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB B CELLS, TOTAL COUNT 86355 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB B CELLS, TOTAL COUNT 86355 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MONONUCLEAR CELL ANTIGEN, QUANTITATIVE (EG, FLOW CYTOMETRY), NOT OTHERWISE SPECIFIED, EACH ANTIGEN 86356 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

MONONUCLEAR CELL ANTIGEN, QUANTITATIVE (EG, FLOW CYTOMETRY), NOT OTHERWISE SPECIFIED, EACH ANTIGEN 86356 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NATURAL KILLER (NK) CELLS, TOTAL COUNT 86357 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NATURAL KILLER (NK) CELLS, TOTAL COUNT 86357 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB T cells count, total 86359 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB T cells count, total 86359 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABT CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO 86360 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABT CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO 86360 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB T CELLS; ABSOLUTE CD4 COUNT 86361 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB T CELLS; ABSOLUTE CD4 COUNT 86361 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Stem cells count, total 86367 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Stem cells count, total 86367 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABMICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH 86376 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABMICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH 86376 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABNUCLEAR MATRIX PROTEIN 22 (NMP22), QUALITATIVE. 86386 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABNUCLEAR MATRIX PROTEIN 22 (NMP22), QUALITATIVE. 86386 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY 86403 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY 86403 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPARTICLE AGGLUTINATION; TITER, EACH ANTIBODY 86406 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPARTICLE AGGLUTINATION; TITER, EACH ANTIBODY 86406 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RHEUMATOID FACTOR; QUALITATIVE 86430 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RHEUMATOID FACTOR; QUALITATIVE 86430 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RHEUMATOID FACTOR; QUANTITATIVE 86431 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB RHEUMATOID FACTOR; QUANTITATIVE 86431 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON 86480 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON 86480 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; ENUMERATION OF GAMMA INTERFERON-PRODUCING T-CELLS IN CELL SUSPENSION 86481 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; ENUMERATION OF GAMMA INTERFERON-PRODUCING T-CELLS IN CELL SUSPENSION 86481 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SKIN TEST; CANDIDA 86485 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SKIN TEST; CANDIDA 86485 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SKIN TEST; COCCIDIOIDOMYCOSIS 86490 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SKIN TEST; COCCIDIOIDOMYCOSIS 86490 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SKIN TEST; HISTOPLASMOSIS 86510 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SKIN TEST; HISTOPLASMOSIS 86510 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SKIN TEST; TUBERCULOSIS, INTRADERMAL 86580 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SKIN TEST; TUBERCULOSIS, INTRADERMAL 86580 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB STREPTOKINASE, ANTIBODY 86590 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB STREPTOKINASE, ANTIBODY 86590 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART) 86592 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART) 86592 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE 86593 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE 86593 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ADENOVIRUS 86603 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ADENOVIRUS 86603 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ASPERGILLUS 86606 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ASPERGILLUS 86606 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; BARTONELLA 86611 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; BARTONELLA 86611 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; BLASTOMYCES 86612 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; BLASTOMYCES 86612 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; BORDETELLA 86615 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; BORDETELLA 86615 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST (EG, WESTERN BLOT OR IMMUNOBLOT) 86617 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST (EG, WESTERN BLOT OR IMMUNOBLOT) 86617 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) 86618 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) 86618 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; BRUCELLA 86622 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; BRUCELLA 86622 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CAMPYLOBACTER 86625 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CAMPYLOBACTER 86625 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB ANTIBODY; CANDIDA 86628 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CANDIDA 86628 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CHLAMYDIA 86631 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CHLAMYDIA 86631 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CHLAMYDIA, IGM 86632 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CHLAMYDIA, IGM 86632 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; COCCIDIOIDES 86635 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; COCCIDIOIDES 86635 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; COXIELLA BRUNETII (Q FEVER) 86638 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; COXIELLA BRUNETII (Q FEVER) 86638 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CRYPTOCOCCUS 86641 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CRYPTOCOCCUS 86641 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CYTOMEGALOVIRUS (CMV) 86644 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CYTOMEGALOVIRUS (CMV) 86644 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CYTOMEGALOVIRUS (CMV), IGM 86645 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; CYTOMEGALOVIRUS (CMV), IGM 86645 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; DIPHTHERIA 86648 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; DIPHTHERIA 86648 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; ENCEPHALITIS, CALIFORNIA (LA CROSSE) 86651 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; ENCEPHALITIS, CALIFORNIA (LA CROSSE) 86651 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ENCEPHALITIS, EASTERN EQUINE 86652 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ENCEPHALITIS, EASTERN EQUINE 86652 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ENCEPHALITIS, ST. LOUIS 86653 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ENCEPHALITIS, ST. LOUIS 86653 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ENCEPHALITIS, WESTERN EQUINE 86654 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ENCEPHALITIS, WESTERN EQUINE 86654 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA) 86663 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA) 86663 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA) 86664 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA) 86664 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA) 86665 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA) 86665 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; EHRLICHIA 86666 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; EHRLICHIA 86666 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; FRANCISELLA TULARENSIS 86668 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; FRANCISELLA TULARENSIS 86668 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; HELICOBACTER PYLORI 86677 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB ANTIBODY; HELICOBACTER PYLORI 86677 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; HEMOPHILUS INFLUENZA 86684 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; HEMOPHILUS INFLUENZA 86684 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABAnalysis for antibody to Human T-cell lymphotropic virus, type 1 (HTLV-1) 86687 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABAnalysis for antibody to Human T-cell lymphotropic virus, type 1 (HTLV-1) 86687 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABAnalysis for antibody to Human T-cell lymphotropic virus, type 2 (HTLV-II 86688 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABAnalysis for antibody to Human T-cell lymphotropic virus, type 2 (HTLV-II 86688 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABAntibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot) 86689 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABAntibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot) 86689 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; HEPATITIS, DELTA AGENT 86692 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; HEPATITIS, DELTA AGENT 86692 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST 86694 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST 86694 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analysis for antibody to Herpes simplex virus, type 1 86695 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LAB ANTIBODY; HISTOPLASMA 86698 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; HISTOPLASMA 86698 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; HIV-1 86701 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LAB ANTIBODY; HIV-1 AND HIV-2, SINGLE RESULT 86703 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; HIV-1 AND HIV-2, SINGLE RESULT 86703 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL 86704 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL 86704 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY 86705 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY 86705 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS BE ANTIBODY (HBEAB) 86707 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS BE ANTIBODY (HBEAB) 86707 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS A ANTIBODY (HAAB); TOTAL 86708 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB HEPATITIS A ANTIBODY (HAAB); TOTAL 86708 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODY 86709 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODY 86709 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; JC (JOHN CUNNINGHAM) VIRUS 86711 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; JC (JOHN CUNNINGHAM) VIRUS 86711 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; LEGIONELLA 86713 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; LEGIONELLA 86713 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; LEPTOSPIRA 86720 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; LEPTOSPIRA 86720 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; LYMPHOCYTIC CHORIOMENINGITIS 86727 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; LYMPHOCYTIC CHORIOMENINGITIS 86727 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; MYCOPLASMA 86738 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; MYCOPLASMA 86738 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; NOCARDIA 86744 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; NOCARDIA 86744 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; PARVOVIRUS 86747 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; PARVOVIRUS 86747 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS 86756 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS 86756 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; RICKETTSIA 86757 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; RICKETTSIA 86757 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ROTAVIRUS 86759 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; ROTAVIRUS 86759 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; RUBELLA 86762 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; RUBELLA 86762 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; RUBEOLA 86765 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; RUBEOLA 86765 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; TOXOPLASMA 86777 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; TOXOPLASMA 86777 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; TOXOPLASMA, IGM 86778 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; TOXOPLASMA, IGM 86778 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analysis for antibody, Treponema pallidum 86780 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analysis for antibody, Treponema pallidum 86780 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; TRICHINELLA 86784 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; TRICHINELLA 86784 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; VARICELLA-ZOSTER 86787 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; VARICELLA-ZOSTER 86787 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; WEST NILE VIRUS, IGM 86788 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; WEST NILE VIRUS, IGM 86788 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; WEST NILE VIRUS 86789 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; WEST NILE VIRUS 86789 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB ANTIBODY; YERSINIA 86793 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY; YERSINIA 86793 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analysis for antibody to Zika virus 86794 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Analysis for antibody to Zika virus 86794 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROGLOBULIN ANTIBODY 86800 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB THYROGLOBULIN ANTIBODY 86800 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS C ANTIBODY; 86803 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEPATITIS C ANTIBODY; 86803 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEPATITIS C ANTIBODY; CONFIRMATORY TEST (EG, IMMUNOBLOT) 86804 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEPATITIS C ANTIBODY; CONFIRMATORY TEST (EG, IMMUNOBLOT) 86804 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITH TITRATION 86805 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITH TITRATION 86805 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITHOUT TITRATION 86806 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITHOUT TITRATION 86806 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); STANDARD METHOD 86807 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); STANDARD METHOD 86807 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); QUICK METHOD 86808 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); QUICK METHOD 86808 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHLA TYPING; A, B, OR C (EG, A10, B7, B27), SINGLE ANTIGEN 86812 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHLA TYPING; A, B, OR C (EG, A10, B7, B27), SINGLE ANTIGEN 86812 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS 86813 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS 86813 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA TYPING; DR/DQ, SINGLE ANTIGEN 86816 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA TYPING; DR/DQ, SINGLE ANTIGEN 86816 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA TYPING; DR/DQ, MULTIPLE ANTIGENS 86817 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HLA TYPING; DR/DQ, MULTIPLE ANTIGENS 86817 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHLA TYPING; LYMPHOCYTE CULTURE, MIXED (MLC) 86821 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHLA TYPING; LYMPHOCYTE CULTURE, MIXED (MLC) 86821 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); FIRST SERUM SAMPLE OR DILUTION 86825 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); FIRST SERUM SAMPLE OR DILUTION 86825 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); EACH ADDITIONAL SERUM SAMPLE OR SAMPLE DILUTION (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) 86826 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); EACH ADDITIONAL SERUM SAMPLE OR SAMPLE DILUTION (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) 86826 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA), SOLID PHASE ASSAYS (EG, MICROSPHERES OR BEADS, ELISA, FLOW CYTOMETRY); QUALITATIVE ASSESSMENT OF THE PRESENCE OR ABSENCE OF ANTIBODY(IES) TO HLA CLASS I AND CLASS II HLA ANTIGENS 86828 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA), SOLID PHASE ASSAYS (EG, MICROSPHERES OR BEADS, ELISA, FLOW CYTOMETRY); QUALITATIVE ASSESSMENT OF THE PRESENCE OR ABSENCE OF ANTIBODY(IES) TO HLA CLASS I AND CLASS II HLA ANTIGENS 86828 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA), SOLID PHASE ASSAYS (EG, MICROSPHERES OR BEADS, ELISA, FLOW CYTOMETRY); QUALITATIVE ASSESSMENT OF THE PRESENCE OR ABSENCE OF ANTIBODY(IES) TO HLA CLASS I OR CLASS II HLA ANTIGENS 86829 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA), SOLID PHASE ASSAYS (EG, MICROSPHERES OR BEADS, ELISA, FLOW CYTOMETRY); QUALITATIVE ASSESSMENT OF THE PRESENCE OR ABSENCE OF ANTIBODY(IES) TO HLA CLASS I OR CLASS II HLA ANTIGENS 86829 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class I 86830 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class I 86830 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Assessment of antibody to human leukocyte antigens (HLA) with antibody identification by qualitative panel using complete HLA phenotypes, HLA class II 86831 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

