101 CMR 320.05
Allowable Fees
Organ and Disease Oriented Panels
Basic metabolic panel (Calcium, ionized) This panel must
include the following: Calcium, ionized (82330) Carbon
dioxide (bicarbonate) (82374) Chloride (82435) Creatinine
(82565) Glucose (82947) Potassium (84132) Sodium (84295)
Urea Nitrogen (BUN) (84520)
Basic metabolic panel (Calcium, total) This panel must include
the following: Calcium, total (82310) Carbon dioxide
(bicarbonate) (82374) Chloride (82435) Creatinine (82565)
Glucose (82947) Potassium (84132) Sodium (84295) Urea
nitrogen (BUN) (84520)
General health panel This panel must include the following:
Comprehensive metabolic panel (80053) Blood count, complete
(CBC), automated and automated differential WBC count
(85025 or 85027 and 85004) OR Blood count, complete (CBC),
automated (85027) and appropriate manual differential WBC
count (85007 or 85009) Thyroid stimulating hormone (TSH)
(84443)
Electrolyte panel This panel must include the following: Carbon
dioxide (bicarbonate) (82374) Chloride (82435) Potassium
(84132) Sodium (84295)
Comprehensive metabolic panel This panel must include the
following: Albumin (82040) Bilirubin, total (82247) Calcium,
total (82310) Carbon dioxide (bicarbonate) (82374) Chloride
(82435) Creatinine (82565) Glucose (82947) Phosphatase,
alkaline (84075) Potassium (84132) Protein, total (84155)
Sodium (84295) Transferase, alanine amino (ALT) (SGPT)
(84460) Transferase, aspartate amino (AST) (SGOT) (84450)
Urea nitrogen (BUN) (84520)
Obstetric panel This panel must include the following: Blood
count, complete (CBC), automated and automated differential
WBC count (85025 or 85027 and 85004) OR Blood count,
complete (CBC), automated (85027) and appropriate manual
differential WBC count (85007 or 85009) Hepatitis B surface
antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis
test, non-treponemal antibody; qualitative (eg, VDRL, RPR,
ART) (86592) Antibody screen, RBC, each serum technique
(86850) Blood typing, ABO (86900) AND Blood typing, Rh
(D) (86901)
Lipid panel This panel must include the following: Cholesterol,
serum, total (82465) Lipoprotein, direct measurement, high
density cholesterol (HDL cholesterol) (83718) Triglycerides
(84478)
Renal function panel This panel must include the following:
Albumin (82040) Calcium, total (82310) Carbon dioxide
(bicarbonate) (82374) Chloride (82435) Creatinine (82565)
Glucose (82947) Phosphorus inorganic (phosphate) (84100)
Potassium (84132) Sodium (84295) Urea nitrogen (BUN)
(84520)
Acute hepatitis panel This panel must include the following:
Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis
B core antibody (HBcAb), IgM antibody (86705) Hepatitis B
surface antigen (HBsAg) (87340) Hepatitis C antibody (86803)
Hepatic function panel This panel must include the following:
Albumin (82040) Bilirubin, total (82247) Bilirubin, direct
(82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase,
aspartate amino (AST) (SGOT) (84450)
Obstetric panel (includes HIV testing)
Drug Testing and Therapeutic Assays
Acetaminophen
Adalimumab
Amikacin
Amiodarone
Caffeine
Carbamazepine; total
Carbamazepine; free
Cyclosporine
Clozapine
Carbamazepine; -10,11-epoxide
Digoxin; total
Digoxin; free
Valproic acid (dipropylacetic acid); total
Valproic acid (dipropylacetic acid); free
Felbamate
Ethosuximide
Everolimus
Gentamicin
Gabapentin, whole blood, serum, or plasma
Haloperidol
Lamotrigine
Lidocaine
Levetiracetam
Lithium
Salicylate
Mycophenolate (mycophenolic acid)
Flecainide
Oxcarbazepine
Phenobarbital
Phenytoin; total
Phenytoin; free
Posaconazole
Primidone
Itraconazole
Procainamide;
Procainamide; with metabolites (eg, n-acetyl procainamide)
Leflunomide
Quinidine
Sirolimus
Tacrolimus
Theophylline
Tiagabine
Tobramycin
Topiramate
Vancomycin
Zonisamide
Methotrexate
Rufinamide
Hydroxychloroquine
Infliximab
Lacosamide
Vedolizumab
Voriconazole
Evocative Suppression Testing
Quantitation of therapeutic drug, not elsewhere specified
Drug test(s), presumptive, any number of drug classes, any
number of devices or procedures; capable of being read by
direct optical observation only (eg, utilizing immunoassay [eg,
dipsticks, cups, cards, or cartridges]), includes sample
validation when performed, per date of service
Drug test(s), presumptive, any number of drug classes, any
number of devices or procedures; read by instrument assisted
direct optical observation (eg, utilizing immunoassay [eg,
dipsticks, cups, cards, or cartridges]), includes sample
validation when performed, per date of service
Drug test(s), presumptive, any number of drug classes, any
number of devices or procedures; by instrument chemistry
analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT,
FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and
mass spectrometry either with or without chromatography, (eg,
DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS,
LDTD, MALDI, TOF) includes sample validation when
performed, per date of service
ACTH stimulation panel; for adrenal insufficiency This panel
must include the following: Cortisol (82533 x 2)
ACTH stimulation panel; for 21 hydroxylase deficiency This
panel must include the following: Cortisol (82533 x 2) 17
hydroxyprogesterone (83498 x 2)
ACTH stimulation panel; for 3 beta-hydroxydehydrogenase
deficiency This panel must include the following: Cortisol
(82533 x 2) 17 hydroxypregnenolone (84143 x 2)
Aldosterone suppression evaluation panel (eg, saline infusion)
This panel must include the following: Aldosterone (82088 x 2)
Renin (84244 x 2)
Calcitonin stimulation panel (eg, calcium, pentagastrin) This
panel must include the following: Calcitonin (82308 x 3)
Corticotropic releasing hormone (CRH) stimulation panel This
panel must include the following: Cortisol (82533 x 6)
Adrenocorticotropic hormone (ACTH) (82024 x 6)
Chorionic gonadotropin stimulation panel; testosterone
response This panel must include the following: Testosterone
(84403 x 2 on 3 pooled blood samples)
Chorionic gonadotropin stimulation panel; estradiol response
This panel must include the following: Estradiol, total (82670 x
2 on 3 pooled blood samples)
Renal vein renin stimulation panel (eg, captopril) This panel
must include the following: Renin (84244 x 6)
Peripheral vein renin stimulation panel (eg, captopril) This
panel must include the following: Renin (84244 x 2)
Combined rapid anterior pituitary evaluation panel This panel
must include the following: Adrenocorticotropic hormone
(ACTH) (82024 x 4) Luteinizing hormone (LH) (83002 x 4)
Follicle stimulating hormone (FSH) (83001 x 4) Prolactin
(84146 x 4) Human growth hormone (HGH) (83003 x 4)
Cortisol (82533 x 4) Thyroid stimulating hormone (TSH)
(84443 x 4)
Dexamethasone suppression panel, 48 hour This panel must
include the following: Free cortisol, urine (82530 x 2) Cortisol
(82533 x 2) Volume measurement for timed collection (81050 x
2)
Glucagon tolerance panel; for insulinoma This panel must
include the following: Glucose (82947 x 3) Insulin (83525 x 3)
Glucagon tolerance panel; for pheochromocytoma This panel
must include the following: Catecholamines, fractionated
(82384 x 2)
Gonadotropin releasing hormone stimulation panel This panel
must include the following: Follicle stimulating hormone (FSH)
(83001 x 4) Luteinizing hormone (LH) (83002 x 4)
Growth hormone stimulation panel (eg, arginine infusion, l-
dopa administration) This panel must include the following:
Human growth hormone (HGH) (83003 x 4)
Growth hormone suppression panel (glucose administration)
This panel must include the following: Glucose (82947 x 3)
Human growth hormone (HGH) (83003 x 4)
Insulin-induced C-peptide suppression panel This panel must
include the following: Insulin (83525) C-peptide (84681 x 5)
Glucose (82947 x 5)
Insulin tolerance panel; for ACTH insufficiency This panel
must include the following: Cortisol (82533 x 5) Glucose
(82947 x 5)
Insulin tolerance panel; for growth hormone deficiency This
panel must include the following: Glucose (82947 x 5) Human
growth hormone (HGH) (83003 x 5)
Metyrapone panel This panel must include the following:
Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2)
Thyrotropin releasing hormone (TRH) stimulation panel; 1 hour
This panel must include the following: Thyroid stimulating
hormone (TSH) (84443 x 3)
Thyrotropin releasing hormone (TRH) stimulation panel; 2 hour
This panel must include the following: Thyroid stimulating
hormone (TSH) (84443 x 4)
Urinalysis
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose,
hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific
gravity, urobilinogen, any number of these constituents; non-
automated, with microscopy
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose,
hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific
gravity, urobilinogen, any number of these constituents;
automated, with microscopy
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose,
hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific
gravity, urobilinogen, any number of these constituents; non-
automated, without microscopy
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose,
hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific
gravity, urobilinogen, any number of these constituents;
automated, without microscopy
Urinalysis; qualitative or semiquantitative, except
immunoassays
Urinalysis; bacteriuria screen, except by culture or dipstick
Urinalysis; microscopic only
Urinalysis; 2 or 3 glass test
Urine pregnancy test, by visual color comparison methods
Volume measurement for timed collection, each
IC
Unlisted urinalysis procedure
Chemistry
Ketone body(s) (eg, acetone, acetoacetic acid, beta-
hydroxybutyrate); qualitative
Ketone body(s) (eg, acetone, acetoacetic acid, beta-
hydroxybutyrate); quantitative
Acetylcholinesterase
Acylcarnitines; qualitative, each specimen
Acylcarnitines; quantitative, each specimen
Adrenocorticotropic hormone (ACTH)
Adenosine, 5-monophosphate, cyclic (cyclic AMP)
Albumin; serum, plasma or whole blood
Albumin; other source, quantitative, each specimen
Albumin; urine (eg, microalbumin), quantitative
Albumin; urine (eg, microalbumin), semiquantitative (eg,
reagent strip assay)
Albumin; ischemia modified
Alcohol (ethanol); breath
Alcohol (ethanol); any specimen except urine and breath,
immunoassay (eg, IA, EIA, ELISA, RIA, EMIT, FPIA) and
enzymatic methods (eg, alcohol dehydrogenase)
Aldolase
Aldosterone
Alpha-1-antitrypsin; total
Alpha-1-antitrypsin; phenotype
Alpha-fetoprotein (AFP); serum
Alpha-fetoprotein (AFP); amniotic fluid
Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and total
AFP (including ratio)
Aluminum
Amines, vaginal fluid, qualitative
Amino acids; single, qualitative, each specimen
Amino acids; multiple, qualitative, each specimen
Amino acids; single, quantitative, each specimen
