Clinical diagnostic laboratory fee schedule cpt codes

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Clinical Diagnostic Laboratory Fee Schedule

CPT codes, descriptions and other data only are copyright American Medical Association.

2015 Codes are in Red

NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges

All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

HCPCS Modifier SHORT DESCRIPTION

2015 Fee Schedule

(60% of Medicare)

36415

Routine venipuncture

$3.00

78267

Breath tst attain/anal c-14

$10.70

78268

Breath test analysis c-14

$91.66

80047

Metabolic panel ionized ca

$9.12

80047 QW

Metabolic panel ionized ca

$9.12

80048

Metabolic panel total ca

$9.12

80048 QW

Metabolic panel total ca

$9.12

80051

Electrolyte panel

$7.60

80051 QW

Electrolyte panel

$7.60

80053

Comprehen metabolic panel

$11.44

80053 QW

Comprehen metabolic panel

$11.44

80061

Lipid panel

$15.49

80061 QW

Lipid panel

$15.49

80069

Renal function panel

$9.12

80069 QW

Renal function panel

$9.12

80074

Acute hepatitis panel

$64.83

80076

Hepatic function panel

$9.12

80150

Assay of amikacin

$20.51

80155

Drug screen quant caffeine

$19.25

80156

Assay carbamazepine total

$19.82

80157

Assay carbamazepine free

$18.04

80158

Assay of cyclosporine

$24.57

80159

Drug screen quant clozapine

$25.17

80162

Assay of digoxin

$18.07

80163

Assay of digoxin free

$18.07

80164

Assay dipropylacetic acid

$18.44

80165

Dipropylacetic acid free

$18.44

80168

Assay of ethosuximide

$22.24

80169

Drug screen quant everolimus

$18.69

80170

Assay of gentamicin

$22.30

80171

Drug screen quant gabapentin

$18.04

80173

Assay of haloperidol

$19.82

80175

Drug screen quan lamotrigine

$18.04

80176

Assay of lidocaine

$19.99

80177

Drug scrn quan levetiracetam

$18.04

80178

Assay of lithium

$9.00

80178 QW

Assay of lithium

$9.00

80180

Drug scrn quan mycophenolate

$24.57

80183

Drug scrn quant oxcarbazepin

$18.04

Rev. Jan. 2015

Page 1

Clinical Diagnostic Laboratory Fee Schedule

CPT codes, descriptions and other data only are copyright American Medical Association.

2015 Codes are in Red

NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges

All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

HCPCS Modifier SHORT DESCRIPTION

2015 Fee Schedule

(60% of Medicare)

80184

Assay of phenobarbital

$15.58

80185

Assay of phenytoin total

$18.04

80186

Assay of phenytoin free

$18.73

80188

Assay of primidone

$22.58

80190

Assay of procainamide

$22.80

80192

Assay of procainamide

$22.80

80194

Assay of quinidine

$19.87

80195

Assay of sirolimus

$18.69

80197

Assay of tacrolimus

$18.69

80198

Assay of theophylline

$19.25

80199

Drug screen quant tiagabine

$24.58

80200

Assay of tobramycin

$21.94

80201

Assay of topiramate

$16.23

80202

Assay of vancomycin

$18.44

80203

Drug screen quant zonisamide

$18.04

80299

Quantitative assay drug

$18.64

80400

Acth stimulation panel

$44.39

80402

Acth stimulation panel

$118.33

80406

Acth stimulation panel

$106.49

80408

Aldosterone suppression eval

$170.78

80410

Calcitonin stimul panel

$109.33

80412

CRH stimulation panel

$402.44

80414

Testosterone response

$70.27

80415

Estradiol response panel

$76.05

80416

Renin stimulation panel

$179.58

80417

Renin stimulation panel

$59.86

80418

Pituitary evaluation panel

$758.01

80420

Dexamethasone panel

$97.58

80422

Glucagon tolerance panel

$62.70

80424

Glucagon tolerance panel

$68.72

80426

Gonadotropin hormone panel

$201.96

80428

Growth hormone panel

$90.77

80430

Growth hormone panel

$106.80

80432

Insulin suppression panel

$172.89

80434

Insulin tolerance panel

$137.68

80435

Insulin tolerance panel

$140.19

80436

Metyrapone panel

$124.06

80438

TRH stimulation panel

$68.60

80439

TRH stimulation panel

$91.47

Rev. Jan. 2015

Page 2

Clinical Diagnostic Laboratory Fee Schedule

CPT codes, descriptions and other data only are copyright American Medical Association.