Assessment of antibody to human leukocyte antigens (HLA) with antibody identification by qualitative panel using complete HLA phenotypes, HLA class II 86831 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA class I 86832 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA class I 86832 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA class II 86833 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA class II 86833 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABAssessment of antibody to human leukocyte antigens (HLA), semi-quatitative panel (eg, titer), HLA class I 86834 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABAssessment of antibody to human leukocyte antigens (HLA), semi-quatitative panel (eg, titer), HLA class I 86834 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Assessment of antibody to human leukocyte antigens (HLA) with solid phase assays, semi-quantitative panel (eg, titer), HLA class II 86835 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Assessment of antibody to human leukocyte antigens (HLA) with solid phase assays, semi-quantitative panel (eg, titer), HLA class II 86835 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE 86850 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE 86850 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY ELUTION (RBC), EACH ELUTION 86860 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ANTIBODY ELUTION (RBC), EACH ELUTION 86860 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY IDENTIFICATION, RBC ANTIBODIES, EACH PANEL FOR EACH SERUM TECHNIQUE 86870 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIBODY IDENTIFICATION, RBC ANTIBODIES, EACH PANEL FOR EACH SERUM TECHNIQUE 86870 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIHUMAN GLOBULIN TEST (COOMBS TEST); DIRECT, EACH ANTISERUM 86880 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIHUMAN GLOBULIN TEST (COOMBS TEST); DIRECT, EACH ANTISERUM 86880 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, QUALITATIVE, EACH REAGENT RED CELL 86885 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, QUALITATIVE, EACH REAGENT RED CELL 86885 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, EACH ANTIBODY TITER 86886 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, EACH ANTIBODY TITER 86886 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood typing, serologic; ABO 86900 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood typing, serologic; ABO 86900 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood typing, serologic; Rh (D) 86901 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood typing, serologic; Rh (D) 86901 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABBlood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test 86902 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABBlood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test 86902 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABBlood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened 86904 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABBlood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened 86904 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABBlood typing, serologic; RBC antigens, other than ABO or Rh (D), each 86905 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABBlood typing, serologic; RBC antigens, other than ABO or Rh (D), each 86905 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood typing, serologic; Rh phenotyping, complete 86906 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Blood typing, serologic; Rh phenotyping, complete 86906 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCOMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE 86920 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCOMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE 86920 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCOMPATIBILITY TEST EACH UNIT; INCUBATION TECHNIQUE 86921 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCOMPATIBILITY TEST EACH UNIT; INCUBATION TECHNIQUE 86921 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCOMPATIBILITY TEST EACH UNIT; ANTIGLOBULIN TECHNIQUE 86922 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCOMPATIBILITY TEST EACH UNIT; ANTIGLOBULIN TECHNIQUE 86922 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COMPATIBILITY TEST EACH UNIT; ELECTRONIC 86923 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB COMPATIBILITY TEST EACH UNIT; ELECTRONIC 86923 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEMOLYSINS AND AGGLUTININS; AUTO, SCREEN, EACH 86940 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEMOLYSINS AND AGGLUTININS; AUTO, SCREEN, EACH 86940 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOLYSINS AND AGGLUTININS; INCUBATED 86941 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HEMOLYSINS AND AGGLUTININS; INCUBATED 86941 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCONCENTRATION (ANY TYPE), FOR INFECTIOUS AGENTS 87015 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCONCENTRATION (ANY TYPE), FOR INFECTIOUS AGENTS 87015 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