Aminolevulinic acid, delta (ALA)
Amino acids, 2 to 5 amino acids, quantitative, each specimen
Amino acids, 6 or more amino acids, quantitative, each
specimen
Ammonia
Amniotic fluid scan (spectrophotometric)
Amylase
Androstanediol glucuronide
Androstenedione
Androsterone
Angiotensin II
Angiotensin I - converting enzyme (ACE)
Anti-mullerian hormone (AMH)
Apolipoprotein, each
Arsenic
Ascorbic acid (Vitamin C), blood
Atomic absorption spectroscopy, each analyte
Beta-2 microglobulin
Bile acids; total
Bile acids; cholylglycine
Bilirubin; total
Bilirubin; direct
Bilirubin; feces, qualitative
Biotinidase, each specimen
Blood, occult, by peroxidase activity (eg, guaiac), qualitative;
feces, consecutive collected specimens with single
determination, for colorectal neoplasm screening (ie, patient
was provided 3 cards or single triple card for consecutive
collection)
Blood, occult, by peroxidase activity (eg, guaiac), qualitative;
other sources
Blood, occult, by peroxidase activity (eg, guaiac), qualitative,
feces, 1-3 simultaneous determinations, performed for other
than colorectal neoplasm screening
Blood, occult, by fecal hemoglobin determination by
immunoassay, qualitative, feces, 1-3 simultaneous
determinations
Bradykinin
Cadmium
Vitamin D; 25 hydroxy, includes fraction(s), if performed
Calcitonin
Calcium; total
Calcium; ionized
Calcium; after calcium infusion test
Calcium; urine quantitative, timed specimen
Calculus; qualitative analysis
Calculus; quantitative analysis, chemical
Calculus; infrared spectroscopy
Calculus; X-ray diffraction
Carbohydrate deficient transferrin
Carbon dioxide (bicarbonate)
Carboxyhemoglobin; quantitative
Carboxyhemoglobin; qualitative
Carcinoembryonic antigen (CEA)
Carnitine (total and free), quantitative, each specimen
Carotene
Catecholamines; total urine
Catecholamines; blood
Catecholamines; fractionated
Cathepsin-D
Ceruloplasmin
Chemiluminescent assay
Chloramphenicol
Chloride; blood
Chloride; urine
Chloride; other source
Chlorinated hydrocarbons, screen
Cholesterol, serum or whole blood, total
Cholinesterase; serum
Cholinesterase; RBC
Chondroitin B sulfate, quantitative
Chromium
Citrate
Collagen cross links, any method
Copper
Corticosterone
Cortisol; free
Cortisol; total
Creatine
Column chromatography, includes mass spectrometry, if
performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-
MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere
specified, qualitative or quantitative, each specimen
Creatine kinase (CK), (CPK); total
Creatine kinase (CK), (CPK); isoenzymes
Creatine kinase (CK), (CPK); MB fraction only
Creatine kinase (CK), (CPK); isoforms
Creatinine; blood
Creatinine; other source
Creatinine; clearance
Cryofibrinogen
Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit)
Cyanide
Cyanocobalamin (Vitamin B-12);
Cyanocobalamin (Vitamin B-12); unsaturated binding capacity
Cystatin C
Cystine and homocystine, urine, qualitative
Dehydroepiandrosterone (DHEA)
Dehydroepiandrosterone-sulfate (DHEA-S)
Desoxycorticosterone, 11-
Deoxycortisol, 11-
Dibucaine number
Dihydrotestosterone (DHT)
Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed
Elastase, pancreatic (EL-1), fecal; quantitative
Elastase, pancreatic (EL-1), fecal; qualitative or semi-
quantitative
Enzyme activity in blood cells, cultured cells, or tissue, not
elsewhere specified; nonradioactive substrate, each specimen
Enzyme activity in blood cells, cultured cells, or tissue, not
elsewhere specified; radioactive substrate, each specimen
Electrophoretic technique, not elsewhere specified
Erythropoietin
Estradiol; total
Estrogens; fractionated
Estrogens; total
Estriol
Estrone
Estradiol; free, direct measurement (eg, equilibrium dialysis)
Ethylene glycol
Etiocholanolone
Fat or lipids, feces; qualitative
Fat or lipids, feces; quantitative
Fat differential, feces, quantitative
Fatty acids, nonesterified
Very long chain fatty acids
Ferritin
Fetal fibronectin, cervicovaginal secretions, semi-quantitative
Fluoride
Folic acid; serum
Folic acid; RBC
Fructose, semen
Galactokinase, RBC
Galactose
Galactose-1-phosphate uridyl transferase; quantitative
Galactose-1-phosphate uridyl transferase; screen
Galectin-3
Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
Gammaglobulin (immunoglobulin); IgE
Gammaglobulin (immunoglobulin); immunoglobulin subclasses
(eg, IgG1, 2, 3, or 4), each
Gases, blood, pH only
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3
(including calculated O2 saturation);
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3
(including calculated O2 saturation); with O2 saturation, by
direct measurement, except pulse oximetry
Gases, blood, O2 saturation only, by direct measurement,
except pulse oximetry
Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin
saturation with oxygen)
Gastric acid analysis, includes pH if performed, each specimen
Gastrin after secretin stimulation
Gastrin
Glucagon
Glucose, body fluid, other than blood
Glucagon tolerance test
Glucose; quantitative, blood (except reagent strip)
Glucose; blood, reagent strip
Glucose; post glucose dose (includes glucose)
Glucose; tolerance test (GTT), 3 specimens (includes glucose)
Glucose; tolerance test, each additional beyond 3 specimens
(List separately in addition to code for primary procedure)
Glucose-6-phosphate dehydrogenase (G6PD); quantitative
Glucose-6-phosphate dehydrogenase (G6PD); screen
Glucose, blood by glucose monitoring device(s) cleared by the
FDA specifically for home use
Glucosidase, beta
Glutamate dehydrogenase
Glutamyltransferase, gamma (GGT)
Glutathione
Glutathione reductase, RBC
Glycated protein
Gonadotropin; follicle stimulating hormone (FSH)
Gonadotropin; luteinizing hormone (LH)
Growth hormone, human (HGH) (somatotropin)
Growth stimulation expressed gene 2 (ST2, Interleukin 1
receptor like-1)
Helicobacter pylori, blood test analysis for urease activity, non-
radioactive isotope (eg, C-13)
Haptoglobin; quantitative
Haptoglobin; phenotypes
Helicobacter pylori; breath test analysis for urease activity, non-
radioactive isotope (eg, C-13)
Helicobacter pylori; drug administration
Heavy metal (eg, arsenic, barium, beryllium, bismuth,
antimony, mercury); qualitative, any number of analytes
Heavy metal (eg, arsenic, barium, beryllium, bismuth,
antimony, mercury); quantitative, each, not elsewhere specified
Hemoglobin fractionation and quantitation; electrophoresis (eg,
A2, S, C, and/or F)
Hemoglobin fractionation and quantitation; chromatography
(eg, A2, S, C, and/or F)
Hemoglobin; by copper sulfate method, non-automated
Hemoglobin; F (fetal), chemical
Hemoglobin; F (fetal), qualitative
Hemoglobin; glycosylated (A1C)
Hemoglobin; glycosylated (A1C) by device cleared by FDA for
home use
Hemoglobin; methemoglobin, qualitative
Hemoglobin; methemoglobin, quantitative
Hemoglobin; plasma
Hemoglobin; sulfhemoglobin, quantitative
Hemoglobin; thermolabile
Hemoglobin; unstable, screen
Hemoglobin; urine
Hemosiderin, qualitative
b-Hexosaminidase, each assay
Histamine
Homocysteine
Homovanillic acid (HVA)
Hydroxycorticosteroids, 17- (17-OHCS)
Hydroxyindolacetic acid, 5-(HIAA)
Hydroxyprogesterone, 17-d
Hydroxyproline; free
Hydroxyproline; total
Immunoassay for analyte other than infectious agent antibody
or infectious agent antigen; qualitative or semiquantitative,
multiple step method
Immunoassay for analyte other than infectious agent antibody
or infectious agent antigen; qualitative or semiquantitative,
single step method (eg, reagent strip)
Immunoassay for analyte other than infectious agent antibody
or infectious agent antigen; quantitative, by radioimmunoassay
(eg, RIA)
Immunoassay for analyte other than infectious agent antibody
or infectious agent antigen; quantitative, not otherwise specified
Immunoglobulin light chains (ie, kappa, lambda), free, each
Insulin; total
Insulin; free
Intrinsic factor
Interleukin-6 (IL-6)
Iron
Iron binding capacity
Isocitric dehydrogenase (IDH)
Ketogenic steroids, fractionation
Ketosteroids, 17- (17-KS); total
Ketosteroids, 17- (17-KS); fractionation
Lactate (lactic acid)
Lactate dehydrogenase (LD), (LDH);
Lactate dehydrogenase (LD), (LDH); isoenzymes, separation
and quantitation
Lactoferrin, fecal; qualitative
Lactoferrin, fecal; quantitative
Lactogen, human placental (HPL) human chorionic
somatomammotropin
Lactose, urine, qualitative
Lead
Fetal lung maturity assessment; lecithin sphingomyelin (L/S)
ratio
Fetal lung maturity assessment; foam stability test
Fetal lung maturity assessment; fluorescence polarization
Fetal lung maturity assessment; lamellar body density
Leucine aminopeptidase (LAP)
Lipase
Lipoprotein (a)
Lipoprotein-associated phospholipase A2 (Lp-PLA2)
Lipoprotein, blood; electrophoretic separation and quantitation
Lipoprotein, blood; high resolution fractionation and
quantitation of lipoproteins including lipoprotein subclasses
when performed (eg, electrophoresis, ultracentrifugation)
Lipoprotein, blood; quantitation of lipoprotein particle
number(s) (eg, by nuclear magnetic resonance spectroscopy),
includes lipoprotein particle subclass(es), when performed
Lipoprotein, direct measurement; high density cholesterol
(HDL cholesterol)
Lipoprotein, direct measurement; VLDL cholesterol
Lipoprotein, direct measurement; LDL cholesterol
Lipoprotein, direct measurement; small dense LDL cholesterol
Luteinizing releasing factor (LRH)
Magnesium
Malate dehydrogenase
Manganese
Mass spectrometry and tandem mass spectrometry (eg, MS,
MS/MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not
elsewhere specified, qualitative or quantitative, each specimen
Mercury, quantitative
Metanephrines
Methemalbumin
Microfluidic analysis utilizing an integrated collection and
analysis device, tear osmolarity
Mucopolysaccharides, acid, quantitative
Mucin, synovial fluid (Ropes test)
Myelin basic protein, cerebrospinal fluid
Myoglobin
Myeloperoxidase (MPO)
Natriuretic peptide
Nephelometry, each analyte not elsewhere specified
Nickel
Nucleotidase 5'-
Oligoclonal immune (oligoclonal bands)
Organic acids; total, quantitative, each specimen
Organic acids; qualitative, each specimen
Organic acid, single, quantitative
Osmolality; blood
Osmolality; urine
Osteocalcin (bone g1a protein)
Oxalate
Oncoprotein; HER-2/neu
Oncoprotein; des-gamma-carboxy-prothrombin (DCP)
Parathormone (parathyroid hormone)
pH; body fluid, not otherwise specified
pH; exhaled breath condensate
Phencyclidine (PCP)
Calprotectin, fecal
Phenylalanine (PKU), blood
Phenylketones, qualitative
Phosphatase, acid; total
Phosphatase, acid; prostatic
Phosphatase, alkaline;
Phosphatase, alkaline; heat stable (total not included)
Phosphatase, alkaline; isoenzymes
Phosphatidylglycerol
Phosphogluconate, 6-, dehydrogenase, RBC
Phosphohexose isomerase
Phosphorus inorganic (phosphate);
Phosphorus inorganic (phosphate); urine
