carta circular pr prov19-011-002€¦ · carta circular pr prov19-011-002 7 de noviembre de 2019 a:...

CARTA CIRCULAR PR PROV19-011-002

7 de noviembre de 2019

A: PROVEEDORES DE SERVICIOS DEL PLAN VITAL Y GRUPOS MÉDICOS

Re: CODIGOS DE HIGH COST HIGH NEED (HCHN)

Estimado Proveedor:

Para el proceso de certificación de pacientes “High Cost/High Need (HCHN)”, la

Administración de Seguros de Salud de Puerto Rico (ASES) ha establecido que los códigos

que sean relacionados a laboratorios o procedimientos de radiología que no provengan de una

reclamación IP, no se utilizaran para la certificación de HCHN. La ASES ha determinado los

siguientes “Revenue Codes” y Códigos de Procedimientos (HCPCS) utilizados por Milliman

para excluir reclamaciones del análisis de HCHN:

RevCode Description

0300 Laboratory-general classification

0301 Laboratory-chemistry

0302 Laboratory-immunology

0303 Laboratory-renal patient (home)

0304 Laboratory-non-routine dialysis

0305 Laboratory-hematology

0306 Laboratory-bacteriology & microbiology

0307 Laboratory-urology

0309 Laboratory-other laboratory

0310 Laboratory pathological-general classification

0311 Laboratory pathological-cytology

0312 Laboratory pathological-histology

0314 Laboratory pathological-biopsy

0319 Laboratory pathological-other

0320 Radiology diagnostic-general classification

0321 Radiology diagnostic-angiocardiography

0322 Radiology diagnostic-arthrography

0323 Radiology diagnostic-arteriography

0324 Radiology diagnostic-chest X-ray

0329 Radiology diagnostic-other

0330 Radiology therapeutic-general classification

0333 Radiology therapeutic-radiation therapy

0339 Radiology therapeutic-other

0340 Nuclear medicine-general classification

0341 Nuclear medicine-diagnostic procedures

0342 Nuclear medicine-therapeutic procedures

0343 Nuclear medicine-Diagnostic Radiopharmaceuticals (Eff 10/1/04)

0344 Nuclear medicine-Therapeutic Radiopharmaceuticals (Eff 10/1/04)

of 55

0349 Nuclear medicine-other

0350 Computed tomographic (CT) scan-general-classification

0351 CT scan-head scan

0352 CT scan-body scan

0359 CT scan-other CT scans

0400 Other imaging services-general classification

0401 Other imaging services-diagnostic mammography

0402 Other imaging services-ultrasound

0403 Other imaging services-screening mammography-(eff 1/1/91)

0404 Other imaging services-positron emission-tomography (eff 10/94)

0409 Other imaging services-other

0610 Magnetic resonance imaging (MRI) and Magnetic Resonance Anigiography (MRA)-general-classification

0611 MRI-brain (including brainstem)

0612 MRI-spinal cord (including spine)

0614 MRI-other

0615 MRA-Head and Neck

0616 MRA-Lower Extremities

0618 MRA-other

0619 MRI-other

0923 Other diagnostic services-pap smear

0925 Other diagnostic services-pregnancy test

0971 Professional fees-laboratory

0972 Professional fees-radiology diagnostic

0973 Professional fees-radiology therapeutic

0974 Professional fees-radiology nuclear medicine

HCPCS Description

36415 Routine venipuncture

36416 Capillary blood draw

70010 Contrast x-ray of brain

70015 Contrast x-ray of brain

70030 X-ray eye for foreign body

70100 X-ray exam of jaw <4views

70110 X-ray exam of jaw 4/> views

70120 X-ray exam of mastoids

70130 X-ray exam of mastoids

70134 X-ray exam of middle ear

70140 X-ray exam of facial bones

70150 X-ray exam of facial bones

70160 X-ray exam of nasal bones

70170 X-ray exam of tear duct

70190 X-ray exam of eye sockets

70200 X-ray exam of eye sockets

70210 X-ray exam of sinuses

70220 X-ray exam of sinuses

70240 X-ray exam pituitary saddle

70250 X-ray exam of skull

70260 X-ray exam of skull

70300 X-ray exam of teeth

70310 X-ray exam of teeth

70320 Full mouth x-ray of teeth

70328 X-ray exam of jaw joint

70330 X-ray exam of jaw joints

70332 X-ray exam of jaw joint

70336 Magnetic image jaw joint

70350 X-ray head for orthodontia

of 55

70355 Panoramic x-ray of jaws

70360 X-ray exam of neck

70370 Throat x-ray & fluoroscopy

70371 Speech evaluation complex

70373 Contrast x-ray of larynx

70380 X-ray exam of salivary gland

70390 X-ray exam of salivary duct

70450 Ct head/brain w/o dye

70460 Ct head/brain w/dye

70470 Ct head/brain w/o & w/dye

70480 Ct orbit/ear/fossa w/o dye

70481 Ct orbit/ear/fossa w/dye

70482 Ct orbit/ear/fossa w/o&w/dye

70486 Ct maxillofacial w/o dye

70487 Ct maxillofacial w/dye

70488 Ct maxillofacial w/o & w/dye

70490 Ct soft tissue neck w/o dye

70491 Ct soft tissue neck w/dye

70492 Ct sft tsue nck w/o & w/dye

70496 Ct angiography head

70498 Ct angiography neck

70540 Mri orbit/face/neck w/o dye

70542 Mri orbit/face/neck w/dye

70543 Mri orbt/fac/nck w/o &w/dye

70544 Mr angiography head w/o dye

70545 Mr angiography head w/dye

70546 Mr angiograph head w/o&w/dye

70547 Mr angiography neck w/o dye

70548 Mr angiography neck w/dye

70549 Mr angiograph neck w/o&w/dye

70551 Mri brain stem w/o dye

70552 Mri brain stem w/dye

70553 Mri brain stem w/o & w/dye

70554 Fmri brain by tech

70555 Fmri brain by phys/psych

70557 Mri brain w/o dye

70558 Mri brain w/dye

70559 Mri brain w/o & w/dye

71010 Chest x-ray 1 view frontal

71015 Chest x-ray stereo frontal

71020 Chest x-ray 2vw frontal&latl

71021 Chest x-ray frnt lat lordotc

71022 Chest x-ray frnt lat oblique

71023 Chest x-ray and fluoroscopy

71030 Chest x-ray 4/> views

71034 Chest x-ray&fluoro 4/> views

71035 Chest x-ray special views

71040 Contrast x-ray of bronchi

71045 X-ray exam chest 1 view

71046 X-ray exam chest 2 views

71047 X-ray exam chest 3 views

71048 X-ray exam chest 4+ views

71060 Contrast x-ray of bronchi

71100 X-ray exam ribs uni 2 views

71101 X-ray exam unilat ribs/chest

of 55

71110 X-ray exam ribs bil 3 views

71111 X-ray exam ribs/chest4/> vws

71120 X-ray exam breastbone 2/>vws

71130 X-ray strenoclavic jt 3/>vws

71250 Ct thorax w/o dye

71260 Ct thorax w/dye

71270 Ct thorax w/o & w/dye

71275 Ct angiography chest

71550 Mri chest w/o dye

71551 Mri chest w/dye

71552 Mri chest w/o & w/dye

71555 Mri angio chest w or w/o dye

72010 X-ray exam spine ap&lat

72020 X-ray exam of spine 1 view

72040 X-ray exam neck spine 2-3 vw

72050 X-ray exam neck spine 4/5vws

72052 X-ray exam neck spine 6/>vws

72069 X-ray exam trunk spine stand

72070 X-ray exam thorac spine 2vws

72072 X-ray exam thorac spine 3vws

72074 X-ray exam thorac spine4/>vw

72080 X-ray exam thoracolmb 2/> vw

72081 X-ray exam entire spi 1 vw

72082 X-ray exam entire spi 2/3 vw

72083 X-ray exam entire spi 4/5 vw

72084 X-ray exam entire spi 6/> vw

72090 X-ray exam scloiosis erect

72100 X-ray exam l-s spine 2/3 vws

72110 X-ray exam l-2 spine 4/>vws

72114 X-ray exam l-s spine bending

72120 X-ray bend only l-s spine

72125 Ct neck spine w/o dye

72126 Ct neck spine w/dye

72127 Ct neck spine w/o & w/dye

72128 Ct chest spine w/o dye

72129 Ct chest spine w/dye

72130 Ct chest spine w/o & w/dye

72131 Ct lumbar spine w/o dye

72132 Ct lumbar spine w/dye

72133 Ct lumbar spine w/o & w/dye

72141 Mri neck spine w/o dye

72142 Mri neck spine w/dye

72146 Mri chest spine w/o dye

72147 Mri chest spine w/dye

72148 Mri lumbar spine w/o dye

72149 Mri lumbar spine w/dye

72156 Mri neck spine w/o & w/dye

72157 Mri chest spine w/o & w/dye

72158 Mri lumbar spine w/o & w/dye

72159 Mr angio spine w/o&w/dye

72170 X-ray exam of pelvis

72190 X-ray exam of pelvis

72191 Ct angiograph pelv w/o&w/dye

72192 Ct pelvis w/o dye

72193 Ct pelvis w/dye

of 55

72194 Ct pelvis w/o & w/dye

72195 Mri pelvis w/o dye

72196 Mri pelvis w/dye

72197 Mri pelvis w/o & w/dye

72198 Mr angio pelvis w/o & w/dye

72200 X-ray exam si joints

72202 X-ray exam si joints 3/> vws

72220 X-ray exam sacrum tailbone

72240 Myelography neck spine

72255 Myelography thoracic spine

72265 Myelography l-s spine

72270 Myelogphy 2/> spine regions

72275 Epidurography

72285 Discography cerv/thor spine

72291 Perq verte/sacroplsty fluor

72292 Perq verte/sacroplsty ct

72295 X-ray of lower spine disk

73000 X-ray exam of collar bone

73010 X-ray exam of shoulder blade

73020 X-ray exam of shoulder

73030 X-ray exam of shoulder

73040 Contrast x-ray of shoulder

73050 X-ray exam of shoulders

73060 X-ray exam of humerus

73070 X-ray exam of elbow

73080 X-ray exam of elbow

73085 Contrast x-ray of elbow

73090 X-ray exam of forearm

73092 X-ray exam of arm infant

73100 X-ray exam of wrist

73110 X-ray exam of wrist

73115 Contrast x-ray of wrist

73120 X-ray exam of hand

73130 X-ray exam of hand

73140 X-ray exam of finger(s)

73200 Ct upper extremity w/o dye

73201 Ct upper extremity w/dye

73202 Ct uppr extremity w/o&w/dye

73206 Ct angio upr extrm w/o&w/dye

73218 Mri upper extremity w/o dye

73219 Mri upper extremity w/dye

73220 Mri uppr extremity w/o&w/dye

73221 Mri joint upr extrem w/o dye

73222 Mri joint upr extrem w/dye

73223 Mri joint upr extr w/o&w/dye

73225 Mr angio upr extr w/o&w/dye

73500 X-ray exam of hip

73501 X-ray exam hip uni 1 view

73502 X-ray exam hip uni 2-3 views

73503 X-ray exam hip uni 4/> views


73520 X-ray exam of hips

73521 X-ray exam hips bi 2 views

73522 X-ray exam hips bi 3-4 views

73523 X-ray exam hips bi 5/> views

of 55

73525 Contrast x-ray of hip


73540 X-ray exam of pelvis & hips

73550 X-ray exam of thigh

73551 X-ray exam of femur 1

73552 X-ray exam of femur 2/>

73560 X-ray exam of knee 1 or 2

73562 X-ray exam of knee 3

73564 X-ray exam knee 4 or more

73565 X-ray exam of knees

73580 Contrast x-ray of knee joint

73590 X-ray exam of lower leg

73592 X-ray exam of leg infant

73600 X-ray exam of ankle

73610 X-ray exam of ankle

73615 Contrast x-ray of ankle

73620 X-ray exam of foot

73630 X-ray exam of foot

73650 X-ray exam of heel

73660 X-ray exam of toe(s)

73700 Ct lower extremity w/o dye

73701 Ct lower extremity w/dye

73702 Ct lwr extremity w/o&w/dye

73706 Ct angio lwr extr w/o&w/dye

73718 Mri lower extremity w/o dye

73719 Mri lower extremity w/dye

73720 Mri lwr extremity w/o&w/dye

73721 Mri jnt of lwr extre w/o dye

73722 Mri joint of lwr extr w/dye

73723 Mri joint lwr extr w/o&w/dye

73725 Mr ang lwr ext w or w/o dye

74000 X-ray exam of abdomen


74018 X-ray exam abdomen 1 view

74019 X-ray exam abdomen 2 views


74021 X-ray exam abdomen 3+ views

74022 X-ray exam series abdomen

74150 Ct abdomen w/o dye

74160 Ct abdomen w/dye

74170 Ct abdomen w/o & w/dye

74174 Ct angio abd&pelv w/o&w/dye

74175 Ct angio abdom w/o & w/dye

74176 Ct abd & pelvis w/o contrast

74177 Ct abd & pelv w/contrast

74178 Ct abd & pelv 1/> regns

74181 Mri abdomen w/o dye

74182 Mri abdomen w/dye

74183 Mri abdomen w/o & w/dye

74185 Mri angio abdom w orw/o dye

74190 X-ray exam of peritoneum

74210 Contrst x-ray exam of throat

74220 Contrast x-ray esophagus

74230 Cine/vid x-ray throat/esoph

74235 Remove esophagus obstruction

of 55

74240 X-ray upper gi delay w/o kub

74241 X-ray upper gi delay w/kub

74245 X-ray upper gi&small intest

74246 Contrst x-ray uppr gi tract



74250 X-ray exam of small bowel



74261 Ct colonography dx

74262 Ct colonography dx w/dye

74263 Ct colonography screening

74270 Contrast x-ray exam of colon

74280 Contrast x-ray exam of colon

74283 Ther nma rdctj intus/obstrcj

74290 Contrast x-ray gallbladder

74291 Contrast x-rays gallbladder

74300 X-ray bile ducts/pancreas

74301 X-rays at surgery add-on

74305 X-ray bile ducts/pancreas