CULTURE, BACTERIAL; BLOOD, AEROBIC, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES (INCLUDES ANAEROBIC CULTURE, IF APPROPRIATE) 87040 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; BLOOD, AEROBIC, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES (INCLUDES ANAEROBIC CULTURE, IF APPROPRIATE) 87040 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; STOOL, AEROBIC, WITH ISOLATION AND PRELIMINARY EXAMINATION (EG, KIA, LIA), SALMONELLA AND SHIGELLA SPECIES 87045 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; STOOL, AEROBIC, WITH ISOLATION AND PRELIMINARY EXAMINATION (EG, KIA, LIA), SALMONELLA AND SHIGELLA SPECIES 87045 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; STOOL, AEROBIC, ADDITIONAL PATHOGENS, ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, EACH PLATE 87046 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; STOOL, AEROBIC, ADDITIONAL PATHOGENS, ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, EACH PLATE 87046 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES 87070 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES 87070 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, ANY SOURCE EXCEPT URINE, BLOOD OR STOOL 87071 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, ANY SOURCE EXCEPT URINE, BLOOD OR STOOL 87071 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, ANY SOURCE EXCEPT URINE, BLOOD OR STOOL 87073 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, ANY SOURCE EXCEPT URINE, BLOOD OR STOOL 87073 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES 87075 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES 87075 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

CULTURE, BACTERIAL; ANAEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE 87076 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; ANAEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE 87076 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE 87077 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE 87077 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY; 87081 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY; 87081 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Culture, bacterial; quantitative colony count, urine 87086 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Culture, bacterial; quantitative colony count, urine 87086 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE 87088 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE 87088 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCulture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair or nail 87101 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCulture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair or nail 87101 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF ISOLATES; OTHER SOURCE (EXCEPT BLOOD) 87102 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF ISOLATES; OTHER SOURCE (EXCEPT BLOOD) 87102 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF ISOLATES; BLOOD 87103 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF ISOLATES; BLOOD 87103 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCulture, fungi, definitive identification, each organism; yeast 87106 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCulture, fungi, definitive identification, each organism; yeast 87106 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; MOLD 87107 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; MOLD 87107 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CULTURE, MYCOPLASMA, ANY SOURCE 87109 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CULTURE, MYCOPLASMA, ANY SOURCE 87109 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CULTURE, CHLAMYDIA, ANY SOURCE 87110 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB CULTURE, CHLAMYDIA, ANY SOURCE 87110 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) ANY SOURCE, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES 87116 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) ANY SOURCE, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES 87116 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, MYCOBACTERIAL, DEFINITIVE IDENTIFICATION, EACH ISOLATE 87118 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, MYCOBACTERIAL, DEFINITIVE IDENTIFICATION, EACH ISOLATE 87118 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, TYPING; IMMUNOFLUORESCENT METHOD, EACH ANTISERUM 87140 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, TYPING; IMMUNOFLUORESCENT METHOD, EACH ANTISERUM 87140 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; GAS LIQUID CHROMATOGRAPHY (GLC) OR HIGH PRESSURE LIQUID CHROMATOGRAPHY (HPLC) METHOD 87143 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; GAS LIQUID CHROMATOGRAPHY (GLC) OR HIGH PRESSURE LIQUID CHROMATOGRAPHY (HPLC) METHOD 87143 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; IMMUNOLOGIC METHOD, OTHER THAN IMMUNOFLUORESENCE (EG, AGGLUTINATION GROUPING), PER ANTISERUM 87147 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; IMMUNOLOGIC METHOD, OTHER THAN IMMUNOFLUORESENCE (EG, AGGLUTINATION GROUPING), PER ANTISERUM 87147 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, DIRECT PROBE TECHNIQUE, PER CULTURE OR ISOLATE, EACH ORGANISM PROBED 87149 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, DIRECT PROBE TECHNIQUE, PER CULTURE OR ISOLATE, EACH ORGANISM PROBED 87149 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, AMPLIFIED PROBE TECHNIQUE, PER CULTURE OR ISOLATE, EACH ORGANISM PROBED 87150 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, AMPLIFIED PROBE TECHNIQUE, PER CULTURE OR ISOLATE, EACH ORGANISM PROBED 87150 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, TYPING; IDENTIFICATION BY PULSE FIELD GEL TYPING 87152 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCULTURE, TYPING; IDENTIFICATION BY PULSE FIELD GEL TYPING 87152 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID SEQUENCING METHOD, EACH ISOLATE (EG, SEQUENCING OF THE 16S RRNA GENE) 87153 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID SEQUENCING METHOD, EACH ISOLATE (EG, SEQUENCING OF THE 16S RRNA GENE) 87153 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CULTURE, TYPING; OTHER METHODS 87158 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CULTURE, TYPING; OTHER METHODS 87158 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); INCLUDES SPECIMEN COLLECTION 87164 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); INCLUDES SPECIMEN COLLECTION 87164 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); WITHOUT COLLECTION 87166 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); WITHOUT COLLECTION 87166 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HOMOGENIZATION, TISSUE, FOR CULTURE 87176 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB HOMOGENIZATION, TISSUE, FOR CULTURE 87176 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABOVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION 87177 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABOVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION 87177 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip) 87181 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip) 87181 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) 87184 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) 87184 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme 87185 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme 87185 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Susceptibility studies, antimicrobial agent, microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate 87186 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Susceptibility studies, antimicrobial agent, microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate 87186 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure) 87187 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure) 87187 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABSusceptibility studies, antimicrobial agent; macrobroth dilution method, each agent 87188 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; macrobroth dilution method, each agent 87188 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; mycobateria, proportion method, each agent 87190 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSusceptibility studies, antimicrobial agent; mycobateria, proportion method, each agent 87190 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SERUM BACTERICIDAL TITER (SCHLICTER TEST) 87197 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SERUM BACTERICIDAL TITER (SCHLICTER TEST) 87197 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA, FUNGI, OR CELL TYPES 87205 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA, FUNGI, OR CELL TYPES 87205 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; FLUORESCENT AND/OR ACID FAST STAIN FOR BACTERIA, FUNGI, PARASITES, VIRUSES OR CELL TYPES 87206 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; FLUORESCENT AND/OR ACID FAST STAIN FOR BACTERIA, FUNGI, PARASITES, VIRUSES OR CELL TYPES 87206 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; SPECIAL STAIN FOR INCLUSION BODIES OR PARASITES (EG, MALARIA, COCCIDIA, MICROSPORIDIA, TRYPANOSOMES, HERPES VIRUSES) 87207 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; SPECIAL STAIN FOR INCLUSION BODIES OR PARASITES (EG, MALARIA, COCCIDIA, MICROSPORIDIA, TRYPANOSOMES, HERPES VIRUSES) 87207 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN (EG, TRICHROME, IRON HEMOTOXYLIN) FOR OVA AND PARASITES 87209 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN (EG, TRICHROME, IRON HEMOTOXYLIN) FOR OVA AND PARASITES 87209 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS (EG, SALINE, INDIA INK, KOH PREPS) 87210 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS (EG, SALINE, INDIA INK, KOH PREPS) 87210 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