Porphobilinogen, urine; qualitative
Porphobilinogen, urine; quantitative
Evaluation of cervicovaginal fluid for specific amniotic fluid
protein(s) (eg, placental alpha microglobulin-1 [PAMG-1],
placental protein 12 [PP12], alpha-fetoprotein), qualitative, each
specimen
Porphyrins, urine; qualitative
Porphyrins, urine; quantitation and fractionation
Porphyrins, feces, quantitative
Potassium; serum, plasma or whole blood
Potassium; urine
Prealbumin
Pregnanediol
Pregnanetriol
Pregnenolone
17-hydroxypregnenolone
Progesterone
Procalcitonin (PCT)
Prolactin
Prostaglandin, each
Prostate specific antigen (PSA); complexed (direct
measurement)
Prostate specific antigen (PSA); total
Prostate specific antigen (PSA); free
Protein, total, except by refractometry; serum, plasma or whole
blood
Protein, total, except by refractometry; urine
Protein, total, except by refractometry; other source (eg,
synovial fluid, cerebrospinal fluid)
Protein, total, by refractometry, any source
Pregnancy-associated plasma protein-A (PAPP-A)
Protein; electrophoretic fractionation and quantitation, serum
Protein; electrophoretic fractionation and quantitation, other
fluids with concentration (eg, urine, CSF)
Protein; Western Blot, with interpretation and report, blood or
other body fluid
Protein; Western Blot, with interpretation and report, blood or
other body fluid, immunological probe for band identification,
each
Protoporphyrin, RBC; quantitative
Protoporphyrin, RBC; screen
Proinsulin
Pyridoxal phosphate (Vitamin B-6)
Pyruvate
Pyruvate kinase
Quinine
Receptor assay; estrogen
Receptor assay; progesterone
Receptor assay; endocrine, other than estrogen or progesterone
(specify hormone)
Receptor assay; non-endocrine (specify receptor)
Renin
Riboflavin (Vitamin B-2)
Selenium
Serotonin
Sex hormone binding globulin (SHBG)
Sialic acid
Silica
Sodium; serum, plasma or whole blood
Sodium; urine
Sodium; other source
Somatomedin
Somatostatin
Spectrophotometry, analyte not elsewhere specified
Specific gravity (except urine)
Sugars, chromatographic, TLC or paper chromatography
Sugars (mono-, di-, and oligosaccharides); single qualitative,
each specimen
Sugars (mono-, di-, and oligosaccharides); multiple qualitative,
each specimen
Sugars (mono-, di-, and oligosaccharides); single quantitative,
each specimen
Sugars (mono-, di-, and oligosaccharides); multiple
quantitative, each specimen
Sulfate, urine
Testosterone; free
Testosterone; total
Testosterone; bioavailable, direct measurement (eg, differential
precipitation)
Thiamine (Vitamin B-1)
Thiocyanate
Thromboxane metabolite(s), including thromboxane if
performed, urine
Thyroglobulin
Thiopurine S-methyltransferase (TPMT)
Thyroxine; total
Thyroxine; requiring elution (eg, neonatal)
Thyroxine; free
Thyroxine binding globulin (TBG)
Thyroid stimulating hormone (TSH)
Thyroid stimulating immune globulins (TSI)
Tocopherol alpha (Vitamin E)
Transcortin (cortisol binding globulin)
Transferase; aspartate amino (AST) (SGOT)
Transferase; alanine amino (ALT) (SGPT)
Transferrin
Triglycerides
Thyroid hormone (T3 or T4) uptake or thyroid hormone binding
ratio (THBR)
Triiodothyronine T3; total (TT-3)
Triiodothyronine T3; free
Triiodothyronine T3; reverse
Troponin, quantitative
Trypsin; duodenal fluid
Trypsin; feces, qualitative
Trypsin; feces, quantitative, 24-hour collection
Tyrosine
Troponin, qualitative
Urea nitrogen; quantitative
Urea nitrogen; semiquantitative (eg, reagent strip test)
Urea nitrogen, urine
Urea nitrogen, clearance
Uric acid; blood
Uric acid; other source
Urobilinogen, feces, quantitative
Urobilinogen, urine; qualitative
Urobilinogen, urine; quantitative, timed specimen
Urobilinogen, urine; semiquantitative
Vanillylmandelic acid (VMA), urine
Vasoactive intestinal peptide (VIP)
Vasopressin (antidiuretic hormone, ADH)
Vitamin A
Vitamin, not otherwise specified
Vitamin K
Volatiles (eg, acetic anhydride, diethylether)
Xylose absorption test, blood and/or urine
Zinc
C-peptide
Gonadotropin, chorionic (hCG); quantitative
Gonadotropin, chorionic (hCG); qualitative
Gonadotropin, chorionic (hCG); free beta chain
Ovulation tests, by visual color comparison methods for human
luteinizing hormone
Unlisted chemistry procedure
Hematology and Coagulation
Bleeding time
Blood count; automated differential WBC count
Blood count; blood smear, microscopic examination with
manual differential WBC count
Blood count; blood smear, microscopic examination without
manual differential WBC count
Blood count; manual differential WBC count, buffy coat
Blood count; spun microhematocrit
Blood count; hematocrit (Hct)
Blood count; hemoglobin (Hgb)
Blood count; complete (CBC), automated (Hgb, Hct, RBC,
WBC and platelet count) and automated differential WBC
count
Blood count; complete (CBC), automated (Hgb, Hct, RBC,
WBC and platelet count)
Blood count; manual cell count (erythrocyte, leukocyte, or
platelet) each
Blood count; red blood cell (RBC), automated
Blood count; reticulocyte, manual
Blood count; reticulocyte, automated
Blood count; reticulocytes, automated, including 1 or more
cellular parameters (eg, reticulocyte hemoglobin content [CHr],
immature reticulocyte fraction [IRF], reticulocyte volume
[MRV], RNA content), direct measurement
Blood count; leukocyte (WBC), automated
Blood count; platelet, automated
Reticulated platelet assay
Chromogenic substrate assay
Clot retraction
Clot lysis time, whole blood dilution
Clotting; factor II, prothrombin, specific
Clotting; factor V (AcG or proaccelerin), labile factor
Clotting; factor VII (proconvertin, stable factor)
Clotting; factor VIII (AHG), 1-stage
Clotting; factor VIII related antigen
Clotting; factor VIII, VW factor, ristocetin cofactor
Clotting; factor VIII, VW factor antigen
Clotting; factor VIII, von Willebrand factor, multimetric
analysis
Clotting; factor IX (PTC or Christmas)
Clotting; factor X (Stuart-Prower)
Clotting; factor XI (PTA)
Clotting; factor XII (Hageman)
Clotting; factor XIII (fibrin stabilizing)
Clotting; factor XIII (fibrin stabilizing), screen solubility
Clotting; prekallikrein assay (Fletcher factor assay)
Clotting; high molecular weight kininogen assay (Fitzgerald
factor assay)
Clotting inhibitors or anticoagulants; antithrombin III, activity
Clotting inhibitors or anticoagulants; antithrombin III, antigen
assay
Clotting inhibitors or anticoagulants; protein C, antigen
Clotting inhibitors or anticoagulants; protein C, activity
Clotting inhibitors or anticoagulants; protein S, total
Clotting inhibitors or anticoagulants; protein S, free
Activated Protein C (APC) resistance assay
Factor inhibitor test
Thrombomodulin
Coagulation time; Lee and White
Coagulation time; activated
Coagulation time; other methods
Euglobulin lysis
Fibrin(ogen) degradation (split) products (FDP) (FSP);
agglutination slide, semiquantitative
Fibrin(ogen) degradation (split) products (FDP) (FSP);
paracoagulation
Fibrin(ogen) degradation (split) products (FDP) (FSP);
quantitative
Fibrin degradation products, D-dimer; qualitative or
semiquantitative
Fibrin degradation products, D-dimer; quantitative
Fibrin degradation products, D-dimer; ultrasensitive (eg, for
evaluation for venous thromboembolism), qualitative or
semiquantitative
Fibrinogen; activity
Fibrinogen; antigen
Fibrinolysins or coagulopathy screen, interpretation and report
Coagulation and fibrinolysis, functional activity, not otherwise
specified (eg, ADAMTS-13), each analyte
Fibrinolytic factors and inhibitors; plasmin
Fibrinolytic factors and inhibitors; alpha-2 antiplasmin
Fibrinolytic factors and inhibitors; plasminogen activator
Fibrinolytic factors and inhibitors; plasminogen, except
antigenic assay
Fibrinolytic factors and inhibitors; plasminogen, antigenic assay
Heinz bodies; direct
Heinz bodies; induced, acetyl phenylhydrazine
Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage;
differential lysis (Kleihauer-Betke)
Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage;
rosette
Hemolysin, acid
Heparin assay
Heparin neutralization
Heparin-protamine tolerance test
Iron stain, peripheral blood
Leukocyte alkaline phosphatase with count
Mechanical fragility, RBC
Muramidase
Osmotic fragility, RBC; unincubated
Osmotic fragility, RBC; incubated
Platelet, aggregation (in vitro), each agent
Phospholipid neutralization; platelet
Phospholipid neutralization; hexagonal phospholipid
Prothrombin time;
Prothrombin time; substitution, plasma fractions, each
Russell viper venom time (includes venom); undiluted
Russell viper venom time (includes venom); diluted
Reptilase test
Sedimentation rate, erythrocyte; non-automated
Sedimentation rate, erythrocyte; automated
Sickling of RBC, reduction
Thrombin time; plasma
Thrombin time; titer
Thromboplastin inhibition, tissue
Thromboplastin time, partial (PTT); plasma or whole blood
Thromboplastin time, partial (PTT); substitution, plasma
fractions, each
Viscosity
IC
Unlisted hematology and coagulation procedure
Immunology
Agglutinins, febrile (eg, Brucella, Francisella, Murine typhus, Q
fever, Rocky Mountain spotted fever, scrub typhus), each
antigen
Allergen specific IgG quantitative or semiquantitative, each
allergen
Allergen specific IgE; quantitative or semiquantitative, crude
allergen extract, each
Allergen specific IgE; qualitative, multiallergen screen (eg,
disk, sponge, card)
Allergen specific IgE; quantitative or semiquantitative,
recombinant or purified component, each
Actin (smooth muscle) antibody (ASMA), each
Antibody identification; leukocyte antibodies
Antibody identification; platelet antibodies
Antibody identification; platelet associated immunoglobulin
assay
Antineutrophil cytoplasmic antibody (ANCA); screen, each
antibody
Antineutrophil cytoplasmic antibody (ANCA); titer, each
antibody
Antinuclear antibodies (ANA);
Antinuclear antibodies (ANA); titer
Acetylcholine receptor (AChR); binding antibody
Acetylcholine receptor (AChR); blocking antibody
Acetylcholine receptor (AChR); modulating antibody
Aquaporin-4 (neuromyelitis optica [NMO]) antibody; enzyme-
linked immunosorbent immunoassay (ELISA)
Aquaporin-4 (neuromyelitis optica [NMO]) antibody; cell-
based immunofluorescence assay (CBA), each
Aquaporin-4 (neuromyelitis optica [NMO]) antibody; flow
cytometry (ie, fluorescence-activated cell sorting [FACS]), each
Antistreptolysin 0; titer
Antistreptolysin 0; screen
C-reactive protein;
C-reactive protein; high sensitivity (hsCRP)
Beta 2 Glycoprotein I antibody, each
Cardiolipin (phospholipid) antibody, each Ig class
Anti-phosphatidylserine (phospholipid) antibody
Cell enumeration using immunologic selection and
identification in fluid specimen (eg, circulating tumor cells in
blood);
Chemotaxis assay, specify method
Cold agglutinin; screen
Cold agglutinin; titer
Complement; antigen, each component
Complement; functional activity, each component
Complement; total hemolytic (CH50)