2015 Codes are in Red

NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges

All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

HCPCS Modifier SHORT DESCRIPTION

2015 Fee Schedule

(60% of Medicare)

81000

Urinalysis nonauto w/scope

$4.31

81001

Urinalysis auto w/scope

$4.31

81002

Urinalysis nonauto w/o scope

$3.28

81003

Urinalysis auto w/o scope

$3.06

81003 QW

Urinalysis auto w/o scope

$3.06

81005

Urinalysis

$2.95

81007

Urine screen for bacteria

$3.49

81007 QW

Urine screen for bacteria

$3.49

81015

Microscopic exam of urine

$4.14

81020

Urinalysis glass test

$5.02

81025

Urine pregnancy test

$1.64

81050

Urinalysis volume measure

$3.85

81161

Dmd dup/delet analysis

$0.00

81206

Bcr/abl1 gene major bp

$223.13

81207

Bcr/abl1 gene minor bp

$197.10

81208

Bcr/abl1 gene other bp

$218.88

81210

Braf gene

$178.80

81211

Brca1&2 seq & com dup/del

$2,178.04

81212

Brca1&2 185&5385&6174 var

$176.26

81213

Brca1&2 uncom dup/del var

$581.26

81214

Brca1 full seq & com dup/del

$1,434.54

81215

Brca1 gene known fam variant

$93.01

81217

Brca2 gene known fam variant

$93.01

81225

Cyp2c19 gene com variants

$291.07

81226

Cyp2d6 gene com variants

$450.46

81227

Cyp2c9 gene com variants

$174.64

81235

Egfr gene com variants

$329.18

81240

F2 gene

$66.96

81241

F5 gene

$83.16

81245

Flt3 gene

$165.51

81246

Flt3 gene analysis

$0.00

81256

Hfe gene

$88.95

81261

Igh gene rearrange amp meth

$269.43

81262

Igh gene rearrang dir probe

$59.40

81263

Igh vari regional mutation

$400.79

81264

Igk rearrangeabn clonal pop

$203.21

81265

Str markers specimen anal

$292.65

81267

Chimerism anal no cell selec

$282.32

81268

Chimerism anal w/cell select

$354.89

Rev. Jan. 2015

Page 3

Clinical Diagnostic Laboratory Fee Schedule

CPT codes, descriptions and other data only are copyright American Medical Association.

2015 Codes are in Red

NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges

All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

HCPCS Modifier SHORT DESCRIPTION

2015 Fee Schedule

(60% of Medicare)

81270

Jak2 gene

$124.75

81275

Kras gene

$196.99

81287

Mgmt gene methylation anal

$0.00

81288

Mlh1 gene

$0.00

81291

Mthfr gene

$59.40

81292

Mlh1 gene full seq

$644.62

81293

Mlh1 gene known variants

$258.41

81294

Mlh1 gene dup/delete variant

$190.20

81295

Msh2 gene full seq

$151.33

81296

Msh2 gene known variants

$129.21

81297

Msh2 gene dup/delete variant

$151.33

81298

Msh6 gene full seq

$287.11

81299

Msh6 gene known variants

$160.84

81300

Msh6 gene dup/delete variant

$161.28

81301

Microsatellite instability

$394.05

81310

Npm1 gene

$246.52

81313

Pca3/klk3 antigen

$0.00

81315

Pml/raralpha com breakpoints

$282.12

81316

Pml/raralpha 1 breakpoint

$430.31

81317

Pms2 gene full seq analysis

$779.34

81318

Pms2 known familial variants

$184.15

81319

Pms2 gene dup/delet variants

$221.11

81321

Pten gene full sequence

$599.20

81322

Pten gene known fam variant

$58.25

81323

Pten gene dup/delet variant

$87.38

81332

Serpina1 gene

$59.40

81340

Trb@ gene rearrange amplify

$284.31

81341

Trb@ gene rearrange dirprobe

$67.48

81342

Trg gene rearrangement anal

$274.21

81370

Hla i & ii typing lr

$547.23

81371

Hla i & ii type verify lr

$327.54

81372

Hla i typing complete lr

$300.61

81373

Hla i typing 1 locus lr

$151.55

81374

Hla i typing 1 antigen lr

$99.00

81375

Hla ii typing ag equiv lr

$300.40

81376

Hla ii typing 1 locus lr

$166.32

81377

Hla ii type 1 ag equiv lr

$124.94

81378

Hla i & ii typing hr

$470.26

81379

Hla i typing complete hr

$456.40

Rev. Jan. 2015

Page 4

Clinical Diagnostic Laboratory Fee Schedule

CPT codes, descriptions and other data only are copyright American Medical Association.