TISSUE EXAMINATION BY KOH SLIDE OF SAMPLES FROM SKIN, HAIR, OR NAILS FOR FUNGI OR ECTOPARASITE OVA OR MITES (EG, SCABIES) 87220 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

TISSUE EXAMINATION BY KOH SLIDE OF SAMPLES FROM SKIN, HAIR, OR NAILS FOR FUNGI OR ECTOPARASITE OVA OR MITES (EG, SCABIES) 87220 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUM DIFFICILE TOXIN) 87230 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUM DIFFICILE TOXIN) 87230 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABVirus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection 87250 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABVirus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection 87250 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE IDENTIFICATION BY CYTOPATHIC EFFECT 87252 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE IDENTIFICATION BY CYTOPATHIC EFFECT 87252 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFICATION (EG, HEMABSORPTION, NEUTRALIZATION, IMMUNOFLUORESENCE STAIN), EACH ISOLATE 87253 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFICATION (EG, HEMABSORPTION, NEUTRALIZATION, IMMUNOFLUORESENCE STAIN), EACH ISOLATE 87253 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES IDENTIFICATION WITH IMMUNOFLUORESCENCE STAIN, EACH VIRUS 87254 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES IDENTIFICATION WITH IMMUNOFLUORESCENCE STAIN, EACH VIRUS 87254 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

VIRUS ISOLATION; INCLUDING IDENTIFICATION BY NON-IMMUNOLOGIC METHOD, OTHER THAN BY CYTOPATHIC EFFECT (EG, VIRUS SPECIFIC ENZYMATIC ACTIVITY) 87255 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

VIRUS ISOLATION; INCLUDING IDENTIFICATION BY NON-IMMUNOLOGIC METHOD, OTHER THAN BY CYTOPATHIC EFFECT (EG, VIRUS SPECIFIC ENZYMATIC ACTIVITY) 87255 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ENTEROVIRUS, DIRECT FLUORESCENT ANTIBODY (DFA) 87267 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ENTEROVIRUS, DIRECT FLUORESCENT ANTIBODY (DFA) 87267 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABINFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; GIARDIA 87269 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABINFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; GIARDIA 87269 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCYTOMEGALOVIRUS, DIRECT FLUORESCENT ANTIBODY (DFA) 87271 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCYTOMEGALOVIRUS, DIRECT FLUORESCENT ANTIBODY (DFA) 87271 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLEX VIRUS TYPE 2 87273 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLEX VIRUS TYPE 2 87273 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B VIRUS 87275 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B VIRUS 87275 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PARAINFLUENZA VIRUS, EACH TYPE 87279 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PARAINFLUENZA VIRUS, EACH TYPE 87279 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCYSTIS CARINII 87281 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCYSTIS CARINII 87281 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABINFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RUBEOLA 87283 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABINFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RUBEOLA 87283 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT FOR MULTIPLE ORGANISMS, EACH POLYVALENT ANTISERUM 87300 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT FOR MULTIPLE ORGANISMS, EACH POLYVALENT ANTISERUM 87300 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; ASPERGILLUS 87305 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; ASPERGILLUS 87305 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; CRYPTOCOCCUS NEOFORMANS 87327 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; CRYPTOCOCCUS NEOFORMANS 87327 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; GIARDIA 87329 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; GIARDIA 87329 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; ENTAMOEBA HISTOLYTICA DISPAR GROUP 87336 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; ENTAMOEBA HISTOLYTICA DISPAR GROUP 87336 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; ENTAMOEBA HISTOLYTICA GROUP 87337 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; ENTAMOEBA HISTOLYTICA GROUP 87337 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HELICOBACTER PYLORI 87339 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HELICOBACTER PYLORI 87339 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS B SURFACE ANTIGEN (HBSAG) 87340 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS B SURFACE ANTIGEN (HBSAG) 87340 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS B SURFACE ANTIGEN (HBSAG) NEUTRALIZATION 87341 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS B SURFACE ANTIGEN (HBSAG) NEUTRALIZATION 87341 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS BE ANTIGEN (HBEAG) 87350 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS BE ANTIGEN (HBEAG) 87350 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS, DELTA AGENT 87380 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS, DELTA AGENT 87380 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; HIV-1 ANTIGEN(S), WITH HIV-1 AND HIV-2 ANTIBODIES, SINGLE RESULT 87389 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; HIV-1 ANTIGEN(S), WITH HIV-1 AND HIV-2 ANTIBODIES, SINGLE RESULT 87389 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HIV-1 87390 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB


Laboratory LAB




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Laboratory LAB Detection test for Influenza virus, A or B 87400 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for Influenza virus, A or B 87400 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; SHIGA-LIKE TOXIN 87427 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; SHIGA-LIKE TOXIN 87427 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for Strep (Streptococcus, group A) 87430 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for Strep (Streptococcus, group A) 87430 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE OR SEMIQUANTITATIVE; MULTIPLE STEP METHOD, POLYVALENT FOR MULTIPLE ORGANISMS, EACH POLYVALENT ANTISERUM 87451 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE OR SEMIQUANTITATIVE; MULTIPLE STEP METHOD, POLYVALENT FOR MULTIPLE ORGANISMS, EACH POLYVALENT ANTISERUM 87451 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE AND BARTONELLA QUINTANA, AMPLIFIED PROBE TECHNIQUE 87471 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE AND BARTONELLA QUINTANA, AMPLIFIED PROBE TECHNIQUE 87471 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE AND BARTONELLA QUINTANA, QUANTIFICATION 87472 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE AND BARTONELLA QUINTANA, QUANTIFICATION 87472 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABDetection test for borrelia burgdorferi, (bacteria), direct probe technique 87475 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABDetection test for borrelia burgdorferi, (bacteria), direct probe technique 87475 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFERI, AMPLIFIED PROBE TECHNIQUE 87476 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFERI, AMPLIFIED PROBE TECHNIQUE 87476 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE 87480 28 280 81 N/A N/A P N PSY / SUB N DOS