Complement fixation tests, each antigen
Cyclic citrullinated peptide (CCP), antibody
Deoxyribonuclease, antibody
Deoxyribonucleic acid (DNA) antibody; native or double
stranded
Deoxyribonucleic acid (DNA) antibody; single stranded
Endomysial antibody (EMA), each immunoglobulin (Ig) class
Extractable nuclear antigen, antibody to, any method (eg,
nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody
Fluorescent noninfectious agent antibody; screen, each antibody
Fluorescent noninfectious agent antibody; titer, each antibody
Gliadin (deamidated) (DGP) antibody, each immunoglobulin
(Ig) class
Growth hormone, human (HGH), antibody
Hemagglutination inhibition test (HAI)
Immunoassay for tumor antigen, qualitative or semiquantitative
(eg, bladder tumor antigen)
Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)
Immunoassay for tumor antigen, quantitative; CA 19-9
Immunoassay for tumor antigen, quantitative; CA 125
Human epididymis protein 4 (HE4)
Heterophile antibodies; screening
Heterophile antibodies; titer
Heterophile antibodies; titers after absorption with beef cells
and guinea pig kidney
Immunoassay for tumor antigen, other antigen, quantitative (eg,
CA 50, 72-4, 549), each
Immunoassay for infectious agent antibody, quantitative, not
otherwise specified
Immunoassay for infectious agent antibody(ies), qualitative or
semiquantitative, single-step method (eg, reagent strip);
Immunoelectrophoresis; serum
Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal
fluid) with concentration
Immunoelectrophoresis; crossed (2-dimensional assay)
Immunoassay for infectious agent antibody(ies), qualitative or
semiquantitative, single step method (eg, reagent strip); severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
(coronavirus disease [COVID-19])
Immunodiffusion; not elsewhere specified
Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each
antigen or antibody
Immune complex assay
Immunofixation electrophoresis; serum
Immunofixation electrophoresis; other fluids with concentration
(eg, urine, CSF)
Inhibin A
Insulin antibodies
Intrinsic factor antibodies
Islet cell antibody
Leukocyte histamine release test (LHR)
Leukocyte phagocytosis
Cellular function assay involving stimulation (eg, mitogen or
antigen) and detection of biomarker (eg, ATP)
Lymphocyte transformation, mitogen (phytomitogen) or antigen
induced blastogenesis
B cells, total count
Mononuclear cell antigen, quantitative (eg, flow cytometry), not
otherwise specified, each antigen
Natural killer (NK) cells, total count
T cells; total count
T cells; absolute CD4 and CD8 count, including ratio
T cells; absolute CD4 count
Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody;
cell-based immunofluorescence assay (CBA), each
Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody;
flow cytometry (ie, fluorescence-activated cell sorting [FACS]),
each
Tissue transglutaminase, each immunoglobulin (Ig) class
Muscle-specific kinase (MuSK) antibody
Stem cells (ie, CD34), total count
Microsomal antibodies (eg, thyroid or liver-kidney), each
Mitochondrial antibody (eg, M2), each
Neutralization test, viral
Nitroblue tetrazolium dye test (NTD)
Nuclear Matrix Protein 22 (NMP22), qualitative
Particle agglutination; screen, each antibody
Particle agglutination; titer, each antibody
Neutralizing antibody, severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-
19]); screen
Neutralizing antibody, severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-
19]); titer
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2) (coronavirus disease [COVID-19]) antibody, quantitative
Rheumatoid factor; qualitative
Rheumatoid factor; quantitative
Tuberculosis test, cell mediated immunity antigen response
measurement; gamma interferon
Tuberculosis test, cell mediated immunity antigen response
measurement; enumeration of gamma interferon-producing T-
cells in cell suspension
Skin test; candida
Streptokinase, antibody
Syphilis test, non-treponemal antibody; qualitative (eg, VDRL,
RPR, ART)
Syphilis test, non-treponemal antibody; quantitative
Voltage-gated calcium channel antibody, each
Antibody; actinomyces
Antibody; adenovirus
Antibody; Aspergillus
Antibody; bacterium, not elsewhere specified
Antibody; Bartonella
Antibody; Blastomyces
Antibody; Bordetella
Antibody; Borrelia burgdorferi (Lyme disease) confirmatory
test (eg, Western Blot or immunoblot)
Antibody; Borrelia burgdorferi (Lyme disease)
Antibody; Borrelia (relapsing fever)
Antibody; Brucella
Antibody; Campylobacter
Antibody; Candida
Antibody; Chlamydia
Antibody; Chlamydia, IgM
Antibody; Coccidioides
Antibody; Coxiella burnetii (Q fever)
Antibody; Cryptococcus
Antibody; cytomegalovirus (CMV)
Antibody; cytomegalovirus (CMV), IgM
Antibody; Diphtheria
Antibody; encephalitis, California (La Crosse)
Antibody; encephalitis, Eastern equine
Antibody; encephalitis, St. Louis
Antibody; encephalitis, Western equine
Antibody; enterovirus (eg, coxsackie, echo, polio)
Antibody; Epstein-Barr (EB) virus, early antigen (EA)
Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)
Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)
Antibody; Ehrlichia
Antibody; Francisella tularensis
Antibody; fungus, not elsewhere specified
Antibody; Giardia lamblia
Antibody; Helicobacter pylori
Antibody; helminth, not elsewhere specified
Antibody; Haemophilus influenza
Antibody; HTLV-I
Antibody; HTLV-II
Antibody; HTLV or HIV antibody, confirmatory test (eg,
Western Blot)
Antibody; hepatitis, delta agent
Antibody; herpes simplex, non-specific type test
Antibody; herpes simplex, type 1
Antibody; herpes simplex, type 2
Antibody; histoplasma
Antibody; HIV-1
Antibody; HIV-2
Antibody; HIV-1 and HIV-2, single result
Hepatitis B core antibody (HBcAb); total
Hepatitis B core antibody (HBcAb); IgM antibody
Hepatitis B surface antibody (HBsAb)
Hepatitis Be antibody (HBeAb)
Hepatitis A antibody (HAAb)
Hepatitis A antibody (HAAb), IgM antibody
Antibody; influenza virus
Antibody; JC (John Cunningham) virus
Antibody; Legionella
Antibody; Leishmania
Antibody; Leptospira
Antibody; Listeria monocytogenes
Antibody; lymphocytic choriomeningitis
Antibody; mucormycosis
Antibody; mumps
Antibody; mycoplasma
Antibody; Neisseria meningitidis
Antibody; Nocardia
Antibody; parvovirus
Antibody; Plasmodium (malaria)
Antibody; protozoa, not elsewhere specified
Antibody; respiratory syncytial virus
Antibody; Rickettsia
Antibody; rotavirus
Antibody; rubella
Antibody; rubeola
Antibody; Salmonella
Antibody; severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) (coronavirus disease [COVID-19])
Antibody; Shigella
Antibody; tetanus
Antibody; Toxoplasma
Antibody; Toxoplasma, IgM
Antibody; Treponema pallidum
Antibody; Trichinella
Antibody; varicella-zoster
Antibody; West Nile virus, IgM
Antibody; West Nile virus
Antibody; virus, not elsewhere specified
Antibody; Yersinia
Antibody; Zika virus, IgM
Thyroglobulin antibody
Hepatitis C antibody;
Hepatitis C antibody; confirmatory test (eg, immunoblot)
Lymphocytotoxicity assay, visual crossmatch; with titration
Lymphocytotoxicity assay, visual crossmatch; without titration
Serum screening for cytotoxic percent reactive antibody (PRA);
standard method
Serum screening for cytotoxic percent reactive antibody (PRA);
quick method
HLA typing; A, B, or C (eg, A10, B7, B27), single antigen
HLA typing; A, B, or C, multiple antigens
HLA typing; DR/DQ, single antigen
HLA typing; DR/DQ, multiple antigens
HLA typing; lymphocyte culture, mixed (MLC)
Human leukocyte antigen (HLA) crossmatch, non-cytotoxic
(eg, using flow cytometry); first serum sample or dilution
Human leukocyte antigen (HLA) crossmatch, non-cytotoxic
(eg, using flow cytometry); each additional serum sample or
sample dilution (List separately in addition to primary
procedure)
Antibody to human leukocyte antigens (HLA), solid phase
assays (eg, microspheres or beads, ELISA, flow cytometry);
qualitative assessment of the presence or absence of
antibody(ies) to HLA Class I and Class II HLA antigens
Antibody to human leukocyte antigens (HLA), solid phase
assays (eg, microspheres or beads, ELISA, Flow cytometry);
qualitative assessment of the presence or absence of
antibody(ies) to HLA Class I or Class II HLA antigens
Antibody to human leukocyte antigens (HLA), solid phase
assays (eg, microspheres or beads, ELISA, Flow cytometry);
antibody identification by qualitative panel using complete
HLA phenotypes, HLA Class I
Antibody to human leukocyte antigens (HLA), solid phase
assays (eg, microspheres or beads, ELISA, Flow cytometry);
antibody identification by qualitative panel using complete
HLA phenotypes, HLA Class II
Antibody to human leukocyte antigens (HLA), solid phase
assays (eg, microspheres or beads, ELISA, Flow cytometry);
high definition qualitative panel for identification of antibody
specificities (eg, individual antigen per bead methodology),
HLA Class I
Antibody to human leukocyte antigens (HLA), solid phase
assays (eg, microspheres or beads, ELISA, Flow cytometry);
high definition qualitative panel for identification of antibody
specificities (eg, individual antigen per bead methodology),
HLA Class II
Antibody to human leukocyte antigens (HLA), solid phase
assays (eg, microspheres or beads, ELISA, Flow cytometry);
semi-quantitative panel (eg, titer), HLA Class I
Antibody to human leukocyte antigens (HLA), solid phase
assays (eg, microspheres or beads, ELISA, Flow cytometry);
semi-quantitative panel (eg, titer), HLA Class II
IC
Unlisted immunology procedure
Transformation
Antibody screen, RBC, each serum technique
IC
Antibody elution (RBC), each elution
IC
Antibody identification, RBC antibodies, each panel for each
serum technique
Antihuman globulin test (Coombs test); direct, each antiserum
Antihuman globulin test (Coombs test); indirect, qualitative,
each reagent red cell
Antihuman globulin test (Coombs test); indirect, each antibody
titer
IC
Autologous blood or component, collection processing and
storage; predeposited
IC
Autologous blood or component, collection processing and
storage; intra- or postoperative salvage
Blood typing, serologic; ABO
Blood typing, serologic; Rh (D)
Blood typing, serologic; antigen testing of donor blood using
reagent serum, each antigen test
Blood typing, serologic; antigen screening for compatible unit
using patient serum, per unit screened
Blood typing, serologic; RBC antigens, other than ABO or Rh
(D), each
Blood typing, serologic; Rh phenotyping, complete
IC
Compatibility test each unit; immediate spin technique
IC
Compatibility test each unit; incubation technique
IC
Compatibility test each unit; antiglobulin technique
IC
Compatibility test each unit; electronic
IC
Fresh frozen plasma, thawing, each unit
IC
Frozen blood, each unit; freezing (includes preparation)
IC
Frozen blood, each unit; thawing
IC