74320 Contrast x-ray of bile ducts

74327 X-ray bile stone removal

74328 X-ray bile duct endoscopy

74329 X-ray for pancreas endoscopy

74330 X-ray bile/panc endoscopy

74340 X-ray guide for gi tube

74355 X-ray guide intestinal tube

74360 X-ray guide gi dilation

74363 X-ray bile duct dilation

74400 Contrst x-ray urinary tract





74430 Contrast x-ray bladder

74440 X-ray male genital tract

74445 X-ray exam of penis

74450 X-ray urethra/bladder

74455 X-ray urethra/bladder

74470 X-ray exam of kidney lesion

74475 X-ray control cath insert

74480 X-ray control cath insert

74485 Dilation urtr/urt rs&i

74710 X-ray measurement of pelvis

74712 Mri fetal sngl/1st gestation

74713 MRI fetal ea addl gestation

74740 X-ray female genital tract

74742 X-ray fallopian tube

74775 X-ray exam of perineum

75557 Cardiac mri for morph

75559 Cardiac mri w/stress img

75561 Cardiac mri for morph w/dye

75563 Card mri w/stress img & dye

75565 Card mri veloc flow mapping

75571 Ct hrt w/o dye w/ca test

of 55

75572 Ct hrt w/3d image

75573 Ct hrt w/3d image congen

75574 Ct angio hrt w/3d image

75600 Contrast exam thoracic aorta

75605 Contrast exam thoracic aorta

75625 Contrast exam abdominl aorta

75630 X-ray aorta leg arteries

75635 Ct angio abdominal arteries

75650 Artery x-rays head & neck

75658 Artery x-rays arm





75676 Artery x-rays neck

75680 Artery x-rays neck

75685 Artery x-rays spine

75705 Artery x-rays spine

75710 Artery x-rays arm/leg

75716 Artery x-rays arms/legs

75726 Artery x-rays abdomen

75731 Artery x-rays adrenal gland

75733 Artery x-rays adrenals

75736 Artery x-rays pelvis

75741 Artery x-rays lung

75743 Artery x-rays lungs

75746 Artery x-rays lung

75756 Artery x-rays chest

75774 Artery x-ray each vessel

75791 Av dialysis shunt imaging

75801 Lymph vessel x-ray arm/leg

75803 Lymph vessel x-ray arms/legs

75805 Lymph vessel x-ray trunk

75807 Lymph vessel x-ray trunk

75809 Nonvascular shunt x-ray

75810 Vein x-ray spleen/liver

75820 Vein x-ray arm/leg

75822 Vein x-ray arms/legs

75825 Vein x-ray trunk

75827 Vein x-ray chest

75831 Vein x-ray kidney

75833 Vein x-ray kidneys

75840 Vein x-ray adrenal gland

75842 Vein x-ray adrenal glands

75860 Vein x-ray neck

75870 Vein x-ray skull

75872 Vein x-ray skull epidural

75880 Vein x-ray eye socket

75885 Vein x-ray liver w/hemodynam

75887 Vein x-ray liver w/o hemodyn

75889 Vein x-ray liver w/hemodynam

75891 Vein x-ray liver

75893 Venous sampling by catheter

75894 X-rays transcath therapy

75896 X-rays transcath therapy

of 55

75898 Follow-up angiography

75900 Intravascular cath exchange

75901 Remove cva device obstruct

75902 Remove cva lumen obstruct

75945 Intravascular us

75946 Intravascular us add-on

75952 Endovasc repair abdom aorta

75953 Abdom aneurysm endovas rpr

75954 Iliac aneurysm endovas rpr

75956 Xray endovasc thor ao repr

75957 Xray endovasc thor ao repr

75958 Xray place prox ext thor ao

75959 Xray place dist ext thor ao

75960 Transcath iv stent rs&i

75961 Retrieval broken catheter

75962 Repair arterial blockage

75964 Repair artery blockage each

75966 Repair arterial blockage

75968 Repair artery blockage each

75970 Vascular biopsy

75978 Repair venous blockage

75980 Contrast xray exam bile duct

75982 Contrast xray exam bile duct

75984 Xray control catheter change

75989 Abscess drainage under x-ray

76000 Fluoroscopy <1 hr phys/qhp

76001 Fluoroscope exam extensive

76010 X-ray nose to rectum

76080 X-ray exam of fistula

76098 X-ray exam surgical specimen

76100 X-ray exam of body section

76101 Complex body section x-ray

76102 Complex body section x-rays

76120 Cine/video x-rays

76125 Cine/video x-rays add-on

76140 X-ray consultation

76376 3d render w/intrp postproces

76377 3d render w/intrp postproces

76380 Cat scan follow-up study

76390 Mr spectroscopy

76496 Fluoroscopic procedure

76497 Ct procedure

76498 Mri procedure

76499 Radiographic procedure

76506 Echo exam of head

76510 Ophth us b & quant a

76511 Ophth us quant a only

76512 Ophth us b w/non-quant a

76513 Echo exam of eye water bath

76514 Echo exam of eye thickness

76516 Echo exam of eye



76536 Us exam of head and neck

76604 Us exam chest

of 55

76641 Ultrasound breast complete

76642 Ultrasound breast limited

76645 Us exam breast(s)

76700 Us exam abdom complete

76705 Echo exam of abdomen

76706 Us abdl aorta screen aaa

76770 Us exam abdo back wall comp

76775 Us exam abdo back wall lim

76776 Us exam k transpl w/doppler

76800 Us exam spinal canal

76801 Ob us < 14 wks single fetus

76802 Ob us < 14 wks addl fetus

76805 Ob us >/= 14 wks sngl fetus

76810 Ob us >/= 14 wks addl fetus

76811 Ob us detailed sngl fetus

76812 Ob us detailed addl fetus

76813 Ob us nuchal meas 1 gest

76814 Ob us nuchal meas add-on

76815 Ob us limited fetus(s)

76816 Ob us follow-up per fetus

76817 Transvaginal us obstetric

76818 Fetal biophys profile w/nst

76819 Fetal biophys profil w/o nst

76820 Umbilical artery echo

76821 Middle cerebral artery echo

76825 Echo exam of fetal heart




76830 Transvaginal us non-ob

76831 Echo exam uterus

76856 Us exam pelvic complete

76857 Us exam pelvic limited

76870 Us exam scrotum

76872 Us transrectal

76873 Echograp trans r pros study

76881 Us compl joint r-t w/img

76882 Us lmtd jt/nonvasc xtr strux

76885 Us exam infant hips dynamic

76886 Us exam infant hips static

76930 Echo guide cardiocentesis

76932 Echo guide for heart biopsy

76936 Echo guide for artery repair

76937 Us guide vascular access

76940 Us guide tissue ablation

76941 Echo guide for transfusion

76942 Echo guide for biopsy

76945 Echo guide villus sampling

76946 Echo guide for amniocentesis

76948 Echo guide ova aspiration

76950 Echo guidance radiotherapy

76965 Echo guidance radiotherapy

76970 Ultrasound exam follow-up

76975 Gi endoscopic ultrasound

76977 Us bone density measure

of 55

76998 Us guide intraop

76999 Echo examination procedure

77001 Fluoroguide for vein device

77002 Needle localization by xray

77003 Fluoroguide for spine inject

77011 Ct scan for localization

77012 Ct scan for needle biopsy

77013 Ct guide for tissue ablation

77014 Ct scan for therapy guide

77021 Mri guidance ndl plmt rs&i

77022 Mri gdn parnchyma tiss abltj

77031 Stereotact guide for brst bx

77032 Guidance for needle breast

77051 Computer dx mammogram add-on

77052 Comp screen mammogram add-on

77053 X-ray of mammary duct

77054 X-ray of mammary ducts

77055 Mammogram one breast

77056 Mammogram both breasts

77057 Mammogram screening

77058 Mri one breast

77059 Mri both breasts

77061 Breast tomosynthesis uni

77062 Breast tomosynthesis bi

77063 Breast tomosynthesis bi

77065 Dx mammo incl cad uni

77066 Dx mammo incl cad bi

77067 Scr mammo bi incl cad

77071 X-ray stress view

77072 X-rays for bone age

77073 X-rays bone length studies

77074 X-rays bone survey limited

77075 X-rays bone survey complete

77076 X-rays bone survey infant

77077 Joint survey single view

77078 Ct bone density axial

77080 Dxa bone density axial

77081 Dxa bone density/peripheral

77082 Dxa bone density vert fx

77084 Magnetic image bone marrow

77085 Dxa bone density study

77086 Fracture assessment via dxa

77261 Radiation therapy planning



77280 Set radiation therapy field



77293 Respirator motion mgmt simul

77295 3-d radiotherapy plan


77300 Radiation therapy dose plan

77301 Radiotherapy dose plan imrt

77305 Teletx isodose plan simple

77306 Telethx isodose plan simple

of 55

77307 Telethx isodose plan cplx

77310 Teletx isodose plan intermed

77315 Teletx isodose plan complex

77316 Brachytx isodose plan simple

77317 Brachytx isodose intermed

77318 Brachytx isodose complex

77321 Special teletx port plan

77326 Brachytx isodose calc simp

77327 Brachytx isodose calc interm

77328 Brachytx isodose plan compl

77331 Special radiation dosimetry

77332 Radiation treatment aid(s)



77336 Radiation physics consult

77338 Design mlc device for imrt

77370 Radiation physics consult

77371 Srs multisource

77372 Srs linear based

77373 Sbrt delivery

77385 Ntsty modul rad tx dlvr smpl

77386 Ntsty modul rad tx dlvr cplx

77387 Guidance for radj tx dlvr

77399 External radiation dosimetry

77401 Radiation treatment delivery













77417 Radiology port images(s)

77418 Radiation tx delivery imrt

77421 Stereoscopic x-ray guidance

77422 Neutron beam tx simple

77423 Neutron beam tx complex

77424 Io rad tx delivery by x-ray

77425 Io rad tx deliver by elctrns

77427 Radiation tx management x5

77431 Radiation therapy management

77432 Stereotactic radiation trmt

77435 Sbrt management

77469 Io radiation tx management

77470 Special radiation treatment

77499 Radiation therapy management

77520 Proton trmt simple w/o comp

77522 Proton trmt simple w/comp

77523 Proton trmt intermediate

77525 Proton treatment complex

of 55

77600 Hyperthermia treatment





77750 Infuse radioactive materials

77761 Apply intrcav radiat simple

77762 Apply intrcav radiat interm

77763 Apply intrcav radiat compl

77767 Hdr rdncl skn surf brachytx

77768 Hdr rdncl skn surf brachytx

77770 Hdr rdncl ntrstl/icav brchtx



77776 Apply interstit radiat simpl

77777 Apply interstit radiat inter

77778 Apply interstit radiat compl

77785 Hdr brachytx 1 channel

77786 Hdr brachytx 2-12 channel

77787 Hdr brachytx over 12 chan

77789 Apply surf ldr radionuclide

77790 Radiation handling

77799 Radium/radioisotope therapy

78000 Thyroid single uptake

78001 Thyroid multiple uptakes

78003 Thyroid suppress/stimul

78006 Thyroid imaging with uptake

78007 Thyroid image mult uptakes

78010 Thyroid imaging

78011 Thyroid imaging with flow

78012 Thyroid uptake measurement

78013 Thyroid imaging w/blood flow

78014 Thyroid imaging w/blood flow

78015 Thyroid met imaging

78016 Thyroid met imaging/studies

78018 Thyroid met imaging body

78020 Thyroid met uptake

78070 Parathyroid planar imaging

78071 Parathyrd planar w/wo subtrj

78072 Parathyrd planar w/spect&ct

78075 Adrenal cortex & medulla img

78099 Endocrine nuclear procedure

78102 Bone marrow imaging ltd

78103 Bone marrow imaging mult

78104 Bone marrow imaging body

78110 Plasma volume single

78111 Plasma volume multiple

78120 Red cell mass single

78121 Red cell mass multiple

78122 Blood volume

78130 Red cell survival study

78135 Red cell survival kinetics

78140 Red cell sequestration

78185 Spleen imaging

78190 Platelet survival kinetics

of 55

78191 Platelet survival

78195 Lymph system imaging

78199 Blood/lymph nuclear exam

78201 Liver imaging

78202 Liver imaging with flow

78205 Liver imaging (3d)

78206 Liver image (3d) with flow

78215 Liver and spleen imaging

78216 Liver & spleen image/flow

78226 Hepatobiliary system imaging

78227 Hepatobil syst image w/drug

78230 Salivary gland imaging

78231 Serial salivary imaging

78232 Salivary gland function exam

78258 Esophageal motility study

78261 Gastric mucosa imaging

78262 Gastroesophageal reflux exam

78264 Gastric emptying imag study



78267 Breath tst attain/anal c-14

78268 Breath test analysis c-14

78270 Vit b-12 absorption exam

78271 Vit b-12 absrp exam int fac

78272 Vit b-12 absorp combined

78278 Acute gi blood loss imaging

78282 Gi protein loss exam

78290 Meckels divert exam

78291 Leveen/shunt patency exam

78299 Gi nuclear procedure