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INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE 87480 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE 87481 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE 87481 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, DIRECT PROBE TECHNIQUE 87485 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, DIRECT PROBE TECHNIQUE 87485 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHNIQUE 87486 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHNIQUE 87486 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, DIRECT PROBE TECHNIQUE 87490 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, DIRECT PROBE TECHNIQUE 87490 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE 87491 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE 87491 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, QUANTIFICATION 87492 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, QUANTIFICATION 87492 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CLOSTRIDIUM DIFFICILE, TOXIN GENE(S), AMPLIFIED PROBE TECHNIQUE 87493 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CLOSTRIDIUM DIFFICILE, TOXIN GENE(S), AMPLIFIED PROBE TECHNIQUE 87493 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS, DIRECT PROBE TECHNIQUE 87495 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS, DIRECT PROBE TECHNIQUE 87495 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS, AMPLIFIED PROBE TECHNIQUE 87496 28 280 81 N/A N/A P N PSY / SUB N DOS



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INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS, AMPLIFIED PROBE TECHNIQUE 87496 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for cytomegalovirus, quantification 87497 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for cytomegalovirus, quantification 87497 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for enterovirus (intestinal virus) 87498 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for enterovirus (intestinal virus) 87498 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); VANCOMYCIN RESISTANCE (EG, ENTEROCOCCUS SPECIES VAN A, VAN B), AMPLIFIED PROBE TECHNIQUE 87500 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); VANCOMYCIN RESISTANCE (EG, ENTEROCOCCUS SPECIES VAN A, VAN B), AMPLIFIED PROBE TECHNIQUE 87500 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype 87501 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype 87501 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription and multiplex amplified probe technique, first 2 types or sub-types 87502 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription and multiplex amplified probe technique, first 2 types or sub-types 87502 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (Li 87503 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (Li 87503 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS, QUANTIFICATION 87517 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS, QUANTIFICATION 87517 01 183 22 N/A N/A P N PSY / SUB N DOS



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Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed 87521 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed 87521 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for Hepatitis C virus 87522 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for Hepatitis C virus 87522 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for HIV-1 virus 87536 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for HIV-1 virus 87536 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECHNIQUE 87591 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECHNIQUE 87591 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 87623 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 87623 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) 87624 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) 87624 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed 87625 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed 87625 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when p 87631 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB




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Laboratory LAB


Laboratory LAB


Laboratory LAB


Laboratory LAB


Laboratory LAB Detection test for respiratory syncytial virus 87634 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for respiratory syncytial virus 87634 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECHNIQUE 87640 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECHNIQUE 87640 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABDetection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique 87641 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABDetection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique 87641 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABDetection test for Strep (Streptococcus, group B), amplified probe technique 87653 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABDetection test for Strep (Streptococcus, group B), amplified probe technique 87653 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQUE 87660 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQUE 87660 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABInfectious agent detection by nucleic acid (dna or rna); trichomonas vaginalis, amplified probe technique 87661 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABInfectious agent detection by nucleic acid (dna or rna); trichomonas vaginalis, amplified probe technique 87661 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB Detection test for Zika virus 87662 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Detection test for Zika virus 87662 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; DIRECT PROBE TECHNIQUE, EACH ORGANISM 87797 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; DIRECT PROBE TECHNIQUE, EACH ORGANISM 87797 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TECHNIQUE, EACH ORGANISM 87798 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TECHNIQUE, EACH ORGANISM 87798 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; DIRECT PROBE(S) TECHNIQUE 87800 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; DIRECT PROBE(S) TECHNIQUE 87800 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECHNIQUE 87801 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECHNIQUE 87801 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABInfectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B 87802 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABInfectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B 87802 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; CLOSTRIDIUM DIFFICILE TOXIN A 87803 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; CLOSTRIDIUM DIFFICILE TOXIN A 87803 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA 87804 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA 87804 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent antigen detection by immunoassay with direct optical observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies 87806 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Infectious agent antigen detection by immunoassay with direct optical observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies 87806 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; RESPIRATORY SYNCYTIAL VIRUS 87807 28 280 81 N/A N/A P N PSY / SUB N DOS



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INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; RESPIRATORY SYNCYTIAL VIRUS 87807 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; TRICHOMONAS VAGINALIS 87808 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; TRICHOMONAS VAGINALIS 87808 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; ADENOVIRUS 87809 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; ADENOVIRUS 87809 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABInfectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A 87880 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABInfectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A 87880 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE PREDICTION USING REGULARLY UPDATED GENOTYPIC BIOINFORMATICS 87900 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE PREDICTION USING REGULARLY UPDATED GENOTYPIC BIOINFORMATICS 87900 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HIV-1, REVERSE TRANSCRIPTASE AND PROTEASE REGIONS 87901 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HIV-1, REVERSE TRANSCRIPTASE AND PROTEASE REGIONS 87901 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESISTANCE TISSUE CULTURE ANALYSIS, HIV 1; FIRST THROUGH 10 DRUGS TESTED 87903 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESISTANCE TISSUE CULTURE ANALYSIS, HIV 1; FIRST THROUGH 10 DRUGS TESTED 87903 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESISTANCE TISSUE CULTURE ANALYSIS, HIV 1; EACH ADDITIONAL DRUG TESTED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 87904 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESISTANCE TISSUE CULTURE ANALYSIS, HIV 1; EACH ADDITIONAL DRUG TESTED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 87904 01 183 22 N/A N/A P N PSY / SUB N DOS