Frozen blood, each unit; freezing (includes preparation) and
thawing
Hemolysins and agglutinins; auto, screen, each
Hemolysins and agglutinins; incubated
Irradiation of blood product, each unit
IC
Volume reduction of blood or blood product (eg, red blood cells
or platelets), each unit
Pooling of platelets or other blood products
Pretreatment of RBCs for use in RBC antibody detection,
identification, and/or compatibility testing; incubation with
chemical agents or drugs, each
Pretreatment of RBCs for use in RBC antibody detection,
identification, and/or compatibility testing; incubation with
enzymes, each
Pretreatment of serum for use in RBC antibody identification;
by dilution
Pretreatment of serum for use in RBC antibody identification;
incubation with inhibitors, each
Pretreatment of serum for use in RBC antibody identification;
by differential red cell absorption using patient RBCs or RBCs
of known phenotype, each absorption
IC
Splitting of blood or blood products, each unit
IC
Unlisted transfusion medicine procedure
Microbiology
Animal inoculation, small animal, with observation and
dissection
Concentration (any type), for infectious agents
Culture, bacterial; blood, aerobic, with isolation and
presumptive identification of isolates (includes anaerobic
culture, if appropriate)
Culture, bacterial; stool, aerobic, with isolation and preliminary
examination (eg, KIA, LIA), Salmonella and Shigella species
Culture, bacterial; stool, aerobic, additional pathogens, isolation
and presumptive identification of isolates, each plate
Culture, bacterial; any other source except urine, blood or stool,
aerobic, with isolation and presumptive identification of isolates
Culture, bacterial; quantitative, aerobic with isolation and
presumptive identification of isolates, any source except urine,
blood or stool
Culture, bacterial; quantitative, anaerobic with isolation and
presumptive identification of isolates, any source except urine,
blood or stool
Culture, bacterial; any source, except blood, anaerobic with
isolation and presumptive identification of isolates
Culture, bacterial; anaerobic isolate, additional methods
required for definitive identification, each isolate
Culture, bacterial; aerobic isolate, additional methods required
for definitive identification, each isolate
Culture, presumptive, pathogenic organisms, screening only;
Culture, presumptive, pathogenic organisms, screening only;
with colony estimation from density chart
Culture, bacterial; quantitative colony count, urine
Culture, bacterial; with isolation and presumptive identification
of each isolate, urine
Culture, fungi (mold or yeast) isolation, with presumptive
identification of isolates; skin, hair, or nail
Culture, fungi (mold or yeast) isolation, with presumptive
identification of isolates; other source (except blood)
Culture, fungi (mold or yeast) isolation, with presumptive
identification of isolates; blood
Culture, fungi, definitive identification, each organism; yeast
Culture, fungi, definitive identification, each organism; mold
Culture, mycoplasma, any source
Culture, chlamydia, any source
Culture, tubercle or other acid-fast bacilli (eg, TB, AFB,
mycobacteria) any source, with isolation and presumptive
identification of isolates
Culture, mycobacterial, definitive identification, each isolate
Culture, typing; immunofluorescent method, each antiserum
Culture, typing; gas liquid chromatography (GLC) or high
pressure liquid chromatography (HPLC) method
Culture, typing; immunologic method, other than
immunofluorescence (eg, agglutination grouping), per
antiserum
Culture, typing; identification by nucleic acid (DNA or RNA)
probe, direct probe technique, per culture or isolate, each
organism probed
Culture, typing; identification by nucleic acid (DNA or RNA)
probe, amplified probe technique, per culture or isolate, each
organism probed
Culture, typing; identification by pulse field gel typing
Culture, typing; identification by nucleic acid sequencing
method, each isolate (eg, sequencing of the 16S rRNA gene)
Culture, typing; identification of blood pathogen and resistance
typing, when performed, by nucleic acid (DNA or RNA) probe,
multiplexed amplified probe technique including multiplex
reverse transcription, when performed, per culture or isolate, 6
or more targets
Culture, typing; other methods
Dark field examination, any source (eg, penile, vaginal, oral,
skin); includes specimen collection
Dark field examination, any source (eg, penile, vaginal, oral,
skin); without collection
Macroscopic examination; arthropod
Macroscopic examination; parasite
Pinworm exam (eg, cellophane tape prep)
Homogenization, tissue, for culture
Ova and parasites, direct smears, concentration and
identification
Susceptibility studies, antimicrobial agent; agar dilution
method, per agent (eg, antibiotic gradient strip)
Susceptibility studies, antimicrobial agent; disk method, per
plate (12 or fewer agents)
Susceptibility studies, antimicrobial agent; enzyme detection
(eg, beta lactamase), per enzyme
Susceptibility studies, antimicrobial agent; microdilution or
agar dilution (minimum inhibitory concentration [MIC] or
breakpoint), each multi-antimicrobial, per plate
Susceptibility studies, antimicrobial agent; microdilution or
agar dilution, minimum lethal concentration (MLC), each plate
(List separately in addition to code for primary procedure)
Susceptibility studies, antimicrobial agent; macrobroth dilution
method, each agent
Susceptibility studies, antimicrobial agent; mycobacteria,
proportion method, each agent
Serum bactericidal titer (Schlichter test)
Smear, primary source with interpretation; Gram or Giemsa
stain for bacteria, fungi, or cell types
Smear, primary source with interpretation; fluorescent and/or
acid fast stain for bacteria, fungi, parasites, viruses or cell types
Smear, primary source with interpretation; special stain for
inclusion bodies or parasites (eg, malaria, coccidia,
microsporidia, trypanosomes, herpes viruses)
Smear, primary source with interpretation; complex special
stain (eg, trichrome, iron hemotoxylin) for ova and parasites
Smear, primary source with interpretation; wet mount for
infectious agents (eg, saline, India ink, KOH preps)
Tissue examination by KOH slide of samples from skin, hair, or
nails for fungi or ectoparasite ova or mites (eg, scabies)
Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile
toxin)
Virus isolation; inoculation of embryonated eggs, or small
animal, includes observation and dissection
Virus isolation; tissue culture inoculation, observation, and
presumptive identification by cytopathic effect
Virus isolation; tissue culture, additional studies or definitive
identification (eg, hemabsorption, neutralization,
immunofluorescence stain), each isolate
Virus isolation; centrifuge enhanced (shell vial) technique,
includes identification with immunofluorescence stain, each
virus
Virus isolation; including identification by non-immunologic
method, other than by cytopathic effect (eg, virus specific
enzymatic activity)
Infectious agent antigen detection by immunofluorescent
technique; adenovirus
Infectious agent antigen detection by immunofluorescent
technique; Bordetella pertussis/parapertussis
Infectious agent antigen detection by immunofluorescent
technique; Enterovirus, direct fluorescent antibody (DFA)
Infectious agent antigen detection by immunofluorescent
technique; giardia
Infectious agent antigen detection by immunofluorescent
technique; Chlamydia trachomatis
Infectious agent antigen detection by immunofluorescent
technique; Cytomegalovirus, direct fluorescent antibody (DFA)
Infectious agent antigen detection by immunofluorescent
technique; cryptosporidium
Infectious agent antigen detection by immunofluorescent
technique; Herpes simplex virus type 2
Infectious agent antigen detection by immunofluorescent
technique; Herpes simplex virus type 1
Infectious agent antigen detection by immunofluorescent
technique; influenza B virus
Infectious agent antigen detection by immunofluorescent
technique; influenza A virus
Infectious agent antigen detection by immunofluorescent
technique; Legionella pneumophila
Infectious agent antigen detection by immunofluorescent
technique; Parainfluenza virus, each type
Infectious agent antigen detection by immunofluorescent
technique; respiratory syncytial virus
Infectious agent antigen detection by immunofluorescent
technique; Pneumocystis carinii
Infectious agent antigen detection by immunofluorescent
technique; Rubeola
Infectious agent antigen detection by immunofluorescent
technique; Treponema pallidum
Infectious agent antigen detection by immunofluorescent
technique; Varicella zoster virus
Infectious agent antigen detection by immunofluorescent
technique; not otherwise specified, each organism
Infectious agent antigen detection by immunofluorescent
technique, polyvalent for multiple organisms, each polyvalent
antiserum
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; adenovirus enteric types 40/41
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Aspergillus
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Chlamydia trachomatis
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Clostridium difficile toxin(s)
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Cryptococcus neoformans
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; cryptosporidium
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; giardia
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; cytomegalovirus
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Escherichia coli 0157
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Entamoeba histolytica dispar group
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Entamoeba histolytica group
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Helicobacter pylori, stool
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Helicobacter pylori
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; hepatitis B surface antigen (HBsAg)
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; hepatitis B surface antigen (HBsAg)
neutralization
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; hepatitis Be antigen (HBeAg)
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; hepatitis, delta agent
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Histoplasma capsulatum
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2
antibodies, single result
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; HIV-1
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; HIV-2
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Influenza, A or B, each
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; respiratory syncytial virus
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; rotavirus