78300 Bone imaging limited area

78305 Bone imaging multiple areas

78306 Bone imaging whole body

78315 Bone imaging 3 phase

78320 Bone imaging (3d)

78350 Bone mineral single photon

78351 Bone mineral dual photon

78399 Musculoskeletal nuclear exam

78414 Non-imaging heart function

78428 Cardiac shunt imaging

78445 Vascular flow imaging

78451 Ht muscle image spect sing

78452 Ht muscle image spect mult

78453 Ht muscle image planar sing

78454 Ht musc image planar mult

78456 Acute venous thrombus image

78457 Venous thrombosis imaging

78458 Ven thrombosis images bilat

78459 Heart muscle imaging (pet)

78466 Heart infarct image

78468 Heart infarct image (ef)

78469 Heart infarct image (3d)

78472 Gated heart planar single

78473 Gated heart multiple

78481 Heart first pass single

of 55

78483 Heart first pass multiple

78491 Heart image (pet) single

78492 Heart image (pet) multiple

78494 Heart image spect

78496 Heart first pass add-on

78499 Cardiovascular nuclear exam

78579 Lung ventilation imaging

78580 Lung perfusion imaging

78582 Lung ventilat&perfus imaging

78597 Lung perfusion differential

78598 Lung perf&ventilat diferentl

78599 Respiratory nuclear exam

78600 Brain image < 4 views

78601 Brain image w/flow < 4 views

78605 Brain image 4+ views

78606 Brain image w/flow 4 + views

78607 Brain imaging (3d)

78608 Brain imaging (pet)

78609 Brain imaging (pet)

78610 Brain flow imaging only

78630 Cerebrospinal fluid scan

78635 Csf ventriculography

78645 Csf shunt evaluation

78647 Cerebrospinal fluid scan

78650 Csf leakage imaging

78660 Nuclear exam of tear flow

78699 Nervous system nuclear exam

78700 Kidney imaging morphol

78701 Kidney imaging with flow

78707 K flow/funct image w/o drug

78708 K flow/funct image w/drug

78709 K flow/funct image multiple

78710 Kidney imaging (3d)

78725 Kidney function study

78730 Urinary bladder retention

78740 Ureteral reflux study

78761 Testicular imaging w/flow

78799 Genitourinary nuclear exam

78800 Tumor imaging limited area

78801 Tumor imaging mult areas

78802 Tumor imaging whole body

78803 Tumor imaging (3d)

78804 Tumor imaging whole body

78805 Abscess imaging ltd area

78806 Abscess imaging whole body

78807 Nuclear localization/abscess

78808 Iv inj ra drug dx study

78811 Pet image ltd area

78812 Pet image skull-thigh

78813 Pet image full body

78814 Pet image w/ct lmtd

78815 Pet image w/ct skull-thigh

78816 Pet image w/ct full body

78999 Nuclear diagnostic exam

79005 Nuclear rx oral admin

of 55

79101 Nuclear rx iv admin

79200 Nuclear rx intracav admin

79300 Nuclr rx interstit colloid

79403 Hematopoietic nuclear tx

79440 Nuclear rx intra-articular

79445 Nuclear rx intra-arterial

79999 Nuclear medicine therapy

80047 Metabolic panel ionized ca

80048 Metabolic panel total ca

80050 General health panel

80051 Electrolyte panel

80053 Comprehen metabolic panel

80055 Obstetric panel

80061 Lipid panel

80069 Renal function panel

80074 Acute hepatitis panel

80076 Hepatic function panel

80081 Obstetric panel

80100 Drug screen qualitate/multi

80101 Drug screen single

80102 Drug confirmation

80103 Drug analysis tissue prep

80104 Drug scrn 1+ class nonchromo

80150 Assay of amikacin

80152 Assay of amitriptyline

80154 Assay of benzodiazepines

80155 Drug assay caffeine

80156 Assay carbamazepine total

80157 Assay carbamazepine free

80158 Drug assay cyclosporine

80159 Drug assay clozapine

80160 Assay of desipramine

80162 Assay of digoxin total

80163 Assay of digoxin free

80164 Assay dipropylacetic acd tot

80165 Dipropylacetic acid free

80166 Assay of doxepin

80168 Assay of ethosuximide

80169 Drug assay everolimus

80170 Assay of gentamicin

80171 Drug screen quant gabapentin

80172 Assay of gold

80173 Assay of haloperidol

80174 Assay of imipramine

80175 Drug screen quan lamotrigine

80176 Assay of lidocaine

80177 Drug scrn quan levetiracetam

80178 Assay of lithium

80180 Drug scrn quan mycophenolate

80182 Assay of nortriptyline

80183 Drug scrn quant oxcarbazepin

80184 Assay of phenobarbital

80185 Assay of phenytoin total

80186 Assay of phenytoin free

80188 Assay of primidone

of 55

80190 Assay of procainamide

80192 Assay of procainamide

80194 Assay of quinidine

80195 Assay of sirolimus

80196 Assay of salicylate

80197 Assay of tacrolimus

80198 Assay of theophylline

80199 Drug screen quant tiagabine

80200 Assay of tobramycin

80201 Assay of topiramate

80202 Assay of vancomycin

80203 Drug screen quant zonisamide

80299 Quantitative assay drug

80300 Drug screen non tlc devices

80301 Drug screen class list a

80302 Drug screen prsmptv 1 class

80303 Drug screen one/mult class

80304 Drug screen one/mult class

80305 Drug test prsmv dir opt obs

80306 Drug test prsmv instrmnt

80307 Drug test prsmv chem anlyzr

80320 Drug screen quantalcohols

80321 Alcohols biomarkers 1or 2

80322 Alcohols biomarkers 3/more

80323 Alkaloids nos

80324 Drug screen amphetamines 1/2

80325 Amphetamines 3or 4

80326 Amphetamines 5 or more

80327 Anabolic steroid 1 or 2

80328 Anabolic steroid 3 or more

80329 Analgesics non-opioid 1 or 2

80330 Analgesics non-opioid 3-5

80331 Analgesics non-opioid 6/more

80332 Antidepressants class 1 or 2

80333 Antidepressants class 3-5

80334 Antidepressants class 6/more

80335 Antidepressant tricyclic 1/2

80336 Antidepressant tricyclic 3-5

80337 Tricyclic & cyclicals 6/more

80338 Antidepressant not specified

80339 Antiepileptics nos 1-3

80340 Antiepileptics nos 4-6

80341 Antiepileptics nos 7/more

80342 Antipsychotics nos 1-3

80343 Antipsychotics nos 4-6

80344 Antipsychotics nos 7/more

80345 Drug screening barbiturates

80346 Benzodiazepines1-12

80347 Benzodiazepines 13 or more

80348 Drug screening buprenorphine

80349 Cannabinoids natural

80350 Cannabinoids synthetic 1-3

80351 Cannabinoids synthetic 4-6

80352 Cannabinoid synthetic 7/more

80353 Drug screening cocaine

of 55

80354 Drug screening fentanyl

80355 Gabapentin non-blood

80356 Heroin metabolite

80357 Ketamine and norketamine

80358 Drug screening methadone

80359 Methylenedioxyamphetamines

80360 Methylphenidate

80361 Opiates 1 or more

80362 Opioids & opiate analogs 1/2

80363 Opioids & opiate analogs 3/4

80364 Opioid &opiate analog 5/more

80365 Drug screening oxycodone

80366 Drug screening pregabalin

80367 Drug screening propoxyphene

80368 Sedative hypnotics

80369 Skeletal muscle relaxant 1/2

80370 Skel musc relaxant 3 or more

80371 Stimulants synthetic

80372 Drug screening tapentadol

80373 Drug screening tramadol

80374 Stereoisomer analysis

80375 Drug/substance nos 1-3

80376 Drug/substance nos 4-6

80377 Drug/substance nos 7/more

80400 Acth stimulation panel



80408 Aldosterone suppression eval

80410 Calcitonin stimul panel

80412 CRH stimulation panel

80414 Testosterone response

80415 Estradiol response panel

80416 Renin stimulation panel

80417 Renin stimulation panel

80418 Pituitary evaluation panel

80420 Dexamethasone panel

80422 Glucagon tolerance panel

80424 Glucagon tolerance panel

80426 Gonadotropin hormone panel

80428 Growth hormone panel

80430 Growth hormone panel

80432 Insulin suppression panel

80434 Insulin tolerance panel

80435 Insulin tolerance panel

80436 Metyrapone panel

80438 TRH stimulation panel

80439 TRH stimulation panel

80440 Trh stimulation panel

80500 Lab pathology consultation

80502 Lab pathology consultation

81000 Urinalysis nonauto w/scope

81001 Urinalysis auto w/scope

81002 Urinalysis nonauto w/o scope

81003 Urinalysis auto w/o scope

81005 Urinalysis

of 55

81007 Urine screen for bacteria

81015 Microscopic exam of urine

81020 Urinalysis glass test

81025 Urine pregnancy test

81050 Urinalysis volume measure

81099 Urinalysis test procedure

81105 Hpa-1 genotyping








81120 Idh1 common variants

81121 Idh2 common variants

81161 Dmd dup/delet analysis

81162 Brca1&2 gen full seq dup/del

81170 Abl1 gene

81175 Asxl1 full gene sequence

81176 Asxl1 gene target seq alys

81200 Aspa gene

81201 Apc gene full sequence

81202 Apc gene known fam variants

81203 Apc gene dup/delet variants

81205 Bckdhb gene

81206 Bcr/abl1 gene major bp

81207 Bcr/abl1 gene minor bp

81208 Bcr/abl1 gene other bp

81209 Blm gene

81210 Braf gene

81211 Brca1&2 seq & com dup/del

81212 Brca1&2 185&5385&6174 vrnt

81213 Brca1&2 uncom dup/del var

81214 Brca1 full seq & com dup/del

81215 Brca1 gene known famil vrnt

81216 Brca2 gene full seq alys

81217 Brca2 gene known famil vrnt

81218 Cebpa gene full sequence

81219 Calr gene com variants

81220 Cftr gene com variants

81221 Cftr gene known fam variants

81222 Cftr gene dup/delet variants

81223 Cftr gene full sequence

81224 Cftr gene intron poly t

81225 Cyp2c19 gene com variants

81226 Cyp2d6 gene com variants

81227 Cyp2c9 gene com variants

81228 Cytogen micrarray copy nmbr

81229 Cytogen m array copy no&snp

81230 Cyp3a4 gene common variants

81231 Cyp3a5 gene common variants

81232 Dpyd gene common variants

81235 Egfr gene com variants

81238 F9 full gene sequence

of 55

81240 F2 gene

81241 F5 gene

81242 Fancc gene

81243 Fmr1 gene detection

81244 Fmr1 gene charac alleles

81245 Flt3 gene

81246 Flt3 gene analysis

81247 G6pd gene alys cmn variant

81248 G6pd known familial variant

81249 G6pd full gene sequence

81250 G6pc gene

81251 Gba gene

81252 Gjb2 gene full sequence

81253 Gjb2 gene known fam variants

81254 Gjb6 gene com variants

81255 Hexa gene

81256 Hfe gene

81257 Hba1/hba2 gene

81258 Hba1/hba2 gene fam vrnt

81259 Hba1/hba2 full gene sequence

81260 Ikbkap gene

81261 Igh gene rearrange amp meth

81262 Igh gene rearrang dir probe

81263 Igh vari regional mutation

81264 Igk rearrangeabn clonal pop

81265 Str markers specimen anal

81266 Str markers spec anal addl

81267 Chimerism anal no cell selec

81268 Chimerism anal w/cell select

81269 Hba1/hba2 gene dup/del vrnts

81270 Jak2 gene

81272 Kit gene targeted seq analys

81273 Kit gene analys d816 variant

81275 Kras gene variants exon 2

81276 Kras gene addl variants

81280 Long qt synd gene full seq

81281 Long qt synd known fam var

81282 Long qt syn gene dup/dlt var

81283 Ifnl3 gene

81287 Mgmt gene prmtr mthyltn alys

81288 Mlh1 gene

81290 Mcoln1 gene

81291 Mthfr gene

81292 Mlh1 gene full seq

81293 Mlh1 gene known variants

81294 Mlh1 gene dup/delete variant

81295 Msh2 gene full seq

81296 Msh2 gene known variants

81297 Msh2 gene dup/delete variant

81298 Msh6 gene full seq

81299 Msh6 gene known variants

81300 Msh6 gene dup/delete variant

81301 Microsatellite instability

81302 Mecp2 gene full seq

81303 Mecp2 gene known variant

of 55

81304 Mecp2 gene dup/delet variant

81310 Npm1 gene

81311 Nras gene variants exon 2&3

81313 Pca3/klk3 antigen

81314 Pdgfra gene

81315 Pml/raralpha com breakpoints

81316 Pml/raralpha 1 breakpoint

81317 Pms2 gene full seq analysis

81318 Pms2 known familial variants

81319 Pms2 gene dup/delet variants

81321 Pten gene full sequence

81322 Pten gene known fam variant

81323 Pten gene dup/delet variant

81324 Pmp22 gene dup/delet

81325 Pmp22 gene full sequence

81326 Pmp22 gene known fam variant

81327 Sept9 gen prmtr mthyltn alys

81328 Slco1b1 gene com variants

81330 Smpd1 gene common variants

81331 Snrpn/ube3a gene

81332 Serpina1 gene

81334 Runx1 gene targeted seq alys

81335 Tpmt gene com variants