2015 Codes are in Red

NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges

All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

HCPCS Modifier SHORT DESCRIPTION

2015 Fee Schedule

(60% of Medicare)

81380

Hla i typing 1 locus hr

$241.21

81381

Hla i typing 1 allele hr

$128.71

81382

Hla ii typing 1 loc hr

$168.31

81383

Hla ii typing 1 allele hr

$148.51

81410

Aortic dysfunction/dilation

$0.00

81411

Aortic dysfunction/dilation

$0.00

81415

Exome sequence analysis

$0.00

81416

Exome sequence analysis

$0.00

81417

Exome re-evaluation

$0.00

81420

Fetal chrmoml aneuploidy

$0.00

81425

Genome sequence analysis

$0.00

81426

Genome sequence analysis

$0.00

81427

Genome re-evaluation

$0.00

81430

Hearing loss sequence analys

$0.00

81431

Hearing loss dup/del analys

$0.00

81435

Hereditary colon cancer

$0.00

81436

Hereditary colon ca synd

$0.00

81440

Mitochondrial gene

$0.00

81445

Targeted genomic seq analys

$0.00

81450

Targeted genomic seq analys

$0.00

81455

Targeted genomic seq analys

$0.00

81460

Whole mitochondrial genome

$0.00

81465

Whole mitochondrial genome

$0.00

81470

X-linked intellectual dblt

$0.00

81471

X-linked intellectual dblt

$0.00

82009

Test for acetone/ketones

$6.15

82010

Acetone assay

$11.12

82010 QW

Acetone assay

$11.12

82013

Acetylcholinesterase assay

$15.20

82016

Acylcarnitines qual

$18.87

82017

Acylcarnitines quant

$2.77

82024

Assay of acth

$44.88

82030

Assay of adp & amp

$35.11

82040

Assay of serum albumin

$6.72

82040 QW

Assay of serum albumin

$6.72

82042

Assay of urine albumin

$7.04

82042 QW

Assay of urine albumin

$7.04

82043

Microalbumin quantitative

$7.87

82043 QW

Microalbumin quantitative

$7.87

Rev. Jan. 2015

Page 5

Clinical Diagnostic Laboratory Fee Schedule

CPT codes, descriptions and other data only are copyright American Medical Association.

2015 Codes are in Red

NOTE: zero pay (0.00) codes will be reimbursed at 45% of bill charges

All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

HCPCS Modifier SHORT DESCRIPTION

2015 Fee Schedule

(60% of Medicare)

82044

Microalbumin semiquant

$6.22

82044 QW

Microalbumin semiquant

$6.22

82045

Albumin ischemia modified

$46.19

82075

Assay of breath ethanol

$15.82

82085

Assay of aldolase

$13.21

82088

Assay of aldosterone

$55.46

82103

Alpha-1-antitrypsin total

$18.29

82104

Alpha-1-antitrypsin pheno

$19.68

82105

Alpha-fetoprotein serum

$22.83

82106

Alpha-fetoprotein amniotic

$22.83

82107

Alpha-fetoprotein l3

$87.65

82108

Assay of aluminum

$34.67

82120

Amines vaginal fluid qual

$5.12

82120 QW

Amines vaginal fluid qual

$5.12

82127

Amino acid single qual

$18.87

82128

Amino acids mult qual

$18.87

82131

Amino acids single quant

$22.95

82135

Assay aminolevulinic acid

$22.39

82136

Amino acids quant 2-5

$2.77

82139

Amino acids quan 6 or more

$2.77

82140

Assay of ammonia

$19.83

82143

Amniotic fluid scan

$9.35

82150

Assay of amylase

$8.82

82150 QW

Assay of amylase

$8.82

82154

Androstanediol glucuronide

$39.24

82157

Assay of androstenedione

$39.84

82160

Assay of androsterone

$34.03

82163

Assay of angiotensin II

$23.74

82164

Angiotensin I enzyme test

$19.87

82172

Assay of apolipoprotein

$19.28

82175

Assay of arsenic

$25.82

82180

Assay of ascorbic acid

$7.91

82190

Atomic absorption

$20.28

82232

Assay of beta-2 protein

$22.02

82239

Bile acids total

$23.31

82240

Bile acids cholylglycine

$29.80

82247

Bilirubin total

$6.83

82247 QW

Bilirubin total

$6.83

82248

Bilirubin direct

$6.83

Rev. Jan. 2015

Page 6

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