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; severe acute respiratory syndrome
coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Shiga-like toxin
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; severe acute respiratory syndrome
coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and
influenza virus types A and B
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; Streptococcus, group A
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; not otherwise specified, each organism
Infectious agent antigen detection by immunoassay technique,
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]) qualitative
or semiquantitative; polyvalent for multiple organisms, each
polyvalent antiserum
Infectious agent antigen detection by immunoassay technique
(eg, enzyme immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric assay [IMCA]), qualitative
or semiquantitative; hepatitis B surface antigen (HBsAg),
quantitative
Infectious agent detection by nucleic acid (DNA or RNA);
Anaplasma phagocytophilum, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Babesia microti, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Bartonella henselae and Bartonella quintana, amplified probe
technique
Infectious agent detection by nucleic acid (DNA or RNA);
Bartonella henselae and Bartonella quintana, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Borrelia burgdorferi, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Borrelia burgdorferi, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Borrelia miyamotoi, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Candida species, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Candida species, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Candida species, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
central nervous system pathogen (eg, Neisseria meningitidis,
Streptococcus pneumoniae, Listeria, Haemophilus influenzae,
E. coli, Streptococcus agalactiae, enterovirus, human
parechovirus, herpes simplex virus type 1 and 2, human
herpesvirus 6, cytomegalovirus, varicella zoster virus,
Cryptococcus), includes multiplex reverse transcription, when
performed, and multiplex amplified probe technique, multiple
types or subtypes, 12-25 targets
Infectious agent detection by nucleic acid (DNA or RNA);
Ehrlichia chaffeensis, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Chlamydia pneumoniae, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Chlamydia pneumoniae, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Chlamydia pneumoniae, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Chlamydia trachomatis, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Chlamydia trachomatis, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Chlamydia trachomatis, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Clostridium difficile, toxin gene(s), amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
cytomegalovirus, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
cytomegalovirus, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
cytomegalovirus, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
enterovirus, amplified probe technique, includes reverse
transcription when performed
Infectious agent detection by nucleic acid (DNA or RNA);
vancomycin resistance (eg, enterococcus species van A, van B),
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
influenza virus, includes reverse transcription, when performed,
and amplified probe technique, each type or subtype
Infectious agent detection by nucleic acid (DNA or RNA);
influenza virus, for multiple types or sub-types, includes
multiplex reverse transcription, when performed, and multiplex
amplified probe technique, first 2 types or sub-types
Infectious agent detection by nucleic acid (DNA or RNA);
influenza virus, for multiple types or sub-types, includes
multiplex reverse transcription, when performed, and multiplex
amplified probe technique, each additional influenza virus type
or sub-type beyond 2 (List separately in addition to code for
primary procedure)
Infectious agent detection by nucleic acid (DNA or RNA);
gastrointestinal pathogen (eg, Clostridium difficile, E. coli,
Salmonella, Shigella, norovirus, Giardia), includes multiplex
reverse transcription, when performed, and multiplex amplified
probe technique, multiple types or subtypes, 3-5 targets
Infectious agent detection by nucleic acid (DNA or RNA);
gastrointestinal pathogen (eg, Clostridium difficile, E. coli,
Salmonella, Shigella, norovirus, Giardia), includes multiplex
reverse transcription, when performed, and multiplex amplified
probe technique, multiple types or subtypes, 6-11 targets
Infectious agent detection by nucleic acid (DNA or RNA);
gastrointestinal pathogen (eg, Clostridium difficile, E. coli,
Salmonella, Shigella, norovirus, Giardia), includes multiplex
reverse transcription, when performed, and multiplex amplified
probe technique, multiple types or subtypes, 12-25 targets
Infectious agent detection by nucleic acid (DNA or RNA);
Gardnerella vaginalis, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Gardnerella vaginalis, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Gardnerella vaginalis, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis B virus, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis B virus, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis C, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis C, amplified probe technique, includes reverse
transcription when performed
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis C, quantification, includes reverse transcription when
performed
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis D (delta), quantification, including reverse
transcription, when performed
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis G, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis G, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis G, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Herpes simplex virus, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Herpes simplex virus, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Herpes simplex virus, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Herpes virus-6, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Herpes virus-6, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Herpes virus-6, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
HIV-1, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
HIV-1, amplified probe technique, includes reverse
transcription when performed
Infectious agent detection by nucleic acid (DNA or RNA);
HIV-1, quantification, includes reverse transcription when
performed
Infectious agent detection by nucleic acid (DNA or RNA);
HIV-2, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
HIV-2, amplified probe technique, includes reverse
transcription when performed
Infectious agent detection by nucleic acid (DNA or RNA);
HIV-2, quantification, includes reverse transcription when
performed
Infectious agent detection by nucleic acid (DNA or RNA);
Legionella pneumophila, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Legionella pneumophila, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Legionella pneumophila, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria species, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria species, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria species, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria tuberculosis, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria tuberculosis, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria tuberculosis, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria avium-intracellulare, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria avium-intracellulare, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycobacteria avium-intracellulare, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Mycoplasma genitalium, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycoplasma pneumoniae, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycoplasma pneumoniae, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Mycoplasma pneumoniae, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Neisseria gonorrhoeae, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Neisseria gonorrhoeae, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Neisseria gonorrhoeae, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia
virus), amplified probe technique, each
Infectious agent detection by nucleic acid (DNA or RNA);
Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43,
44)
Infectious agent detection by nucleic acid (DNA or RNA);
Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31,
33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
Infectious agent detection by nucleic acid (DNA or RNA);
Human Papillomavirus (HPV), types 16 and 18 only, includes
type 45, if performed
Infectious agent detection by nucleic acid (DNA or RNA);
respiratory virus (eg, adenovirus, influenza virus, coronavirus,
metapneumovirus, parainfluenza virus, respiratory syncytial
virus, rhinovirus), includes multiplex reverse transcription,
when performed, and multiplex amplified probe technique,
multiple types or subtypes, 3-5 targets
Infectious agent detection by nucleic acid (DNA or RNA);
respiratory virus (eg, adenovirus, influenza virus, coronavirus,
metapneumovirus, parainfluenza virus, respiratory syncytial
virus, rhinovirus), includes multiplex reverse transcription,
when performed, and multiplex amplified probe technique,
multiple types or subtypes, 6-11 targets
Infectious agent detection by nucleic acid (DNA or RNA);
respiratory virus (eg, adenovirus, influenza virus, coronavirus,
metapneumovirus, parainfluenza virus, respiratory syncytial
virus, rhinovirus), includes multiplex reverse transcription,
when performed, and multiplex amplified probe technique,
multiple types or subtypes, 12-25 targets
Infectious agent detection by nucleic acid (DNA or RNA);
respiratory syncytial virus, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2) (coronavirus disease [COVID-19]), amplified probe
technique
Infectious agent detection by nucleic acid (DNA or RNA);
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2) (coronavirus disease [COVID-19]) and influenza virus types
A and B, multiplex amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2) (coronavirus disease [COVID-19]), influenza virus types A
and B, and respiratory syncytial virus, multiplex amplified
probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Staphylococcus aureus, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Staphylococcus aureus, methicillin resistant, amplified probe
technique
Infectious agent detection by nucleic acid (DNA or RNA);