81340 Trb@ gene rearrange amplify

81341 Trb@ gene rearrange dirprobe

81342 Trg gene rearrangement anal

81346 Tyms gene com variants

81350 Ugt1a1 gene

81355 Vkorc1 gene

81361 Hbb gene com variants

81362 Hbb gene known fam variant

81363 Hbb gene dup/del variants

81364 Hbb full gene sequence

81370 Hla i & ii typing lr

81371 Hla i & ii type verify lr

81372 Hla i typing complete lr

81373 Hla i typing 1 locus lr

81374 Hla i typing 1 antigen lr

81375 Hla ii typing ag equiv lr

81376 Hla ii typing 1 locus lr

81377 Hla ii type 1 ag equiv lr

81378 Hla i & ii typing hr

81379 Hla i typing complete hr

81380 Hla i typing 1 locus hr

81381 Hla i typing 1 allele hr

81382 Hla ii typing 1 loc hr

81383 Hla ii typing 1 allele hr

81400 Mopath procedure level 1








of 55


81410 Aortic dysfunction/dilation

81411 Aortic dysfunction/dilation

81412 Ashkenazi jewish assoc dis

81413 Car ion chnnlpath inc 10 gns

81414 Car ion chnnlpath inc 2 gns

81415 Exome sequence analysis

81416 Exome sequence analysis

81417 Exome re-evaluation

81420 Fetal chrmoml aneuploidy

81422 Fetal chrmoml microdeltj

81425 Genome sequence analysis

81426 Genome sequence analysis

81427 Genome re-evaluation

81430 Hearing loss sequence analys

81431 Hearing loss dup/del analys

81432 Hrdtry brst ca-rlatd dsordrs

81433 Hrdtry brst ca-rlatd dsordrs

81434 Hereditary retinal disorders

81435 Hereditary colon ca dsordrs

81436 Hereditary colon ca dsordrs

81437 Heredtry nurondcrn tum dsrdr

81438 Heredtry nurondcrn tum dsrdr

81439 Hrdtry cardmypy gene panel

81440 Mitochondrial gene

81442 Noonan spectrum disorders

81445 Targeted genomic seq analys

81448 Hrdtry perph neurphy panel



81460 Whole mitochondrial genome

81465 Whole mitochondrial genome

81470 X-linked intellectual dblt

81471 X-linked intellectual dblt

81479 Unlisted molecular pathology

81490 Autoimmune rheumatoid arthr

81493 Cor artery disease mrna

81500 Onco (ovar) two proteins

81503 Onco (ovar) five proteins

81504 Oncology tissue of origin

81506 Endo assay seven anal

81507 Fetal aneuploidy trisom risk

81508 Ftl cgen abnor two proteins

81509 Ftl cgen abnor 3 proteins

81510 Ftl cgen abnor three anal

81511 Ftl cgen abnor four anal

81512 Ftl cgen abnor five anal

81519 Oncology breast mrna

81520 Onc breast mrna 58 genes

81521 Onc breast mrna 70 genes

81525 Oncology colon MRNA

81528 Oncology colorectal scr

81535 Oncology gynecologic

81536 Oncology gynecologic

81538 Oncology lung

of 55

81539 Oncology prostate prob score

81540 Oncology tum unknown origin

81541 Onc prostate mrna 46 genes

81545 Oncology thyroid

81551 Onc prostate 3 genes

81595 Cardiology hrt trnspl mrna

81599 Unlisted maaa

82000 Assay of blood acetaldehyde

82003 Assay of acetaminophen

82009 Test for acetone/ketones

82010 Acetone assay

82013 Acetylcholinesterase assay

82016 Acylcarnitines qual

82017 Acylcarnitines quant

82024 Assay of acth

82030 Assay of adp & amp

82040 Assay of serum albumin

82042 Other source albumin quan ea

82043 Ur albumin quantitative

82044 Ur albumin semiquantitative

82045 Albumin ischemia modified

82055 Assay of ethanol

82075 Assay of breath ethanol

82085 Assay of aldolase

82088 Assay of aldosterone

82101 Assay of urine alkaloids

82103 Alpha-1-antitrypsin total

82104 Alpha-1-antitrypsin pheno

82105 Alpha-fetoprotein serum

82106 Alpha-fetoprotein amniotic

82107 Alpha-fetoprotein l3

82108 Assay of aluminum

82120 Amines vaginal fluid qual

82127 Amino acid single qual

82128 Amino acids mult qual

82131 Amino acids single quant

82135 Assay aminolevulinic acid

82136 Amino acids quant 2-5

82139 Amino acids quan 6 or more

82140 Assay of ammonia

82143 Amniotic fluid scan

82145 Assay of amphetamines

82150 Assay of amylase

82154 Androstanediol glucuronide

82157 Assay of androstenedione

82160 Assay of androsterone

82163 Assay of angiotensin II

82164 Angiotensin I enzyme test

82172 Assay of apolipoprotein

82175 Assay of arsenic

82180 Assay of ascorbic acid

82190 Atomic absorption

82205 Assay of barbiturates

82232 Assay of beta-2 protein

82239 Bile acids total

of 55

82240 Bile acids cholylglycine

82247 Bilirubin total

82248 Bilirubin direct

82252 Fecal bilirubin test

82261 Assay of biotinidase

82270 Occult blood feces

82271 Occult blood other sources

82272 Occult bld feces 1-3 tests

82274 Assay test for blood fecal

82286 Assay of bradykinin

82300 Assay of cadmium

82306 Vitamin d 25 hydroxy

82308 Assay of calcitonin

82310 Assay of calcium

82330 Assay of calcium

82331 Calcium infusion test

82340 Assay of calcium in urine

82355 Calculus analysis qual

82360 Calculus assay quant

82365 Calculus spectroscopy

82370 X-ray assay calculus

82373 Assay c-d transfer measure

82374 Assay blood carbon dioxide

82375 Assay carboxyhb quant

82376 Assay carboxyhb qual

82378 Carcinoembryonic antigen

82379 Assay of carnitine

82380 Assay of carotene

82382 Assay urine catecholamines

82383 Assay blood catecholamines

82384 Assay three catecholamines

82387 Assay of cathepsin-d

82390 Assay of ceruloplasmin

82397 Chemiluminescent assay

82415 Assay of chloramphenicol

82435 Assay of blood chloride

82436 Assay of urine chloride

82438 Assay other fluid chlorides

82441 Test for chlorohydrocarbons

82465 Assay bld/serum cholesterol

82480 Assay serum cholinesterase

82482 Assay rbc cholinesterase

82485 Assay chondroitin sulfate

82486 Gas/liquid chromatography

82487 Paper chromatography

82488 Paper chromatography

82489 Thin layer chromatography

82491 Chromotography quant sing

82492 Chromotography quant mult

82495 Assay of chromium

82507 Assay of citrate

82520 Assay of cocaine

82523 Collagen crosslinks

82525 Assay of copper

82528 Assay of corticosterone

of 55

82530 Cortisol free

82533 Total cortisol

82540 Assay of creatine

82541 Column chromotography qual

82542 Col chromotography qual/quan

82543 Column chromotograph/isotope

82544 Column chromotograph/isotope

82550 Assay of ck (cpk)

82552 Assay of cpk in blood

82553 Creatine mb fraction

82554 Creatine isoforms

82565 Assay of creatinine

82570 Assay of urine creatinine

82575 Creatinine clearance test

82585 Assay of cryofibrinogen

82595 Assay of cryoglobulin

82600 Assay of cyanide

82607 Vitamin B-12

82608 B-12 binding capacity

82610 Cystatin c

82615 Test for urine cystines

82626 Dehydroepiandrosterone

82627 Dehydroepiandrosterone

82633 Desoxycorticosterone

82634 Deoxycortisol

82638 Assay of dibucaine number

82646 Assay of dihydrocodeinone

82649 Assay of dihydromorphinone

82651 Assay of dihydrotestosterone

82652 Vit d 1 25-dihydroxy

82654 Assay of dimethadione

82656 Pancreatic elastase fecal

82657 Enzyme cell activity

82658 Enzyme cell activity ra

82664 Electrophoretic test

82666 Assay of epiandrosterone

82668 Assay of erythropoietin

82670 Assay of estradiol

82671 Assay of estrogens

82672 Assay of estrogen

82677 Assay of estriol

82679 Assay of estrone

82690 Assay of ethchlorvynol

82693 Assay of ethylene glycol

82696 Assay of etiocholanolone

82705 Fats/lipids feces qual

82710 Fats/lipids feces quant

82715 Assay of fecal fat

82725 Assay of blood fatty acids

82726 Long chain fatty acids

82728 Assay of ferritin

82731 Assay of fetal fibronectin

82735 Assay of fluoride

82742 Assay of flurazepam

82746 Assay of folic acid serum

of 55

82747 Assay of folic acid rbc

82757 Assay of semen fructose

82759 Assay of rbc galactokinase

82760 Assay of galactose

82775 Assay galactose transferase

82776 Galactose transferase test

82777 Galectin-3

82784 Assay iga/igd/igg/igm each

82785 Assay of ige

82787 Igg 1 2 3 or 4 each

82800 Blood pH

82803 Blood gases any combination

82805 Blood gases w/o2 saturation

82810 Blood gases o2 sat only

82820 Hemoglobin-oxygen affinity

82930 Gastric analy w/ph ea spec

82938 Gastrin test

82941 Assay of gastrin

82943 Assay of glucagon

82945 Glucose other fluid

82946 Glucagon tolerance test

82947 Assay glucose blood quant

82948 Reagent strip/blood glucose

82950 Glucose test

82951 Glucose tolerance test (GTT)

82952 GTT-added samples

82953 Glucose-tolbutamide test

82955 Assay of g6pd enzyme

82960 Test for G6PD enzyme

82962 Glucose blood test

82963 Assay of glucosidase

82965 Assay of gdh enzyme

82975 Assay of glutamine

82977 Assay of GGT

82978 Assay of glutathione

82979 Assay rbc glutathione

82980 Assay of glutethimide

82985 Assay of glycated protein

83001 Assay of gonadotropin (fsh)

83002 Assay of gonadotropin (lh)

83003 Assay growth hormone (hgh)

83006 Growth stimulation gene 2

83008 Assay of guanosine

83009 H pylori (c-13) blood

83010 Assay of haptoglobin quant

83012 Assay of haptoglobins

83013 H pylori (c-13) breath

83014 H pylori drug admin

83015 Heavy metal qual any anal

83018 Heavy metal quant each nes

83020 Hemoglobin electrophoresis

83021 Hemoglobin chromotography

83026 Hemoglobin copper sulfate

83030 Fetal hemoglobin chemical

83033 Fetal hemoglobin assay qual

of 55

83036 Glycosylated hemoglobin test

83037 Glycosylated hb home device

83045 Blood methemoglobin test

83050 Blood methemoglobin assay

83051 Assay of plasma hemoglobin

83055 Blood sulfhemoglobin test

83060 Blood sulfhemoglobin assay

83065 Assay of hemoglobin heat

83068 Hemoglobin stability screen

83069 Assay of urine hemoglobin

83070 Assay of hemosiderin qual

83071 Assay of hemosiderin quant

83080 Assay of b hexosaminidase

83088 Assay of histamine

83090 Assay of homocystine

83150 Assay of homovanillic acid

83491 Assay of corticosteroids 17

83497 Assay of 5-hiaa

83498 Assay of progesterone 17-d

83499 Assay of progesterone 20-

83500 Assay free hydroxyproline

83505 Assay total hydroxyproline

83516 Immunoassay nonantibody

83518 Immunoassay dipstick

83519 Ria nonantibody

83520 Immunoassay quant nos nonab

83525 Assay of insulin

83527 Assay of insulin

83528 Assay of intrinsic factor

83540 Assay of iron

83550 Iron binding test

83570 Assay of idh enzyme

83582 Assay of ketogenic steroids

83586 Assay 17- ketosteroids

83593 Fractionation ketosteroids

83605 Assay of lactic acid

83615 Lactate (LD) (LDH) enzyme

83625 Assay of ldh enzymes

83630 Lactoferrin fecal (qual)

83631 Lactoferrin fecal (quant)

83632 Placental lactogen

83633 Test urine for lactose

83634 Assay of urine for lactose

83655 Assay of lead

83661 L/s ratio fetal lung

83662 Foam stability fetal lung

83663 Fluoro polarize fetal lung

83664 Lamellar bdy fetal lung

83670 Assay of lap enzyme

83690 Assay of lipase

83695 Assay of lipoprotein(a)

83698 Assay lipoprotein pla2

83700 Lipopro bld electrophoretic

83701 Lipoprotein bld hr fraction

83704 Lipoprotein bld quan part

of 55

83718 Assay of lipoprotein

83719 Assay of blood lipoprotein

83721 Assay of blood lipoprotein

83727 Assay of lrh hormone

83735 Assay of magnesium

83775 Assay malate dehydrogenase

83785 Assay of manganese

83788 Mass spectrometry qual

83789 Mass spectrometry qual/quan

83805 Assay of meprobamate

83825 Assay of mercury

83835 Assay of metanephrines

83840 Assay of methadone

83857 Assay of methemalbumin

83858 Assay of methsuximide

83861 Microfluid analy tears

83864 Mucopolysaccharides

83866 Mucopolysaccharides screen

83872 Assay synovial fluid mucin

83873 Assay of csf protein

83874 Assay of myoglobin

83876 Assay myeloperoxidase

83880 Assay of natriuretic peptide