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INFECTIOUS AGENT ENZYMATIC ACTIVITY OTHER THAN VIRUS (EG, SIALIDASE ACTIVITY IN VAGINAL FLUID) 87905 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT ENZYMATIC ACTIVITY OTHER THAN VIRUS (EG, SIALIDASE ACTIVITY IN VAGINAL FLUID) 87905 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HIV-1, OTHER REGION (EG, INTEGRASE, FUSION) 87906 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HIV-1, OTHER REGION (EG, INTEGRASE, FUSION) 87906 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABINFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS 87910 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABINFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS 87910 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABINFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS 87912 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABINFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS 87912 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS WITH INTERPRETATION 88104 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS WITH INTERPRETATION 88104 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SIMPLE FILTER METHOD WITH INTERPRETATION 88106 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SIMPLE FILTER METHOD WITH INTERPRETATION 88106 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG, SACCOMANNO TECHNIQUE) 88108 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG, SACCOMANNO TECHNIQUE) 88108 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION (EG, LIQUID BASED SLIDE PREPARATION METHOD), EXCEPT CERVICAL OR VAGINAL 88112 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION (EG, LIQUID BASED SLIDE PREPARATION METHOD), EXCEPT CERVICAL OR VAGINAL 88112 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG, FISH), URINARY TRACT SPECIMEN WITH MORPHOMETRIC ANALYSIS, 3-5 MOLECULAR PROBES, EACH SPECIMEN; MANUAL 88120 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG, FISH), URINARY TRACT SPECIMEN WITH MORPHOMETRIC ANALYSIS, 3-5 MOLECULAR PROBES, EACH SPECIMEN; MANUAL 88120 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG, FISH), URINARY TRACT SPECIMEN WITH MORPHOMETRIC ANALYSIS, 3-5 MOLECULAR PROBES, EACH SPECIMEN; USING COMPUTER-ASSISTED TECHNOLOGY 88121 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG, FISH), URINARY TRACT SPECIMEN WITH MORPHOMETRIC ANALYSIS, 3-5 MOLECULAR PROBES, EACH SPECIMEN; USING COMPUTER-ASSISTED TECHNOLOGY 88121 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM); REQUIRING INTERPRETATION BY PHYSICIAN (LIST SEPARATELY IN ADDITION TO CODE FOR TECHNICAL SERVICE) 88141 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM); REQUIRING INTERPRETATION BY PHYSICIAN (LIST SEPARATELY IN ADDITION TO CODE FOR TECHNICAL SERVICE) 88141 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION; MANUAL SCREENING UNDER PHYSICIAN SUPERVISION 88142 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION; MANUAL SCREENING UNDER PHYSICIAN SUPERVISION 88142 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; MANUAL SCREENING UNDER PHYSICIAN SUPERVISION 88150 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; MANUAL SCREENING UNDER PHYSICIAN SUPERVISION 88150 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND RESCREENING UNDER PHYSICIAN SUPERVISION 88153 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND RESCREENING UNDER PHYSICIAN SUPERVISION 88153 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL, DEFINITIVE HORMONAL EVALUATION (EG, MATURATION INDEX, KARYOPYKNOTIC INDEX, ESTROGENIC INDEX) (LIST SEPARATELY IN ADDITION TO CODE(S) FOR OTHER TECHNICAL AND INTERPRETATION SERVICES) 88155 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL, DEFINITIVE HORMONAL EVALUATION (EG, MATURATION INDEX, KARYOPYKNOTIC INDEX, ESTROGENIC INDEX) (LIST SEPARATELY IN ADDITION TO CODE(S) FOR OTHER TECHNICAL AND INTERPRETATION SERVICES) 88155 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION 88160 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION 88160 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND INTERPRETATION 88161 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND INTERPRETATION 88161 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SLIDES AND/OR MULTIPLE STAINS 88162 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SLIDES AND/OR MULTIPLE STAINS 88162 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); MANUAL SCREENING UNDER PHYSICIAN SUPERVISION 88164 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); MANUAL SCREENING UNDER PHYSICIAN SUPERVISION 88164 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SCREENING AND RESCREENING UNDER PHYSICIAN SUPERVISION 88165 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SCREENING AND RESCREENING UNDER PHYSICIAN SUPERVISION 88165 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SCREENING AND COMPUTER-ASSISTED RESCREENING UNDER PHYSICIAN SUPERVISION 88166 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SCREENING AND COMPUTER-ASSISTED RESCREENING UNDER PHYSICIAN SUPERVISION 88166 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SCREENING AND COMPUTER-ASSISTED RESCREENING USING CELL SELECTION AND REVIEW UNDER PHYSICIAN SUPERVISION 88167 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SCREENING AND COMPUTER-ASSISTED RESCREENING USING CELL SELECTION AND REVIEW UNDER PHYSICIAN SUPERVISION 88167 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION; SCREENING BY AUTOMATED SYSTEM, UNDER PHYSICIAN SUPERVISION 88174 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION; SCREENING BY AUTOMATED SYSTEM, UNDER PHYSICIAN SUPERVISION 88174 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION; WITH SCREENING BY AUTOMATED SYSTEM AND MANUAL RESCREENING OR REVIEW, UNDER PHYSICIAN SUPERVISION 88175 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION; WITH SCREENING BY AUTOMATED SYSTEM AND MANUAL RESCREENING OR REVIEW, UNDER PHYSICIAN SUPERVISION 88175 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABFLOW CYTOMETRY; CELL CYCLE OR DNA ANALYSIS 88182 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFLOW CYTOMETRY; CELL CYCLE OR DNA ANALYSIS 88182 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; FIRST MARKER 88184 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; FIRST MARKER 88184 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; EACH ADDITIONAL MARKER (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST MARKER) 88185 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; EACH ADDITIONAL MARKER (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST MARKER) 88185 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABFLOW CYTOMETRY, INTERPRETATION; 2 TO 8 MARKERS 88187 28 280 81 N/A N/A P N PSY / SUB N DOS




Laboratory LABFLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS 88189 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABFLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS 88189 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; LYMPHOCYTE 88230 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; LYMPHOCYTE 88230 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; SKIN OR OTHER SOLID TISSUE BIOPSY 88233 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; SKIN OR OTHER SOLID TISSUE BIOPSY 88233 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; AMNIOTIC FLUID OR CHORIONIC VILLUS CELLS 88235 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; AMNIOTIC FLUID OR CHORIONIC VILLUS CELLS 88235 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTISSUE CULTURE FOR NEOPLASTIC DISORDERS; BONE MARROW, BLOOD CELLS 88237 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTISSUE CULTURE FOR NEOPLASTIC DISORDERS; BONE MARROW, BLOOD CELLS 88237 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABTISSUE CULTURE FOR NEOPLASTIC DISORDERS; SOLID TUMOR 88239 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABTISSUE CULTURE FOR NEOPLASTIC DISORDERS; SOLID TUMOR 88239 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE SISTER CHROMATID EXCHANGE (SCE), 20-25 CELLS 88245 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE SISTER CHROMATID EXCHANGE (SCE), 20-25 CELLS 88245 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE BREAKAGE, SCORE 50-100 CELLS, COUNT 20 CELLS, 2 KARYOTYPES (EG, FOR ATAXIA TELANGIECTASIA, FANCONI ANEMIA, FRAGILE X) 88248 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE BREAKAGE, SCORE 50-100 CELLS, COUNT 20 CELLS, 2 KARYOTYPES (EG, FOR ATAXIA TELANGIECTASIA, FANCONI ANEMIA, FRAGILE X) 88248 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 100 CELLS, CLASTOGEN STRESS (EG, DIEPOXYBUTANE, MITOMYCIN C, IONIZING RADIATION, UV RADIATION) 88249 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 100 CELLS, CLASTOGEN STRESS (EG, DIEPOXYBUTANE, MITOMYCIN C, IONIZING RADIATION, UV RADIATION) 88249 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, WITH BANDING 88261 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, WITH BANDING 88261 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES, WITH BANDING 88262 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES, WITH BANDING 88262 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; COUNT 45 CELLS FOR MOSAICISM, 2 KARYOTYPES, WITH BANDING 88263 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; COUNT 45 CELLS FOR MOSAICISM, 2 KARYOTYPES, WITH BANDING 88263 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS 88264 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS 88264 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS, AMNIOTIC FLUID OR CHORIONIC VILLUS, COUNT 15 CELLS, 1 KARYOTYPE, WITH BANDING 88267 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS, AMNIOTIC FLUID OR CHORIONIC VILLUS, COUNT 15 CELLS, 1 KARYOTYPE, WITH BANDING 88267 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS, IN SITU FOR AMNIOTIC FLUID CELLS, COUNT CELLS FROM 6-12 COLONIES, 1 KARYOTYPE, WITH BANDING 88269 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS, IN SITU FOR AMNIOTIC FLUID CELLS, COUNT CELLS FROM 6-12 COLONIES, 1 KARYOTYPE, WITH BANDING 88269 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH STUDY 88280 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH STUDY 88280 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED BANDING TECHNIQUE (EG, NOR, C-BANDING) 88283 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED BANDING TECHNIQUE (EG, NOR, C-BANDING) 88283 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH STUDY 88285 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH STUDY 88285 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCHROMOSOME ANALYSIS; ADDITIONAL HIGH RESOLUTION STUDY 88289 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LABCHROMOSOME ANALYSIS; ADDITIONAL HIGH RESOLUTION STUDY 88289 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Surgical pathology, gross examination only (Level 1) 88300 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Surgical pathology, gross examination only (Level 1) 88300 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Pathology examination of tissue using a microscope 88302 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Pathology examination of tissue using a microscope 88302 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSurgical pathology, gross and microscopic examination (Level III) 88304 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSurgical pathology, gross and microscopic examination (Level III) 88304 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSurgical pathology, gross and microscopic examination (Level IV) 88305 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSurgical pathology, gross and microscopic examination (Level IV) 88305 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSurgical pathology, gross and microscopic examination (Level V) 88307 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSurgical pathology, gross and microscopic examination (Level V) 88307 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSurgical pathology, gross and microscopic examination (Level VI) 88309 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSurgical pathology, gross and microscopic examination (Level VI) 88309 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION) 88311 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION) 88311 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHENAMINE SILVER) 88312 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHENAMINE SILVER) 88312 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT STAIN FOR MICROORGANISMS, STAINS FOR ENZYME CONSTITUENTS, OR IMMUNOCYTOCHEMISTRY AND IMMUNOHISTOCHEMISTRY 88313 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT STAIN FOR MICROORGANISMS, STAINS FOR ENZYME CONSTITUENTS, OR IMMUNOCYTOCHEMISTRY AND IMMUNOHISTOCHEMISTRY 88313 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; HISTOCHEMICAL STAIN ON FROZEN TISSUE BLOCK (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 88314 28 280 81 N/A N/A P N PSY / SUB N DOS