Streptococcus, group A, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Streptococcus, group A, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Streptococcus, group A, quantification
Infectious agent detection by nucleic acid (DNA or RNA);
Streptococcus, group B, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Trichomonas vaginalis, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA);
Trichomonas vaginalis, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Zika
virus, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA), not
otherwise specified; direct probe technique, each organism
Infectious agent detection by nucleic acid (DNA or RNA), not
otherwise specified; amplified probe technique, each organism
Infectious agent detection by nucleic acid (DNA or RNA), not
otherwise specified; quantification, each organism
Infectious agent detection by nucleic acid (DNA or RNA),
multiple organisms; direct probe(s) technique
Infectious agent detection by nucleic acid (DNA or RNA),
multiple organisms; amplified probe(s) technique
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; Streptococcus, group B
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; Clostridium difficile toxin A
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; Influenza
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; HIV-1 antigen(s), with HIV-1
and HIV-2 antibodies
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; respiratory syncytial virus
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; Trichomonas vaginalis
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; adenovirus
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; Chlamydia trachomatis
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease
[COVID-19])
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; Neisseria gonorrhoeae
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; Streptococcus, group A
Infectious agent antigen detection by immunoassay with direct
optical (ie, visual) observation; not otherwise specified
Infectious agent drug susceptibility phenotype prediction using
regularly updated genotypic bioinformatics
Infectious agent genotype analysis by nucleic acid (DNA or
RNA); HIV-1, reverse transcriptase and protease regions
Infectious agent genotype analysis by nucleic acid (DNA or
RNA); Hepatitis C virus
Infectious agent phenotype analysis by nucleic acid (DNA or
RNA) with drug resistance tissue culture analysis, HIV 1; first
through 10 drugs tested
Infectious agent phenotype analysis by nucleic acid (DNA or
RNA) with drug resistance tissue culture analysis, HIV 1; each
additional drug tested (List separately in addition to code for
primary procedure)
Infectious agent enzymatic activity other than virus (eg,
sialidase activity in vaginal fluid)
Infectious agent genotype analysis by nucleic acid (DNA or
RNA); HIV-1, other region (eg, integrase, fusion)
Infectious agent genotype analysis by nucleic acid (DNA or
RNA); cytomegalovirus
Infectious agent genotype analysis by nucleic acid (DNA or
RNA); Hepatitis B virus
Infectious agent genotype analysis by nucleic acid (DNA or
RNA); severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) (coronavirus disease [COVID-19]), mutation
identification in targeted region(s)
IC
Unlisted microbiology procedure
Anatomic Pathology
IC
Necropsy (autopsy), gross examination only; without CNS
IC
Necropsy (autopsy), gross examination only; with brain
IC
Necropsy (autopsy), gross examination only; with brain and
spinal cord
IC
Necropsy (autopsy), gross examination only; infant with brain
IC
Necropsy (autopsy), gross examination only; stillborn or
newborn with brain
IC
Necropsy (autopsy), gross examination only; macerated
stillborn
IC
Necropsy (autopsy), gross and microscopic; without CNS
IC
Necropsy (autopsy), gross and microscopic; with brain
IC
Necropsy (autopsy), gross and microscopic; with brain and
spinal cord
IC
Necropsy (autopsy), gross and microscopic; infant with brain
IC
Necropsy (autopsy), gross and microscopic; stillborn or
newborn with brain
IC
Necropsy (autopsy), limited, gross and/or microscopic; regional
IC
Necropsy (autopsy), limited, gross and/or microscopic; single
organ
IC
Necropsy (autopsy); forensic examination
IC
Necropsy (autopsy); coroner's call
IC
Unlisted necropsy (autopsy) procedure
Cytopathology
Sex chromatin identification; Barr bodies
Sex chromatin identification; peripheral blood smear,
polymorphonuclear drumsticks
Cytopathology, cervical or vaginal (any reporting system),
collected in preservative fluid, automated thin layer preparation;
manual screening under physician supervision
Cytopathology, cervical or vaginal (any reporting system),
collected in preservative fluid, automated thin layer preparation;
with manual screening and rescreening under physician
supervision
Cytopathology smears, cervical or vaginal; screening by
automated system under physician supervision
Cytopathology smears, cervical or vaginal; screening by
automated system with manual rescreening under physician
supervision
Cytopathology, slides, cervical or vaginal; manual screening
under physician supervision
Cytopathology, slides, cervical or vaginal; with manual
screening and computer-assisted rescreening under physician
supervision
Cytopathology, slides, cervical or vaginal; with manual
screening and rescreening under physician supervision
Cytopathology, slides, cervical or vaginal, definitive hormonal
evaluation (eg, maturation index, karyopyknotic index,
estrogenic index) (List separately in addition to code[s] for
other technical and interpretation services)
Cytopathology, slides, cervical or vaginal (the Bethesda
System); manual screening under physician supervision
Cytopathology, slides, cervical or vaginal (the Bethesda
System); with manual screening and rescreening under
physician supervision
Cytopathology, slides, cervical or vaginal (the Bethesda
System); with manual screening and computer-assisted
rescreening under physician supervision
Cytopathology, slides, cervical or vaginal (the Bethesda
System); with manual screening and computer-assisted
rescreening using cell selection and review under physician
supervision
Cytopathology, cervical or vaginal (any reporting system),
collected in preservative fluid, automated thin layer preparation;
screening by automated system, under physician supervision
Cytopathology, cervical or vaginal (any reporting system),
collected in preservative fluid, automated thin layer preparation;
with screening by automated system and manual rescreening or
review, under physician supervision
Cytogenic Studies
Tissue culture for non-neoplastic disorders; lymphocyte
Tissue culture for non-neoplastic disorders; skin or other solid
tissue biopsy
Tissue culture for non-neoplastic disorders; amniotic fluid or
chorionic villus cells
Tissue culture for neoplastic disorders; bone marrow, blood
cells
Tissue culture for neoplastic disorders; solid tumor
Cryopreservation, freezing and storage of cells, each cell line
Thawing and expansion of frozen cells, each aliquot
Chromosome analysis for breakage syndromes; baseline Sister
Chromatid Exchange (SCE), 20-25 cells
Chromosome analysis for breakage syndromes; baseline
breakage, score 50-100 cells, count 20 cells, 2 karyotypes (eg,
for ataxia telangiectasia, Fanconi anemia, fragile X)
Chromosome analysis for breakage syndromes; score 100 cells,
clastogen stress (eg, diepoxybutane, mitomycin C, ionizing
radiation, UV radiation)
Chromosome analysis; count 5 cells, 1 karyotype, with banding
Chromosome analysis; count 15-20 cells, 2 karyotypes, with
banding
Chromosome analysis; count 45 cells for mosaicism, 2
karyotypes, with banding
Chromosome analysis; analyze 20-25 cells
Chromosome analysis, amniotic fluid or chorionic villus, count
15 cells, 1 karyotype, with banding
Chromosome analysis, in situ for amniotic fluid cells, count
cells from 6-12 colonies, 1 karyotype, with banding
Molecular cytogenetics; DNA probe, each (eg, FISH)
Molecular cytogenetics; chromosomal in situ hybridization,
analyze 3-5 cells (eg, for derivatives and markers)
Molecular cytogenetics; chromosomal in situ hybridization,
analyze 10-30 cells (eg, for microdeletions)
Molecular cytogenetics; interphase in situ hybridization,
analyze 25-99 cells
Molecular cytogenetics; interphase in situ hybridization,
analyze 100-300 cells
Chromosome analysis; additional karyotypes, each study
Chromosome analysis; additional specialized banding technique
(eg, NOR, C-banding)
Chromosome analysis; additional cells counted, each study
Chromosome analysis; additional high resolution study
Protein analysis of tissue by Western Blot, with interpretation
and report;
Protein analysis of tissue by Western Blot, with interpretation
and report; immunological probe for band identification, each
In vivo, (e.g., Transcutaneous) Laboratory Procedures
Bilirubin, total, transcutaneous
Hemoglobin (Hgb), quantitative, transcutaneous
Hemoglobin, quantitative, transcutaneous, per day;
carboxyhemoglobin
Hemoglobin, quantitative, transcutaneous, per day;
methemoglobin
Other Procedures
Cell count, miscellaneous body fluids (eg, cerebrospinal fluid,
joint fluid), except blood;
Cell count, miscellaneous body fluids (eg, cerebrospinal fluid,
joint fluid), except blood; with differential count
Leukocyte assessment, fecal, qualitative or semiquantitative
Crystal identification by light microscopy with or without
polarizing lens analysis, tissue or any body fluid (except urine)
Fat stain, feces, urine, or respiratory secretions
Meat fibers, feces
Nasal smear for eosinophils
Reproductive Medicine Procedures
IC
Culture of oocyte(s)/embryo(s), less than 4 days;
IC
Culture of oocyte(s)/embryo(s), less than 4 days; with co-
culture of oocyte(s)/embryos
IC
Assisted embryo hatching, microtechniques (any method)
IC
Oocyte identification from follicular fluid
IC
Preparation of embryo for transfer (any method)
IC
Sperm identification from aspiration (other than seminal fluid)
IC
Cryopreservation; embryo(s)
IC
Cryopreservation; sperm
IC
Sperm identification from testis tissue, fresh or cryopreserved
IC
Insemination of oocytes
IC
Extended culture of oocyte(s)/embryo(s), 4-7 days
IC
Assisted oocyte fertilization, microtechnique; less than or equal
to 10 oocytes
IC
Assisted oocyte fertilization, microtechnique; greater than 10
oocytes
IC
Biopsy, oocyte polar body or embryo blastomere,
microtechnique (for pre-implantation genetic diagnosis); less
than or equal to 5 embryos
IC
Biopsy, oocyte polar body or embryo blastomere,
microtechnique (for pre-implantation genetic diagnosis); greater
than 5 embryos
Semen analysis; presence and/or motility of sperm including
Huhner test (post coital)
Semen analysis; motility and count (not including Huhner test)
Semen analysis; volume, count, motility, and differential