83883 Assay nephelometry not spec

83885 Assay of nickel

83887 Assay of nicotine

83890 Molecule isolate

83891 Molecule isolate nucleic

83892 Molecular diagnostics

83893 Molecule dot/slot/blot

83894 Molecule gel electrophor


83897 Molecule nucleic transfer

83898 Molecule nucleic ampli each

83900 Molecule nucleic ampli 2 seq

83901 Molecule nucleic ampli addon


83903 Molecule mutation scan

83904 Molecule mutation identify



83907 Lyse cells for nucleic ext

83908 Nucleic acid signal ampli

83909 Nucleic acid high resolute

83912 Genetic examination

83913 Molecular rna stabilization

83914 Mutation ident ola/sbce/aspe

83915 Assay of nucleotidase

83916 Oligoclonal bands

83918 Organic acids total quant

83919 Organic acids qual each

83921 Organic acid single quant

83925 Assay of opiates

83930 Assay of blood osmolality

83935 Assay of urine osmolality

of 55

83937 Assay of osteocalcin

83945 Assay of oxalate

83950 Oncoprotein her-2/neu

83951 Oncoprotein dcp

83970 Assay of parathormone

83986 Assay ph body fluid nos

83987 Exhaled breath condensate

83992 Assay for phencyclidine

83993 Assay for calprotectin fecal

84022 Assay of phenothiazine

84030 Assay of blood pku

84035 Assay of phenylketones

84060 Assay acid phosphatase

84061 Phosphatase forensic exam

84066 Assay prostate phosphatase

84075 Assay alkaline phosphatase

84078 Assay alkaline phosphatase

84080 Assay alkaline phosphatases

84081 Assay phosphatidylglycerol

84085 Assay of rbc pg6d enzyme

84087 Assay phosphohexose enzymes

84100 Assay of phosphorus

84105 Assay of urine phosphorus

84106 Test for porphobilinogen

84110 Assay of porphobilinogen

84112 Eval amniotic fluid protein

84119 Test urine for porphyrins

84120 Assay of urine porphyrins

84126 Assay of feces porphyrins

84127 Assay of feces porphyrins

84132 Assay of serum potassium

84133 Assay of urine potassium

84134 Assay of prealbumin

84135 Assay of pregnanediol

84138 Assay of pregnanetriol

84140 Assay of pregnenolone

84143 Assay of 17-hydroxypregneno

84144 Assay of progesterone

84145 Procalcitonin (pct)

84146 Assay of prolactin

84150 Assay of prostaglandin

84152 Assay of psa complexed

84153 Assay of psa total

84154 Assay of psa free

84155 Assay of protein serum

84156 Assay of protein urine

84157 Assay of protein other

84160 Assay of protein any source

84163 Pappa serum

84165 Protein e-phoresis serum

84166 Protein e-phoresis/urine/csf

84181 Western blot test

84182 Protein western blot test

84202 Assay RBC protoporphyrin

84203 Test RBC protoporphyrin

of 55

84206 Assay of proinsulin

84207 Assay of vitamin b-6

84210 Assay of pyruvate

84220 Assay of pyruvate kinase

84228 Assay of quinine

84233 Assay of estrogen

84234 Assay of progesterone

84235 Assay of endocrine hormone

84238 Assay nonendocrine receptor

84244 Assay of renin


84255 Assay of selenium

84260 Assay of serotonin

84270 Assay of sex hormone globul

84275 Assay of sialic acid

84285 Assay of silica

84295 Assay of serum sodium

84300 Assay of urine sodium

84302 Assay of sweat sodium

84305 Assay of somatomedin

84307 Assay of somatostatin

84311 Spectrophotometry

84315 Body fluid specific gravity

84375 Chromatogram assay sugars

84376 Sugars single qual

84377 Sugars multiple qual

84378 Sugars single quant

84379 Sugars multiple quant

84392 Assay of urine sulfate

84402 Assay of free testosterone

84403 Assay of total testosterone

84410 Testosterone bioavailable


84430 Assay of thiocyanate

84431 Thromboxane urine

84432 Assay of thyroglobulin

84436 Assay of total thyroxine

84437 Assay of neonatal thyroxine

84439 Assay of free thyroxine

84442 Assay of thyroid activity

84443 Assay thyroid stim hormone

84445 Assay of tsi globulin

84446 Assay of vitamin e

84449 Assay of transcortin

84450 Transferase (AST) (SGOT)

84460 Alanine amino (ALT) (SGPT)

84466 Assay of transferrin

84478 Assay of triglycerides

84479 Assay of thyroid (t3 or t4)

84480 Assay triiodothyronine (t3)

84481 Free assay (FT-3)

84482 T3 reverse

84484 Assay of troponin quant

84485 Assay duodenal fluid trypsin

84488 Test feces for trypsin

of 55

84490 Assay of feces for trypsin

84510 Assay of tyrosine

84512 Assay of troponin qual

84520 Assay of urea nitrogen

84525 Urea nitrogen semi-quant

84540 Assay of urine/urea-n

84545 Urea-N clearance test

84550 Assay of blood/uric acid

84560 Assay of urine/uric acid

84577 Assay of feces/urobilinogen

84578 Test urine urobilinogen

84580 Assay of urine urobilinogen

84583 Assay of urine urobilinogen

84585 Assay of urine vma

84586 Assay of vip

84588 Assay of vasopressin

84590 Assay of vitamin a

84591 Assay of nos vitamin

84597 Assay of vitamin k

84600 Assay of volatiles

84620 Xylose tolerance test

84630 Assay of zinc

84681 Assay of c-peptide

84702 Chorionic gonadotropin test

84703 Chorionic gonadotropin assay

84704 Hcg free betachain test

84830 Ovulation tests

84999 Clinical chemistry test

85002 Bleeding time test

85004 Automated diff wbc count

85007 Bl smear w/diff wbc count

85008 Bl smear w/o diff wbc count

85009 Manual diff wbc count b-coat

85013 Spun microhematocrit

85014 Hematocrit

85018 Hemoglobin

85025 Complete cbc w/auto diff wbc

85027 Complete cbc automated

85032 Manual cell count each

85041 Automated rbc count

85044 Manual reticulocyte count

85045 Automated reticulocyte count

85046 Reticyte/hgb concentrate

85048 Automated leukocyte count

85049 Automated platelet count

85055 Reticulated platelet assay

85060 Blood smear interpretation

85097 Bone marrow interpretation

85130 Chromogenic substrate assay

85170 Blood clot retraction

85175 Blood clot lysis time

85210 Clot factor ii prothrom spec

85220 Blooc clot factor v test

85230 Clot factor vii proconvertin

85240 Clot factor viii ahg 1 stage

of 55

85244 Clot factor viii reltd antgn

85245 Clot factor viii vw ristoctn

85246 Clot factor viii vw antigen

85247 Clot factor viii multimetric

85250 Clot factor ix ptc/chrstmas

85260 Clot factor x stuart-power

85270 Clot factor xi pta

85280 Clot factor xii hageman

85290 Clot factor xiii fibrin stab

85291 Clot factor xiii fibrin scrn

85292 Clot factor fletcher fact

85293 Clot factor wght kininogen

85300 Antithrombin iii activity

85301 Antithrombin iii antigen

85302 Clot inhibit prot c antigen

85303 Clot inhibit prot c activity

85305 Clot inhibit prot s total

85306 Clot inhibit prot s free

85307 Assay activated protein c

85335 Factor inhibitor test

85337 Thrombomodulin

85345 Coagulation time lee & white

85347 Coagulation time activated

85348 Coagulation time otr method

85360 Euglobulin lysis

85362 Fibrin degradation products

85366 Fibrinogen test

85370 Fibrinogen test

85378 Fibrin degrade semiquant

85379 Fibrin degradation quant

85380 Fibrin degradj d-dimer

85384 Fibrinogen activity

85385 Fibrinogen antigen

85390 Fibrinolysins screen i&r

85396 Clotting assay whole blood

85397 Clotting funct activity

85400 Fibrinolytic plasmin

85410 Fibrinolytic antiplasmin

85415 Fibrinolytic plasminogen



85441 Heinz bodies direct

85445 Heinz bodies induced

85460 Hemoglobin fetal

85461 Hemoglobin fetal

85475 Hemolysin acid

85520 Heparin assay

85525 Heparin neutralization

85530 Heparin-protamine tolerance

85536 Iron stain peripheral blood

85540 Wbc alkaline phosphatase

85547 RBC mechanical fragility

85549 Muramidase

85555 RBC osmotic fragility

85557 RBC osmotic fragility

of 55

85576 Blood platelet aggregation

85597 Phospholipid pltlt neutraliz

85598 Hexagnal phosph pltlt neutrl

85610 Prothrombin time

85611 Prothrombin test

85612 Viper venom prothrombin time

85613 Russell viper venom diluted

85635 Reptilase test

85651 Rbc sed rate nonautomated

85652 Rbc sed rate automated

85660 RBC sickle cell test

85670 Thrombin time plasma

85675 Thrombin time titer

85705 Thromboplastin inhibition

85730 Thromboplastin time partial

85732 Thromboplastin time partial

85810 Blood viscosity examination

85999 Hematology procedure

86000 Agglutinins febrile antigen

86001 Allergen specific igg

86003 Allg spec ige crude xtrc ea

86005 Allg spec ige multiallg scr

86008 Allg spec ige recomb ea

86021 WBC antibody identification

86022 Platelet antibodies

86023 Immunoglobulin assay

86038 Antinuclear antibodies

86039 Antinuclear antibodies (ANA)

86060 Antistreptolysin o titer

86063 Antistreptolysin o screen

86077 Phys blood bank serv xmatch

86078 Phys blood bank serv reactj

86079 Phys blood bank serv authrj

86140 C-reactive protein

86141 C-reactive protein hs

86146 Beta-2 glycoprotein antibody

86147 Cardiolipin antibody ea ig

86148 Anti-phospholipid antibody

86152 Cell enumeration & id

86153 Cell enumeration phys interp

86155 Chemotaxis assay

86156 Cold agglutinin screen

86157 Cold agglutinin titer

86160 Complement antigen

86161 Complement/function activity

86162 Complement total (ch50)

86171 Complement fixation each

86185 Counterimmunoelectrophoresis

86200 Ccp antibody

86215 Deoxyribonuclease antibody

86225 Dna antibody native

86226 Dna antibody single strand

86235 Nuclear antigen antibody

86243 Fc receptor

86255 Fluorescent antibody screen

of 55

86256 Fluorescent antibody titer

86277 Growth hormone antibody

86280 Hemagglutination inhibition

86294 Immunoassay tumor qual

86300 Immunoassay tumor ca 15-3

86301 Immunoassay tumor ca 19-9

86304 Immunoassay tumor ca 125

86305 Human epididymis protein 4

86308 Heterophile antibody screen

86309 Heterophile antibody titer

86310 Heterophile antibody absrbj

86316 Immunoassay tumor other

86317 Immunoassay infectious agent

86318 Immunoassay infectious agent

86320 Serum immunoelectrophoresis

86325 Other immunoelectrophoresis

86327 Immunoelectrophoresis assay

86329 Immunodiffusion nes

86331 Immunodiffusion ouchterlony

86332 Immune complex assay

86334 Immunofix e-phoresis serum

86335 Immunfix e-phorsis/urine/csf

86336 Inhibin A

86337 Insulin antibodies

86340 Intrinsic factor antibody

86341 Islet cell antibody

86343 Leukocyte histamine release

86344 Leukocyte phagocytosis

86352 Cell function assay w/stim

86353 Lymphocyte transformation

86355 B cells total count

86356 Mononuclear cell antigen

86357 Nk cells total count

86359 T cells total count

86360 T cell absolute count/ratio

86361 T cell absolute count

86367 Stem cells total count

86376 Microsomal antibody each

86378 Migration inhibitory factor

86382 Neutralization test viral

86384 Nitroblue tetrazolium dye

86386 Nuclear matrix protein 22

86403 Particle agglut antbdy scrn

86406 Particle agglut antbdy titr

86430 Rheumatoid factor test qual

86431 Rheumatoid factor quant

86480 Tb test cell immun measure

86481 Tb ag response t-cell susp

86485 Skin test candida

86486 Skin test nos antigen

86490 Coccidioidomycosis skin test

86510 Histoplasmosis skin test

86580 Tb intradermal test

86590 Streptokinase antibody

86592 Syphilis test non-trep qual

of 55

86593 Syphilis test non-trep quant

86602 Antinomyces antibody

86603 Adenovirus antibody

86606 Aspergillus antibody

86609 Bacterium antibody

86611 Bartonella antibody

86612 Blastomyces antibody

86615 Bordetella antibody

86617 Lyme disease antibody

86618 Lyme disease antibody

86619 Borrelia antibody

86622 Brucella antibody

86625 Campylobacter antibody

86628 Candida antibody

86631 Chlamydia antibody

86632 Chlamydia igm antibody