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Laboratory LAB

SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; HISTOCHEMICAL STAIN ON FROZEN TISSUE BLOCK (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 88314 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP III, FOR ENZYME CONSTITUENTS 88319 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP III, FOR ENZYME CONSTITUENTS 88319 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABCONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES 88323 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABCONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES 88323 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PATHOLOGY CONSULTATION DURING SURGERY; 88329 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB PATHOLOGY CONSULTATION DURING SURGERY; 88329 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSUE BLOCK, WITH FROZEN SECTION(S), SINGLE SPECIMEN 88331 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSUE BLOCK, WITH FROZEN SECTION(S), SINGLE SPECIMEN 88331 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTION(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 88332 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTION(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 88332 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQUASH PREP), INITIAL SITE 88333 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQUASH PREP), INITIAL SITE 88333 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQUASH PREP), EACH ADDITIONAL SITE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 88334 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQUASH PREP), EACH ADDITIONAL SITE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 88334 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) 88341 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) 88341 01 183 22 N/A N/A P N PSY / SUB N DOS



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Laboratory LABImmunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 88342 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABImmunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 88342 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABImmunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure 88344 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABImmunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure 88344 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD 88346 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD 88346 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ELECTRON MICROSCOPY; DIAGNOSTIC 88348 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB ELECTRON MICROSCOPY; DIAGNOSTIC 88348 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Immunofluorescence per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) 88350 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Immunofluorescence per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) 88350 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MORPHOMETRIC ANALYSIS; SKELETAL MUSCLE 88355 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MORPHOMETRIC ANALYSIS; SKELETAL MUSCLE 88355 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MORPHOMETRIC ANALYSIS; NERVE 88356 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB MORPHOMETRIC ANALYSIS; NERVE 88356 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABMORPHOMETRIC ANALYSIS; TUMOR (EG, DNA PLOIDY) 88358 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABMORPHOMETRIC ANALYSIS; TUMOR (EG, DNA PLOIDY) 88358 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual 88360 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual 88360 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; using computer-assisted technology 88361 28 280 81 N/A N/A P N PSY / SUB N DOS



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Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; using computer-assisted technology 88361 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NERVE TEASING PREPARATIONS 88362 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NERVE TEASING PREPARATIONS 88362 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

EXAMINATION AND SELECTION OF RETRIEVED ARCHIVAL (IE, PREVIOUSLY DIAGNOSED) TISSUE(S) FOR MOLECULAR ANALYSIS (EG, KRAS MUTATIONAL ANALYSIS) 88363 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

EXAMINATION AND SELECTION OF RETRIEVED ARCHIVAL (IE, PREVIOUSLY DIAGNOSED) TISSUE(S) FOR MOLECULAR ANALYSIS (EG, KRAS MUTATIONAL ANALYSIS) 88363 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure) 88364 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure) 88364 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIn situ hybridization (eg, FISH), per specimen; initial single probe stain procedure 88365 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIn situ hybridization (eg, FISH), per specimen; initial single probe stain procedure 88365 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABIn situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure 88366 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABIn situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure 88366 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; initial single probe stain procedure 88367 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; initial single probe stain procedure 88367 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; initial single probe stain procedure 88368 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; initial single probe stain procedure 88368 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure) 88369 28 280 81 N/A N/A P N PSY / SUB N DOS



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Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure) 88369 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABPROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT; 88371 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABPROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT; 88371 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each 88372 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each 88372 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure) 88373 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure) 88373 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure 88374 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure 88374 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure 88377 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure 88377 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node) 88387 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node) 88387 01 183 22 N/A N/A P N PSY / SUB N DOS



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Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node); in conjunction with a touch imprint, intraoperative 88388 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node); in conjunction with a touch imprint, intraoperative 88388 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILIRUBIN, TOTAL, TRANSCUTANEOUS 88720 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB BILIRUBIN, TOTAL, TRANSCUTANEOUS 88720 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEMOGLOBIN (HGB), QUANTITATIVE, TRANSCUTANEOUS 88738 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHEMOGLOBIN (HGB), QUANTITATIVE, TRANSCUTANEOUS 88738 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin 88740 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin 88740 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABHemoglobin, quantitative, transcutaneous, per day; methemoglobin 88741 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABHemoglobin, quantitative, transcutaneous, per day; methemoglobin 88741 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CAFFEINE HALOTHANE CONTRACTURE TEST (CHCT) FOR MALIGNANT HYPERTHERMIA SUSCEPTIBILITY, INCLUDING INTERPRETATION AND REPORT 89049 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CAFFEINE HALOTHANE CONTRACTURE TEST (CHCT) FOR MALIGNANT HYPERTHERMIA SUSCEPTIBILITY, INCLUDING INTERPRETATION AND REPORT 89049 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EXCEPT BLOOD; 89050 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EXCEPT BLOOD; 89050 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT 89051 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT 89051 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABLeukocyte assessment, fecal, qualitative or semiquantitative 89055 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABLeukocyte assessment, fecal, qualitative or semiquantitative 89055 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB

CRYSTAL IDENTIFICATION BY LIGHT MICROSCOPY WITH OR WITHOUT POLARIZING LENS ANALYSIS, TISSUE OR ANY BODY FLUID (EXCEPT URINE) 89060 28 280 81 N/A N/A P N PSY / SUB N DOS