86635 Coccidioides antibody

86638 Q fever antibody

86641 Cryptococcus antibody

86644 CMV antibody

86645 Cmv antibody igm

86648 Diphtheria antibody

86651 Encephalitis californ antbdy

86652 Encephaltis east eqne anbdy

86653 Encephaltis st louis antbody

86654 Encephaltis west eqne antbdy

86658 Enterovirus antibody

86663 Epstein-barr antibody

86664 Epstein-barr nuclear antigen

86665 Epstein-barr capsid vca

86666 Ehrlichia antibody

86668 Francisella tularensis

86671 Fungus nes antibody

86674 Giardia lamblia antibody

86677 Helicobacter pylori antibody

86682 Helminth antibody

86684 Hemophilus influenza antibdy

86687 Htlv-i antibody

86688 Htlv-ii antibody

86689 Htlv/hiv confirmj antibody

86692 Hepatitis delta agent antbdy

86694 Herpes simplex nes antbdy

86695 Herpes simplex type 1 test

86696 Herpes simplex type 2 test

86698 Histoplasma antibody

86701 Hiv-1antibody

86702 Hiv-2 antibody

86703 Hiv-1/hiv-2 1 result antbdy

86704 Hep b core antibody total

86705 Hep b core antibody igm

86706 Hep b surface antibody

86707 Hepatitis be antibody

86708 Hepatitis a antibody

86709 Hepatitis a igm antibody

86710 Influenza virus antibody

of 55

86711 John cunningham antibody

86713 Legionella antibody

86717 Leishmania antibody

86720 Leptospira antibody

86723 Listeria monocytogenes

86727 Lymph choriomeningitis ab

86729 Lympho venereum antibody

86732 Mucormycosis antibody

86735 Mumps antibody

86738 Mycoplasma antibody

86741 Neisseria meningitidis

86744 Nocardia antibody

86747 Parvovirus antibody

86750 Malaria antibody

86753 Protozoa antibody nos

86756 Respiratory virus antibody

86757 Rickettsia antibody

86759 Rotavirus antibody

86762 Rubella antibody

86765 Rubeola antibody

86768 Salmonella antibody

86771 Shigella antibody

86774 Tetanus antibody

86777 Toxoplasma antibody

86778 Toxoplasma antibody igm

86780 Treponema pallidum

86784 Trichinella antibody

86787 Varicella-zoster antibody

86788 West nile virus ab igm

86789 West nile virus antibody

86790 Virus antibody nos

86793 Yersinia antibody

86794 Zika virus igm antibody

86800 Thyroglobulin antibody

86803 Hepatitis c ab test

86804 Hep c ab test confirm

86805 Lymphocytotoxicity assay

86806 Lymphocytotoxicity assay

86807 Cytotoxic antibody screening

86808 Cytotoxic antibody screening

86812 Hla typing a b or c

86813 Hla typing a b or c

86816 Hla typing dr/dq

86817 Hla typing dr/dq

86821 Lymphocyte culture mixed

86822 Lymphocyte culture primed

86825 Hla x-math non-cytotoxic

86826 Hla x-match noncytotoxc addl

86828 Hla class i&ii antibody qual

86829 Hla class i/ii antibody qual

86830 Hla class i phenotype qual

86831 Hla class ii phenotype qual

86832 Hla class i high defin qual

86833 Hla class ii high defin qual

86834 Hla class i semiquant panel

of 55

86835 Hla class ii semiquant panel

86849 Immunology procedure

86850 Rbc antibody screen

86860 Rbc antibody elution

86870 Rbc antibody identification

86880 Coombs test direct

86885 Coombs test indirect qual

86886 Coombs test indirect titer

86890 Autologous blood process

86891 Autologous blood op salvage

86900 Blood typing serologic abo

86901 Blood typing serologic rh(d)

86902 Blood type antigen donor ea

86904 Blood typing patient serum

86905 Blood typing rbc antigens

86906 Bld typing serologic rh phnt

86910 Blood typing paternity test

86911 Blood typing antigen system

86920 Compatibility test spin

86921 Compatibility test incubate

86922 Compatibility test antiglob

86923 Compatibility test electric

86927 Plasma fresh frozen

86930 Frozen blood prep

86931 Frozen blood thaw

86932 Frozen blood freeze/thaw

86940 Hemolysins/agglutinins auto

86941 Hemolysins/agglutinins

86945 Blood product/irradiation

86950 Leukacyte transfusion

86960 Vol reduction of blood/prod

86965 Pooling blood platelets

86970 Rbc pretx incubatj w/chemicl

86971 Rbc pretx incubatj w/enzymes

86972 Rbc pretx incubatj w/density

86975 Rbc serum pretx incubj drugs

86976 Rbc serum pretx id dilution

86977 Rbc serum pretx incubj/inhib

86978 Rbc pretreatment serum

86985 Split blood or products

86999 Transfusion procedure

87001 Small animal inoculation

87003 Small animal inoculation

87015 Specimen infect agnt concntj

87040 Blood culture for bacteria

87045 Feces culture aerobic bact

87046 Stool cultr aerobic bact ea

87070 Culture othr specimn aerobic

87071 Culture aerobic quant other

87073 Culture bacteria anaerobic

87075 Cultr bacteria except blood

87076 Culture anaerobe ident each

87077 Culture aerobic identify

87081 Culture screen only

87084 Culture of specimen by kit

of 55

87086 Urine culture/colony count

87088 Urine bacteria culture

87101 Skin fungi culture

87102 Fungus isolation culture

87103 Blood fungus culture

87106 Fungi identification yeast

87107 Fungi identification mold

87109 Mycoplasma

87110 Chlamydia culture

87116 Mycobacteria culture

87118 Mycobacteric identification

87140 Culture type immunofluoresc

87143 Culture typing glc/hplc

87147 Culture type immunologic

87149 Dna/rna direct probe

87150 Dna/rna amplified probe

87152 Culture type pulse field gel

87153 Dna/rna sequencing

87158 Culture typing added method

87164 Dark field examination

87166 Dark field examination

87168 Macroscopic exam arthropod

87169 Macroscopic exam parasite

87172 Pinworm exam

87176 Tissue homogenization cultr

87177 Ova and parasites smears

87181 Microbe susceptible diffuse

87184 Microbe susceptible disk

87185 Microbe susceptible enzyme

87186 Microbe susceptible mic

87187 Microbe susceptible mlc

87188 Microbe suscept macrobroth

87190 Microbe suscept mycobacteri

87197 Bactericidal level serum

87205 Smear gram stain

87206 Smear fluorescent/acid stai

87207 Smear special stain

87209 Smear complex stain

87210 Smear wet mount saline/ink

87220 Tissue exam for fungi

87230 Assay toxin or antitoxin

87250 Virus inoculate eggs/animal

87252 Virus inoculation tissue

87253 Virus inoculate tissue addl

87254 Virus inoculation shell via

87255 Genet virus isolate hsv

87260 Adenovirus ag if

87265 Pertussis ag if

87267 Enterovirus antibody dfa

87269 Giardia ag if

87270 Chlamydia trachomatis ag if

87271 Cytomegalovirus dfa

87272 Cryptosporidium ag if

87273 Herpes simplex 2 ag if

87274 Herpes simplex 1 ag if

of 55

87275 Influenza b ag if

87276 Influenza a ag if

87277 Legionella micdadei ag if

87278 Legion pneumophilia ag if

87279 Parainfluenza ag if

87280 Respiratory syncytial ag if

87281 Pneumocystis carinii ag if

87283 Rubeola ag if

87285 Treponema pallidum ag if

87290 Varicella zoster ag if

87299 Antibody detection nos if

87300 Ag detection polyval if

87301 Adenovirus ag ia

87305 Aspergillus ag ia

87320 Chylmd trach ag ia

87324 Clostridium ag ia

87327 Cryptococcus neoform ag ia

87328 Cryptosporidium ag ia

87329 Giardia ag ia

87332 Cytomegalovirus ag ia

87335 E coli 0157 ag ia

87336 Entamoeb hist dispr ag ia

87337 Entamoeb hist group ag ia

87338 Hpylori stool ia

87339 H pylori ag ia

87340 Hepatitis b surface ag ia

87341 Hepatitis b surface ag ia

87350 Hepatitis be ag ia

87380 Hepatitis delta ag ia

87385 Histoplasma capsul ag ia

87389 Hiv-1 ag w/hiv-1 & hiv-2 ab

87390 Hiv-1 ag ia

87391 Hiv-2 ag ia

87400 Influenza a/b ag ia

87420 Resp syncytial ag ia

87425 Rotavirus ag ia

87427 Shiga-like toxin ag ia

87430 Strep a ag ia

87449 Ag detect nos ia mult

87450 Ag detect nos ia single

87451 Ag detect polyval ia mult

87470 Bartonella dna dir probe

87471 Bartonella dna amp probe

87472 Bartonella dna quant

87475 Lyme dis dna dir probe

87476 Lyme dis dna amp probe

87477 Lyme dis dna quant

87480 Candida dna dir probe

87481 Candida dna amp probe

87482 Candida dna quant

87483 Cns dna amp probe type 12-25

87485 Chylmd pneum dna dir probe

87486 Chylmd pneum dna amp probe

87487 Chylmd pneum dna quant

87490 Chylmd trach dna dir probe

of 55

87491 Chylmd trach dna amp probe

87492 Chylmd trach dna quant

87493 C diff amplified probe

87495 Cytomeg dna dir probe

87496 Cytomeg dna amp probe

87497 Cytomeg dna quant

87498 Enterovirus probe&revrs trns

87500 Vanomycin dna amp probe

87501 Influenza dna amp prob 1+

87502 Influenza dna amp probe

87503 Influenza dna amp prob addl

87505 Nfct agent detection gi

87506 Iadna-dna/rna probe tq 6-11

87507 Iadna-dna/rna probe tq 12-25

87510 Gardner vag dna dir probe

87511 Gardner vag dna amp probe

87512 Gardner vag dna quant

87515 Hepatitis b dna dir probe

87516 Hepatitis b dna amp probe

87517 Hepatitis b dna quant

87520 Hepatitis c rna dir probe

87521 Hepatitis c probe&rvrs trnsc

87522 Hepatitis c revrs trnscrpj

87525 Hepatitis g dna dir probe

87526 Hepatitis g dna amp probe

87527 Hepatitis g dna quant

87528 Hsv dna dir probe

87529 Hsv dna amp probe

87530 Hsv dna quant

87531 Hhv-6 dna dir probe

87532 Hhv-6 dna amp probe

87533 Hhv-6 dna quant

87534 Hiv-1 dna dir probe

87535 Hiv-1 probe&reverse trnscrpj

87536 Hiv-1 quant&revrse trnscrpj

87537 Hiv-2 dna dir probe

87538 Hiv-2 probe&revrse trnscripj

87539 Hiv-2 quant&revrse trnscripj

87540 Legion pneumo dna dir prob

87541 Legion pneumo dna amp prob

87542 Legion pneumo dna quant

87550 Mycobacteria dna dir probe

87551 Mycobacteria dna amp probe

87552 Mycobacteria dna quant

87555 M.tuberculo dna dir probe

87556 M.tuberculo dna amp probe

87557 M.tuberculo dna quant

87560 M.avium-intra dna dir prob

87561 M.avium-intra dna amp prob

87562 M.avium-intra dna quant

87580 M.pneumon dna dir probe

87581 M.pneumon dna amp probe

87582 M.pneumon dna quant

87590 N.gonorrhoeae dna dir prob

87591 N.gonorrhoeae dna amp prob

of 55

87592 N.gonorrhoeae dna quant

87620 Hpv dna dir probe

87621 Hpv dna amp probe

87622 Hpv dna quant

87623 Hpv low-risk types

87624 Hpv high-risk types

87625 Hpv types 16 & 18 only

87631 Resp virus 3-5 targets



87634 Rsv dna/rna amp probe

87640 Staph a dna amp probe

87641 Mr-staph dna amp probe

87650 Strep a dna dir probe

87651 Strep a dna amp probe

87652 Strep a dna quant

87653 Strep b dna amp probe

87660 Trichomonas vagin dir probe

87661 Trichomonas vaginalis amplif

87662 Zika virus dna/rna amp probe

87797 Detect agent nos dna dir

87798 Detect agent nos dna amp

87799 Detect agent nos dna quant

87800 Detect agnt mult dna direc

87801 Detect agnt mult dna ampli

87802 Strep b assay w/optic

87803 Clostridium toxin a w/optic

87804 Influenza assay w/optic

87806 Hiv antigen w/hiv antibodies

87807 Rsv assay w/optic

87808 Trichomonas assay w/optic

87809 Adenovirus assay w/optic

87810 Chylmd trach assay w/optic

87850 N. gonorrhoeae assay w/optic

87880 Strep a assay w/optic

87899 Agent nos assay w/optic

87900 Phenotype infect agent drug

87901 Genotype dna hiv reverse t

87902 Genotype dna/rna hep c

87903 Phenotype dna hiv w/culture

87904 Phenotype dna hiv w/clt add

87905 Sialidase enzyme assay

87906 Genotype dna/rna hiv

87910 Genotype cytomegalovirus

87912 Genotype dna hepatitis b

87999 Microbiology procedure

88000 Autopsy (necropsy) gross






88020 Autopsy (necropsy) complete



of 55



88036 Limited autopsy

88037 Limited autopsy

88040 Forensic autopsy (necropsy)

88045 Coroners autopsy (necropsy)

88099 Necropsy (autopsy) procedure

88104 Cytopath fl nongyn smears

88106 Cytopath fl nongyn filter

88108 Cytopath concentrate tech

88112 Cytopath cell enhance tech

88120 Cytp urne 3-5 probes ea spec

88121 Cytp urine 3-5 probes cmptr

88125 Forensic cytopathology

88130 Sex chromatin identification

88140 Sex chromatin identification

88141 Cytopath c/v interpret

88142 Cytopath c/v thin layer

88143 Cytopath c/v thin layer redo

88147 Cytopath c/v automated

88148 Cytopath c/v auto rescreen

88150 Cytopath c/v manual

88152 Cytopath c/v auto redo

88153 Cytopath c/v redo

88154 Cytopath c/v select

88155 Cytopath c/v index add-on

88160 Cytopath smear other source



88164 Cytopath tbs c/v manual

88165 Cytopath tbs c/v redo

88166 Cytopath tbs c/v auto redo

88167 Cytopath tbs c/v select

88172 Cytp dx eval fna 1st ea site

88173 Cytopath eval fna report

88174 Cytopath c/v auto in fluid

88175 Cytopath c/v auto fluid redo

88177 Cytp fna eval ea addl

88182 Cell marker study

88184 Flowcytometry/ tc 1 marker

88185 Flowcytometry/tc add-on

88187 Flowcytometry/read 2-8

88188 Flowcytometry/read 9-15

88189 Flowcytometry/read 16 & >

88199 Cytopathology procedure

88230 Tissue culture lymphocyte

88233 Tissue culture skin/biopsy

88235 Tissue culture placenta

88237 Tissue culture bone marrow

88239 Tissue culture tumor

88240 Cell cryopreserve/storage

88241 Frozen cell preparation

88245 Chromosome analysis 20-25


88249 Chromosome analysis 100

of 55





88267 Chromosome analys placenta

88269 Chromosome analys amniotic

88271 Cytogenetics dna probe

88272 Cytogenetics 3-5




88280 Chromosome karyotype study

88283 Chromosome banding study

88285 Chromosome count additional

88289 Chromosome study additional

88291 Cyto/molecular report

88299 Cytogenetic study

88300 Surgical path gross

88302 Tissue exam by pathologist





88311 Decalcify tissue

88312 Special stains group 1

88313 Special stains group 2

88314 Histochemical stains add-on

88319 Enzyme histochemistry

88321 Microslide consultation

88323 Microslide consultation

88325 Comprehensive review of data

88329 Path consult introp

88331 Path consult intraop 1 bloc

88332 Path consult intraop addl

88333 Intraop cyto path consult 1

88334 Intraop cyto path consult 2

88341 Immunohisto antb addl slide

88342 Immunohisto antb 1st stain

88343 Immunohisto antibod add slid

88344 Immunohisto antibody slide

88346 Immunofluor antb 1st stain

88347 Immunofluorescent study

88348 Electron microscopy

88349 Scanning electron microscopy

88350 Immunofluor antb addl stain

88355 Analysis skeletal muscle

88356 Analysis nerve

88358 Analysis tumor

88360 Tumor immunohistochem/manual

88361 Tumor immunohistochem/comput

88362 Nerve teasing preparations

88363 Xm archive tissue molec anal

88364 Insitu hybridization (fish)



of 55

88367 Insitu hybridization auto

88368 Insitu hybridization manual

88369 M/phmtrc alysishquant/semiq

88371 Protein western blot tissue

88372 Protein analysis w/probe

88373 M/phmtrc alys ishquant/semiq


88375 Optical endomicroscpy interp


88380 Microdissection laser

88381 Microdissection manual

88384 Eval molecular probes 11-50

88385 Eval molecul probes 51-250

88386 Eval molecul probes 251-500

88387 Tiss exam molecular study

88388 Tiss ex molecul study add-on

88399 Surgical pathology procedure

88720 Bilirubin total transcut

88738 Hgb quant transcutaneous

88740 Transcutaneous carboxyhb

88741 Transcutaneous methb

88749 In vivo lab service

89049 Chct for mal hyperthermia

89050 Body fluid cell count

89051 Body fluid cell count

89055 Leukocyte assessment fecal

89060 Exam synovial fluid crystals

89125 Specimen fat stain

89160 Exam feces for meat fibers

89190 Nasal smear for eosinophils

89220 Sputum specimen collection

89230 Collect sweat for test

89240 Pathology lab procedure

89250 Cultr oocyte/embryo <4 days

89251 Cultr oocyte/embryo <4 days

89253 Embryo hatching

89254 Oocyte identification

89255 Prepare embryo for transfer

89257 Sperm identification

89258 Cryopreservation embryo(s)

89259 Cryopreservation sperm

89260 Sperm isolation simple

89261 Sperm isolation complex

89264 Identify sperm tissue

89268 Insemination of oocytes

89272 Extended culture of oocytes

89280 Assist oocyte fertilization

89281 Assist oocyte fertilization

89290 Biopsy oocyte polar body

89291 Biopsy oocyte polar body

89300 Semen analysis w/huhner

89310 Semen analysis w/count

89320 Semen anal vol/count/mot

89321 Semen anal sperm detection

89322 Semen anal strict criteria

of 55

89325 Sperm antibody test

89329 Sperm evaluation test

89330 Evaluation cervical mucus

89331 Retrograde ejaculation anal

89335 Cryopreserve testicular tiss

89337 Cryopreservation oocyte(s)

89342 Storage/year embryo(s)

89343 Storage/year sperm/semen

89344 Storage/year reprod tissue

89346 Storage/year oocyte(s)

89352 Thawing cryopresrved embryo

89353 Thawing cryopresrved sperm

89354 Thaw cryoprsvrd reprod tiss

89356 Thawing cryopresrved oocyte

89398 Unlisted reprod med lab proc

0001M Infectious dis hcv 6 assays

0001U Rbn dna hea 35 ag 11 bld grp

0002M Liver dis 10 assays w/ash

0002U Onc clrct 3 ur metab alg plp

0003M Liver dis 10 assays w/nash

0003U Onc ovar 5 prtn ser alg scor

0004M Scoliosis dna alys

0004U Nfct ds dna 27 resist genes

0005U Onco prst8 3 gene ur alg

0006M Onc hep gene risk classifier

0006U Detc ia meds 120+ analytes

0007M Onc gastro 51 gene nomogram

0007U Rx test prsmv ur w/def conf

0008M Onc breast risk score

0008U Hpylori detcj abx rstnc dna

0009M Fetal aneuploidy trisom risk

0009U Onc brst ca erbb2 amp/nonamp

0010M Onc Prostate prob score

0010U Nfct ds strn typ whl gen seq

0011U Rx mntr lc-ms/ms oral fluid

0012U Germln do gene reargmt detcj

0013U Onc sld org neo gene reargmt

0014U Hem hmtlmf neo gene reargmt

0015U Rx metab advrs rx rxn dna

0016U Onc hmtlmf neo rna bcr/abl1

0017U Onc hmtlmf neo jak2 mut dna

0018U Onc thyr 10 microrna seq alg

0019U Onc rna tiss predict alg

0020U Rx test prsmv ur w/def conf

0021U Onc prst8 detcj 8 autoantb

0022U Trgt gen seq dna&rna 23 gene

0023U Onc aml dna detcj/nondetcj

0024U Glyca nuc mr spectrsc quan

0025U Tenofovir liq chrom ur quan

0026U Onc thyr dna&mrna 112 genes

0027U JAK2 gene trgt seq alys

0028U CYP2D6 gene cpy nmr cmn vrnt

0029U Rx metab advrs trgt seq alys

0030T Antiprothrombin antibody

0030U Rx metab warf trgt seq alys

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0031U CYP1A2 gene

0032U Comt gene

0033U HTR2A HTR2C genes

0034U Tpmt NUDT15 genes

0042T Ct perfusion w/contrast cbf

0073T Delivery comp imrt

0085T Breath test heart reject

0103T Holotranscobalamin

0111T Rbc membranes fatty acids

0159T Cad breast mri

0174T Cad cxr with interp

0175T Cad cxr remote

0182T Hdr elect brachytherapy

0197T Intrafraction track motion

0279T Ctc test

0280T Ctc test w/i & r

0291T Iv oct for proc init vessel

0292T Iv oct for proc addl vessel

0342T Thxp apheresis w/hdl delip

0346T Ultrasound elastography

0348T Rsa spine exam

0349T Rsa upper extr exam

0350T Rsa lower extr exam

0351T Intraop oct brst/node spec

0352T Oct brst/node i&r per spec

0353T Intraop oct breast cavity

0354T Oct breast surg cavity i&r

0394T Hdr elctrnc skn surf brchytx

0395T Hdr elctr ntrst/ntrcv brchtx

0398T Mrgfus strtctc les abltj

0423T Assay secretory type ii pla2

0470T Oct skn img acquisj i&r 1st

0471T Oct skn img acquisj i&r addl

0475T rec ftl car sgl 3 ch i&r

0476T rec ftl car sgl elec tr data

0477T rec ftl car sgl xrtj alys

0478T rec ftl car 3 ch rev i&r

0482T Absl quan myocrd bld flo pet

0485T Oct mid ear i&r unilateral

0486T Oct mid ear i&r bilateral

0487T Trvg biomchn mapg w/reprt

0500T Hpv 5+ hi risk hpv types

0501T Cor ffr derived cor cta data

0502T Cor ffr data prep & transmis

0503T Cor ffr alys gnrj ffr mdl

0504T Cor ffr data review i&r

ATP02 Auto.Test Panel Pricing Code, 1-2 Tests

ATP03 Auto.Test Panel Pricing Code, 3 Tests








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ATP16 Auto Test Panel Pricing Code 13-16 Test

ATP18 Auto Test Panel Pricing Code, 17-18 Test

ATP19 Auto Test Panel Pricing Code, 19 Tests



ATP22 Auto.Test Panel Pricing Code, 22+ Tests

ATP23 Auto.Test Panel Pricing Code, 23+ Tests

C1716 Brachytx, non-str, Gold-198

C1717 Brachytx, non-str,HDR Ir-192

C1719 Brachytx, NS, Non-HDRIr-192

C2616 Brachytx, non-str,Yttrium-90

C2634 Brachytx, non-str, HA, I-125

C2635 Brachytx, non-str, HA, P-103

C2636 Brachy linear, non-str,P-103

C2637 Brachy,non-str,Ytterbium-169

C2638 Brachytx, stranded, I-125

C2639 Brachytx, non-stranded,I-125

C2640 Brachytx, stranded, P-103

C2641 Brachytx, non-stranded,P-103

C2642 Brachytx, stranded, C-131

C2643 Brachytx, non-stranded,C-131

C2644 Brachytx cesium-131 chloride

C2645 Brachytx planar, p-103

C2698 Brachytx, stranded, NOS

C2699 Brachytx, non-stranded, NOS

C8900 MRA w/cont, abd

C8901 MRA w/o cont, abd

C8902 MRA w/o fol w/cont, abd

C8903 Mri w/cont, breast, uni

C8904 MRI w/o cont, breast, uni

C8905 MRI w/o fol w/cont, brst, un

C8906 Mri w/cont, breast, bi

C8907 MRI w/o cont, breast, bi

C8908 MRI w/o fol w/cont, breast,

C8909 MRA w/cont, chest

C8910 MRA w/o cont, chest

C8911 MRA w/o fol w/cont, chest

C8912 MRA w/cont, lwr ext

C8913 MRA w/o cont, lwr ext

C8914 MRA w/o fol w/cont, lwr ext

C8918 MRA w/cont, pelvis

C8919 MRA w/o cont, pelvis

C8920 MRA w/o fol w/cont, pelvis

C8931 MRA, w/dye, spinal canal

C8932 MRA, w/o dye, spinal canal

C8933 MRA, w/o&w/dye, spinal canal

C8934 MRA, w/dye, upper extremity

C8935 MRA, w/o dye, upper extr

C8936 MRA, w/o&w/dye, upper extr

C9728 Place device/marker, non pro

C9733 Non-ophthalmic FVA

C9744 Abd us w/contrast

G0027 Semen analysis

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G0103 PSA screening

G0123 Screen cerv/vag thin layer

G0124 Screen c/v thin layer by MD

G0130 Single energy x-ray study

G0141 Scr c/v cyto,autosys and md

G0143 Scr c/v cyto,thinlayer,rescr



G0147 Scr c/v cyto, automated sys

G0148 Scr c/v cyto, autosys, rescr

G0202 Scr mammo bi incl cad

G0204 Dx mammo incl cad bi

G0206 Dx mammo incl cad uni

G0219 PET img wholbod melano nonco

G0235 PET not otherwise specified

G0252 PET imaging initial dx

G0275 Renal angio, cardiac cath

G0278 Iliac art angio,cardiac cath

G0279 Tomosynthesis, mammo

G0288 Recon, CTA for surg plan

G0297 Ldct for lung ca screen

G0298 Hiv combination assay

G0306 CBC/diffwbc w/o platelet

G0307 CBC without platelet

G0328 Fecal blood scrn immunoassay

G0389 Ultrasound exam AAA screen

G0416 Prostate biopsy, any mthd

G0417 Sat biopsy prostate 21-40

G0418 Sat biopsy prostate 41-60

G0419 Sat biopsy prostate: >60

G0431 Drug screen multiple class

G0432 EIA HIV-1/HIV-2 screen

G0433 ELISA HIV-1/HIV-2 screen

G0434 Drug screen multi drug class

G0435 Oral HIV-1/HIV-2 screen

G0450 Screen STI w four lab test

G0452 Molecular pathology interpr

G0458 LDR prostate brachy comp rat

G0461 Immunohisto/cyto chem 1st st

G0462 Immunohisto/cyto chem add

G0464 Colorec ca scr, sto bas dna

G0471 Ven blood coll SNF/HHA

G0472 Hep c screen high risk/other

G0475 Hiv combination assay

G0476 Hpv combo assay ca screen

G0477 Drug test presump optical

G0478 Drug test presump opt inst

G0479 Drug test presump not opt

G0480 Drug test def 1-7 classes



G0483 Drug test def 22+ classes

G0499 Hepb screen high risk indiv

G0659 Drug test def simple all cl

G6001 Echo guidance radiotherapy

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G6002 Stereoscopic x-ray guidance