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CRYSTAL IDENTIFICATION BY LIGHT MICROSCOPY WITH OR WITHOUT POLARIZING LENS ANALYSIS, TISSUE OR ANY BODY FLUID (EXCEPT URINE) 89060 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Fat stain, feces, urine, or respiratory secretions 89125 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB Fat stain, feces, urine, or respiratory secretions 89125 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NASAL SMEAR FOR EOSINOPHILS 89190 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB NASAL SMEAR FOR EOSINOPHILS 89190 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LABSPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE) 89220 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LABSPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE) 89220 01 183 22 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SWEAT COLLECTION BY IONTOPHORESIS 89230 28 280 81 N/A N/A P N PSY / SUB N DOS

Laboratory LAB SWEAT COLLECTION BY IONTOPHORESIS 89230 01 183 22 N/A N/A P N PSY / SUB N DOS

Provider Type Provider Type Description

Provider Specialty Provider Specialty Description

010 Acute Care Hospital011 Private Psych Hosp013 RTF (JCAHO Certified) Hospital018 Extended Acute Psych Inpatient Unit019 D&A Rehab Hosp022 Private Psych Unit183 Hospital Based Medical Clinic370 Tobacco Cessation441 D&A Rehab Unit

05 Home Health 370 Tobacco Cessation07 Capitation 072 MCO - BH

074 Mobile Mental Health Treatment076 Peer Specialist080 Federally Qualified Health Center081 Rural Health Clinic082 Independent Medical/Surgical Clinic083 Family Planning Clinic084 Methadone Maintenance110 Psychiatric Outpatient184 D&A Outpatient340 Program Exception370 Tobacco Cessation558 Behavior Specialist for Children with Autism800 FQHC Therapeutic Staff Support801 FQHC Mobile Therapy802 FQHC Behavioral Specialist Consultant803 FQHC Summer Therapeutic Activity Program804 RHC Therapeutic Staff Support805 RHC Mobile Therapy806 RHC Behavioral Specialist Consultant807 RHC Summer Therapeutic Activity Program

808 Psychiatric Outpatient Therapeutic Staff Support

01 Inpatient Facility

08 Clinic

809 Psychiatric Outpatient Mobile Therapy810 Psychiatric Outpatient Behavioral Specialist

Consultant811 Psychiatric Outpatient Summer Therapeutic Activity

Program

093 CRNP103 Family and Adult Psychiatric Mental Health370 Tobacco Cessation548 Therapeutic Staff Support549 Mobile Therapy558 Behavior Specialist for Children with Autism559 Behavioral Specialist Consultant076 Peer Specialist110 Psychiatric Outpatient111 Community Mental Health112 Outpatient Practitioner - MH113 Partial Psych Hosp - Children114 Partial Psych Hosp - Adult115 Family Based Mental Health116 Licensed Clinical Social Worker117 Licensed Social Worker118 Mental Health Crisis Intervention119 MH - OMHSAS123 Psychiatric Rehabilitation127 D&A Outpatient128 D&A Intensive Outpatient 129 D&A Partial Hospitalization131 D&A Halfway House132 D&A Medically Monitored Detox133 D&A Medically Monitored Residential, Short Term134 D&A Medically Monitored Residential, Long Term184 Outpatient D&A340 Program Exception442 Partial Psych Hosp Children Therapeutic Staff

Support

11 Mental Health/Substance Abuse

11 Mental Health/Substance Abuse continued

09 CRNP

443 Partial Psych Hosp Children Mobile Therapy444 Partial Psych Hosp Children Behavioral Specialist

Consultant445 Partial Psych Hosp Children Summer Therapeutic

Activity Program446

Partial Psych Hosp Adult Therapeutic Staff Support

447 Partial Psych Hosp Adult Mobile Therapy448 Partial Psych Hosp Adult Behavioral Specialist

Consultant449 Partial Psych Hosp Adult Summer Therapeutic

Activity Program

450 Family Based MH Therapeutic Staff Support451 Family Based MH Mobile Therapy452

Family Based MH Behavioral Specialist Consultant453 Family Based MH Summer Therapeutic Activity

Program

548 Therapeutic Staff Support549 Mobile Therapy558 Behavior Specialist for Children with Autism559 Behavioral Specialist Consultant561 Entity BSC-ASD (ABA)562 Entity TSS (ABA)

16 Nurse 162 Psychiatric Nurse171 Occupational Therapist174 Art Therapist175 Music Therapist190 General Psychologist370 Tobacco Cessation548 Therapeutic Staff Support549 Mobile Therapy558 Behavior Specialist for Children with Autism559 Behavioral Specialist Consultant076 Peer Specialist138 D&A Targeted Case Management212 MA Case Management for under 21 years of age

19 Psychologist

19 Psychologist continued

21 Case Manager

17 Therapist

221 MH TCM - Resource Coordination222 MH TCM - Intensive

27 Dentist 370 Tobacco Cessation28 Laboratory 280 Independent Laboratory

315 Emerency Medicine316 Family Practice322 Internal Medicine339 Psychiatry345 Pediatrics370 Tobacco Cessation548 Therapeutic Staff Support549 Mobile Therapy558 Behavior Specialist for Children with Autism559 Behavioral Specialist Consultant

37 Tobacco Cessation 370 Tobacco Cessation520 Children & Youth Licensed Group Home with a

Mental Health Treatment Component

523 Host Home/Children56 Residential Treatment Facility 560 RTF (Non-JCAHO certified)

Modifiers Modifier Descriptions Modifiers Modifier DescriptionsAH Clinical psychologist SC Medically necessary service or supplyGO OP Occupational Therapy Service TF Intermediate level of care

TG Complex/high tech level of careTJ Program group, child and/or adolescent

HA Child/adolescent programHB Adult program, non geriatric HE Mental health program UA Licensed children's programHF Substance abuse program UB Medicaid Pricing ModifierHG Opioid addiction treatment program UC Pilot program

GT Via interactive audio and video telecommunication systems

TT Individualized service provided to more than one patient in same setting

31 Physician

52 Community Residential Rehab

g g ts a e ot be a o a ea t p o de type/p o de spec a ty but e cou te s a e pe tted to be sub tted as defined throughout this document

UKServices provided on behalf of the client to someone other than the client (collateral relationship)

U1 PsychiatricHO Masters degree level U2 Medicare/TPL contractual disallowanceHP Doctoral level U7 Medicaid Pricing ModifierHQ Group setting U8 Medicaid Pricing ModifierHT Multi-disciplinary team U9 Medicaid Pricing ModifierHW Funded by state mental health agency

POS Place of Service Description POS Place of Service Description03 School 49 Independent Clinic11 Office 50 Federally Qualified Health Ctr12 Home 52 Psychiatric Facility - PH15 Mobile Unit 54 ICF/MR21 Inpatient Hospital 56 Psychiatric RTF22 Outpatient Hospital 57 Non-Residential Substance Abuse Treatment Fac23 Emergency Room - Hospital 65 End-Stage Renal Disease Treatment Facility24 Ambulatory Surgical Center 72 Rural Health Clinic31 Skilled Nursing Facility 81 Independent Laboratory32 Nursing Facility 99 Other POS

Pricing Modifiers

HK Specialized mental health programs for high-risk populations

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