G6003 Radiation treatment delivery












G6015 Radiation tx delivery imrt

G6016 Delivery comp imrt

G6017 Intrafraction track motion

G6030 Assay of amitriptyline

G6031 Assay of benzodiazepines

G6032 Assay of desipramine

G6034 Assay of doxepin

G6035 Assay of gold

G6036 Assay of imipramine

G6037 Assay of nortiptyline

G6038 Assay of salicylate

G6039 Assay of acetaminophen

G6040 Assay of ethanol

G6041 Assay of urine alkaloids

G6042 Assay of amphetamines

G6043 Assay of barbiturates

G6044 Assay of cocaine

G6045 Assay of dihydrocodeinone

G6046 Assay of dihydromorphinone

G6047 Assay of dihydrotestosterone

G6048 Assay of dimethadione

G6049 Asssay of epiandrosterone

G6050 Assay of ethchlorvynol

G6051 Assay of flurazepam

G6052 Assay of meprobamate

G6053 Assay of methadone

G6054 Assay of methsuximide

G6055 Assay of nicotine

G6056 Assay of opiates

G6057 Assay of phenothiazine

G6058 Drug confirmation

G9143 Warfarin respon genetic test

P2028 Cephalin floculation test

P2029 Congo red blood test

P2031 Hair analysis

P2033 Blood thymol turbidity

P2038 Blood mucoprotein

P3000 Screen pap by tech w md supv

P3001 Screening pap smear by phys

P7001 Culture bacterial urine

Q0092 Set up port xray equipment

Q0111 Wet mounts/ w preparations

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Q0112 Potassium hydroxide preps

Q0113 Pinworm examinations

Q0114 Fern test

Q0115 Post-coital mucous exam

Q3031 Collagen skin test

R0070 Transport portable x-ray

R0075 Transport port x-ray multipl

R0076 Transport portable EKG

S0832 Low dose ct lung screening

S2120 Low density lipoprotein(LDL)

S3600 Stat lab

S3601 Stat lab home/nf

S3620 Newborn metabolic screening

S3625 Maternal triple screen test

S3626 Maternal serum quad screen

S3630 Eosinophil blood count

S3645 HIV-1 antibody testing of or

S3650 Saliva test, hormone level;

S3652 Saliva test, hormone level;

S3655 Antisperm antibodies test

S3708 Gastrointestinal fat absorpt

S3721 Pca3 testing

S3722 Dose optimization AUC - 5FU

S3800 Genetic testing ALS

S3833 Comp APC sequence

S3834 Sing mutation APC

S3840 DNA analysis RET-oncogene

S3841 Gene test retinoblastoma

S3842 Gene test Hippel-Lindau

S3844 DNA analysis deafness

S3845 Gene test alpha-thalassemia

S3846 Gene test beta-thalassemia

S3849 Gene test Niemann-Pick

S3850 Gene test sickle cell

S3852 DNA analysis APOE alzheimer

S3853 Gene test myo musclr dyst

S3854 Gene profile panel breast

S3855 Gene test presenilin-1 gene

S3861 Genetic test brugada

S3865 comp genet test hyp cardiomy

S3866 spec gene test hyp cardiomy

S3870 CGH test developmental delay

S3890 Fecal DNA analysis

S8030 Tantalum ring application

S8032 Low dose CT lung screening

S8035 Magnetic source imaging

S8037 mrcp

S8042 MRI low field

S8055 Us guidance fetal reduct

S8080 Scintimammography

S8085 Fluorine-18 fluorodeoxygluco

S8092 Electron beam computed tomog

S9024 Paranasal sinus ultrasound

S9529 Venipuncture home/snf

71090 X-ray & pacemaker insertion

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73542 X-ray exam sacroiliac joint

75722 Artery x-rays kidney

75724 Artery x-rays kidneys

75940 X-ray placement vein filter

77079 Ct bone density peripheral

77083 Radiographic absorptiometry

78220 Liver function study

78223 Hepatobiliary imaging

78584 Lung V/Q image single breath

78585 Lung V/Q imaging

78586 Aerosol lung image single

78587 Aerosol lung image multiple

78588 Perfusion lung image

78591 Vent image 1 breath 1 proj

78593 Vent image 1 proj gas

78594 Vent image mult proj gas

78596 Lung differential function

88107 Cytopath fl nongyn sm/fltr

88318 Chemical histochemistry

S3711 Circulating tumor cell test

S3713 KRAS mutation analysis

S3818 BRCA1 gene anal

S3819 BRCA2 gene anal

S3820 Comp BRCA1/BRCA2

S3822 Sing mutation brst/ovar

S3823 3 mutation brst/ovar

S3828 Comp MLH1 gene

S3829 Comp MSH2 gene

S3830 Gene test HNPCC comp

S3831 Gene test HNPCC single

S3835 Gene test cystic fibrosis

S3837 Gene test hemochromato

S3843 DNA analysis factor v

S3847 Gene test Tay-Sachs

S3848 Gene test Gaucher

S3851 Gene test canavan

S3860 Genet test cardiac ion-comp

S3862 Genet test cardiac ion-spec

S8049 Intraoperative radiation the

75992 Atherectomy, x-ray exam





76150 X-ray exam, dry process

76350 Special x-ray contrast study

76880 Us exam, extremity

82926 Assay of gastric acid

82928 Assay of gastric acid

86903 Blood typing, antigen screen

89100 Sample intestinal contents

89105 Sample intestinal contents

89130 Sample stomach contents



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89225 Starch granules, feces

89235 Water load test

0140T Exhaled breath condensate ph

G0430 Drug screen multi class

S3628 PAMG-1 rapid assay for ROM

75558 Cardiac mri flow/velocity

75560 Cardiac mri flow/vel/stress

75562 Card mri flow/vel w/dye

75564 Ht mri w/flo/vel/strs & dye

75790 Visualize A-V shunt

78460 Heart muscle blood, single

78461 Heart muscle blood, multiple

78464 Heart image (3d), single

78465 Heart image (3d), multiple

78478 Heart wall motion add-on

78480 Heart function add-on

82307 Assay of vitamin D

86781 Treponema pallidum, confirm

0066T Ct colonography;screen

0067T Ct colonography;dx

0144T CT heart wo dye; qual calc

0145T CT heart w/wo dye funct

0146T CCTA w/wo dye

0147T CCTA w/wo, quan calcium

0148T CCTA w/wo, strxr

0149T CCTA w/wo, strxr quan calc

0150T CCTA w/wo, disease strxr

0151T CT heart funct add-on

0194T Procalcitonin (pct)

0026T Measure remnant lipoproteins

0028T Dexa body composition study

0041T Detect ur infect agnt w/cpas

0043T Co expired gas analysis

0060T Electrical impedance scan

74350 X-ray guide, stomach tube

75552 Heart mri for morph w/o dye

75553 Heart mri for morph w/dye

75554 Cardiac MRI/function

75555 Cardiac MRI/limited study

75556 Cardiac MRI/flow mapping

77781 High intensity brachytherapy




78615 Cerebral vascular flow image

78890 Nuclear medicine data proc

78891 Nuclear med data proc

86586 Skin test, unlisted

88400 Bilirubin total transcut

G0394 Blood occult test,colorectal

0082T Stereotactic rad delivery

0083T Stereotactic rad tx mngmt

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75998 Fluoroguide for vein device

76003 Needle localization by x-ray

76005 Fluoroguide for spine inject

76006 X-ray stress view

76012 Percut vertebroplasty fluor

76013 Percut vertebroplasty, ct

76020 X-rays for bone age

76040 X-rays, bone evaluation

76061 X-rays, bone survey

76062 X-rays, bone survey

76065 X-rays, bone evaluation

76066 Joint survey, single view

76070 Ct bone density, axial

76071 Ct bone density, peripheral

76075 Dxa bone density, axial

76076 Dxa bone density/peripheral

76077 Dxa bone density/v-fracture

76078 Radiographic absorptiometry

76082 Computer mammogram add-on

76083 Computer mammogram add-on

76086 X-ray of mammary duct

76088 X-ray of mammary ducts

76090 Mammogram, one breast

76091 Mammogram, both breasts

76092 Mammogram, screening

76093 Magnetic image, breast

76094 Magnetic image, both breasts

76095 Stereotactic breast biopsy

76096 X-ray of needle wire, breast

76355 Ct scan for localization

76360 Ct scan for needle biopsy

76362 Ct guide for tissue ablation

76370 Ct scan for therapy guide

76393 Mr guidance for needle place

76394 Mri for tissue ablation

76400 Magnetic image, bone marrow

76778 Us exam kidney transplant

76986 Ultrasound guide intraoper

78704 Imaging renogram

78715 Renal vascular flow exam

78760 Testicular imaging

G0265 Cryopresevation Freeze+stora

G0266 Thawing + expansion froz cel

S3618 Blood Chemistry For Free Beta Human Chorionic Gonadotropin (Hcg)

0010T Tb test, gamma interferon

0023T Phenotype drug test, hiv 1

0038T Rad endovasc taa rpr w/cover

0039T Rad s/i, endovasc taa repair

0040T Rad s/i, endovasc taa prosth

0152T Computer chest add-on

76375 3d/holograph reconstr add-on

78160 Plasma iron turnover

78162 Radioiron absorption exam

78170 Red cell iron utilization

78172 Total body iron estimation

of 55

78455 Venous thrombosis study

78810 Tumor imaging (PET)

78990 Provide diag radionuclide(s)

79000 Init hyperthyroid therapy

79001 Repeat hyperthyroid therapy

79020 Thyroid ablation

79030 Thyroid ablation, carcinoma

79035 Thyroid metastatic therapy

79100 Hematopoetic nuclear therapy

79400 Nonhemato nuclear therapy

79420 Intravascular nuclear ther

79900 Provide ther radiopharm(s)

82273 Test for blood, other source

83715 Assay of blood lipoproteins

83716 Assay of blood lipoproteins

86064 B cells, total count

86379 Nk cells, total count

86585 TB tine test

86587 Stem cells, total count

88180 Cell marker study

G0001 Drawing blood for specimen

G0030 PET imaging prev PET single

G0031 PET imaging prev PET multple

G0032 PET follow SPECT 78464 singl

G0033 PET follow SPECT 78464 mult

G0034 PET follow SPECT 76865 singl

G0035 PET follow SPECT 78465 mult

G0036 PET follow cornry angio sing

G0037 PET follow cornry angio mult

G0038 PET follow myocard perf sing

G0039 PET follow myocard perf mult

G0040 PET follow stress echo singl

G0041 PET follow stress echo mult

G0042 PET follow ventriculogm sing

G0043 PET follow ventriculogm mult

G0044 PET following rest ECG singl

G0045 PET following rest ECG mult

G0046 PET follow stress ECG singl

G0047 PET follow stress ECG mult

G0107 CA screen; fecal blood test

G0125 PET img WhBD sgl pulm ring

G0210 PET img wholebody dxlung

G0211 PET img wholbody init lung

G0212 PET img wholebod restag lung

G0213 PET img wholbody dx

G0214 PET img wholebod init

G0215 PETimg wholebod restag

G0216 PET img wholebod dx melanoma

G0217 PET img wholebod init melan

G0218 PET img wholebod restag mela

G0242 Multisource photon ster plan

G0243 Multisour photon stero treat

G0253 PET image brst dection recur

G0220 PET img wholebod dx lymphoma

G0221 PET imag wholbod init lympho

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G0222 PET imag wholbod resta lymph

G0223 PET imag wholbod reg dx head

G0224 PET imag wholbod reg ini hea

G0225 PET whol restag headneckonly

G0226 PET img wholbody dx esophagl

G0227 PET img wholbod ini esophage

G0228 PET img wholbod restg esopha

G0229 PET img metaboloc brain pres

G0230 PET myocard viability post

G0231 PET WhBD colorec; gamma cam

G0232 PET whbd lymphoma; gamma cam

G0233 PET whbd melanoma; gamma cam

G0234 PET WhBD pulm nod; gamma cam

G0254 PET image brst eval to tx

G0330 PET image initial dx cervcal

G0331 PET image restage ovarian ca

G0336 PET imaging brain alzheimers

S3701 NMP-22 assay

S8004 Wholebody radiopharm trgcell

S8075 CAD of digital mammogr

S8093 CT angiography coronary

S9022 Digital subtraction angiogra

De tener alguna pregunta puede comunicarse con nuestro Centro de Llamadas de Servicios

para Proveedores, sin cargo, al (888) 558-5501. Nuestras horas de servicio son de lunes a

viernes, de 7:00 a.m. a 7:00 p.m.

Gracias por su respaldo y por hacer posible que servicios de excelencia continúen llegando a

nuestros asegurados.

Cordialmente,

Molina Healthcare de Puerto Rico

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