Semen analysis; sperm presence and motility of sperm, if
performed
Semen analysis; volume, count, motility, and differential using
strict morphologic criteria (eg, Kruger)
Sperm antibodies
Sperm evaluation; hamster penetration test
Sperm evaluation; cervical mucus penetration test, with or
without spinnbarkeit test
Sperm evaluation, for retrograde ejaculation, urine (sperm
concentration, motility, and morphology, as indicated)
IC
Cryopreservation, reproductive tissue, testicular
IC
Storage (per year); embryo(s)
IC
Storage (per year); sperm/semen
IC
Storage (per year); reproductive tissue, testicular/ovarian
IC
Storage (per year); oocyte(s)
IC
Thawing of cryopreserved; embryo(s)
IC
Thawing of cryopreserved; sperm/semen, each aliquot
IC
Thawing of cryopreserved; reproductive tissue,
testicular/ovarian
IC
Thawing of cryopreserved; oocytes, each aliquot
IC
Unlisted reproductive medicine laboratory procedure
Other Pathology and Laboratory
Collection of venous blood by venipuncture
Urea breath test, C-14 (isotopic); acquisition for analysis
Urea breath test, C-14 (isotopic); analysis
Human Platelet Antigen 1 genotyping (HPA-1), ITGB3
(integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61
[GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT],
post-transfusion purpura), gene analysis, common variant,
HPA-1a/b (L33P)
Human Platelet Antigen 2 genotyping (HPA-2), GP1BA
(glycoprotein Ib [platelet], alpha polypeptide [GPIba]) (eg,
neonatal alloimmune thrombocytopenia [NAIT], post-
transfusion purpura), gene analysis, common variant, HPA-2a/b
(T145M)
Human Platelet Antigen 3 genotyping (HPA-3), ITGA2B
(integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa
complex], antigen CD41 [GPIIb]) (eg, neonatal alloimmune
thrombocytopenia [NAIT], post-transfusion purpura), gene
analysis, common variant, HPA-3a/b (I843S)
Human Platelet Antigen 4 genotyping (HPA-4), ITGB3
(integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61
[GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT],
post-transfusion purpura), gene analysis, common variant,
HPA-4a/b (R143Q)
Human Platelet Antigen 5 genotyping (HPA-5), ITGA2
(integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor]
[GPIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT],
post-transfusion purpura), gene analysis, common variant (eg,
HPA-5a/b (K505E))
Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3
(integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61]
[GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT],
post-transfusion purpura), gene analysis, common variant,
HPA-6a/b (R489Q)
Human Platelet Antigen 9 genotyping (HPA-9w), ITGA2B
(integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa
complex, antigen CD41] [GPIIb]) (eg, neonatal alloimmune
thrombocytopenia [NAIT], post-transfusion purpura), gene
analysis, common variant, HPA-9a/b (V837M)
Human Platelet Antigen 15 genotyping (HPA-15), CD109
(CD109 molecule) (eg, neonatal alloimmune thrombocytopenia
[NAIT], post-transfusion purpura), gene analysis, common
variant, HPA-15a/b (S682Y)
IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg,
glioma), common variants (eg, R132H, R132C)
IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial)
(eg, glioma), common variants (eg, R140W, R172M)
DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy)
deletion analysis, and duplication analysis, if performed
$1,609.32
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2,
DNA repair associated) (eg, hereditary breast and ovarian
cancer) gene analysis; full sequence analysis and full
duplication/deletion analysis (ie, detection of large gene
rearrangements)
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2,
DNA repair associated) (eg, hereditary breast and ovarian
cancer) gene analysis; full sequence analysis
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2,
DNA repair associated) (eg, hereditary breast and ovarian
cancer) gene analysis; full duplication/deletion analysis (ie,
detection of large gene rearrangements)
BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast
and ovarian cancer) gene analysis; full sequence analysis
BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast
and ovarian cancer) gene analysis; full duplication/deletion
analysis (ie, detection of large gene rearrangements)
BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast
and ovarian cancer) gene analysis; full duplication/deletion
analysis (ie, detection of large gene rearrangements)
CCND1/IGH (t(11;14)) (eg, mantle cell lymphoma)
translocation analysis, major breakpoint, qualitative and
quantitative, if performed
ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase)
(eg, acquired imatinib tyrosine kinase inhibitor resistance), gene
analysis, variants in the kinase domain
AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg,
fragile X intellectual disability 2 [FRAXE]) gene analysis;
evaluation to detect abnormal (eg, expanded) alleles
AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg,
fragile X intellectual disability 2 [FRAXE]) gene analysis;
characterization of alleles (eg, expanded size and methylation
status)
AR (androgen receptor) (eg, spinal and bulbar muscular
atrophy, Kennedy disease, X chromosome inactivation) gene
analysis; full gene sequence
AR (androgen receptor) (eg, spinal and bulbar muscular
atrophy, Kennedy disease, X chromosome inactivation) gene
analysis; known familial variant
ASXL1 (additional sex combs like 1, transcriptional regulator)
(eg, myelodysplastic syndrome, myeloproliferative neoplasms,
chronic myelomonocytic leukemia), gene analysis; full gene
sequence
ASXL1 (additional sex combs like 1, transcriptional regulator)
(eg, myelodysplastic syndrome, myeloproliferative neoplasms,
chronic myelomonocytic leukemia), gene analysis; targeted
sequence analysis (eg, exon 12)
ATN1 (atrophin 1) (eg, dentatorubral-pallidoluysian atrophy)
gene analysis, evaluation to detect abnormal (eg, expanded)
alleles
ATXN1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis,
evaluation to detect abnormal (eg, expanded) alleles
ATXN2 (ataxin 2) (eg, spinocerebellar ataxia) gene analysis,
evaluation to detect abnormal (eg, expanded) alleles
ATXN3 (ataxin 3) (eg, spinocerebellar ataxia, Machado-Joseph
disease) gene analysis, evaluation to detect abnormal (eg,
expanded) alleles
ATXN7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis,
evaluation to detect abnormal (eg, expanded) alleles
ATXN8OS (ATXN8 opposite strand [non-protein coding]) (eg,
spinocerebellar ataxia) gene analysis, evaluation to detect
abnormal (eg, expanded) alleles
ATXN10 (ataxin 10) (eg, spinocerebellar ataxia) gene analysis,
evaluation to detect abnormal (eg, expanded) alleles
CACNA1A (calcium voltage-gated channel subunit alpha1 A)
(eg, spinocerebellar ataxia) gene analysis; evaluation to detect
abnormal (eg, expanded) alleles
CACNA1A (calcium voltage-gated channel subunit alpha1 A)
(eg, spinocerebellar ataxia) gene analysis; full gene sequence
CACNA1A (calcium voltage-gated channel subunit alpha1 A)
(eg, spinocerebellar ataxia) gene analysis; known familial
variant
CNBP (CCHC-type zinc finger nucleic acid binding protein)
(eg, myotonic dystrophy type 2) gene analysis, evaluation to
detect abnormal (eg, expanded) alleles
CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene
analysis; evaluation to detect abnormal (eg, expanded) alleles
CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene
analysis; full gene sequence
CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene
analysis; known familial variant(s)
NTRK1 (neurotrophic receptor tyrosine kinase 1) (eg, solid
tumors) translocation analysis
NTRK2 (neurotrophic receptor tyrosine kinase 2) (eg, solid
tumors) translocation analysis
NTRK3 (neurotrophic receptor tyrosine kinase 3) (eg, solid
tumors) translocation analysis
NTRK (neurotrophic receptor tyrosine kinase 1, 2, and 3) (eg,
solid tumors) translocation analysis
ASPA (aspartoacylase) (eg, Canavan disease) gene analysis,
common variants (eg, E285A, Y231X)
APC (adenomatous polyposis coli) (eg, familial adenomatosis
polyposis [FAP], attenuated FAP) gene analysis; full gene
sequence
APC (adenomatous polyposis coli) (eg, familial adenomatosis
polyposis [FAP], attenuated FAP) gene analysis; known
familial variants
APC (adenomatous polyposis coli) (eg, familial adenomatosis
polyposis [FAP], attenuated FAP) gene analysis;
duplication/deletion variants
AR (androgen receptor) (eg, spinal and bulbar muscular
atrophy, Kennedy disease, X chromosome inactivation) gene
analysis; characterization of alleles (eg, expanded size or
methylation status)
BCKDHB (branched-chain keto acid dehydrogenase E1, beta
polypeptide) (eg, maple syrup urine disease) gene analysis,
common variants (eg, R183P, G278S, E422X)
BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia)
translocation analysis; major breakpoint, qualitative or
quantitative
BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia)
translocation analysis; minor breakpoint, qualitative or
quantitative
BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia)
translocation analysis; other breakpoint, qualitative or
quantitative
BLM (Bloom syndrome, RecQ helicase-like) (eg, Bloom
syndrome) gene analysis, 2281del6ins7 variant
BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg,
colon cancer, melanoma), gene analysis, V600 variant(s)
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2,
DNA repair associated) (eg, hereditary breast and ovarian
cancer) gene analysis; 185delAG, 5385insC, 6174delT variants
BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast
and ovarian cancer) gene analysis; known familial variant
BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast
and ovarian cancer) gene analysis; full sequence analysis
BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast
and ovarian cancer) gene analysis; known familial variant
CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha)
(eg, acute myeloid leukemia), gene analysis, full gene sequence
CALR (calreticulin) (eg, myeloproliferative disorders), gene
analysis, common variants in exon 9
CFTR (cystic fibrosis transmembrane conductance regulator)
(eg, cystic fibrosis) gene analysis; common variants (eg,
ACMG/ACOG guidelines)
CFTR (cystic fibrosis transmembrane conductance regulator)
(eg, cystic fibrosis) gene analysis; known familial variants
CFTR (cystic fibrosis transmembrane conductance regulator)
(eg, cystic fibrosis) gene analysis; duplication/deletion variants
CFTR (cystic fibrosis transmembrane conductance regulator)
(eg, cystic fibrosis) gene analysis; full gene sequence
CFTR (cystic fibrosis transmembrane conductance regulator)
(eg, cystic fibrosis) gene analysis; intron 8 poly-T analysis (eg,
male infertility)
CYP2C19 (cytochrome P450, family 2, subfamily C,
polypeptide 19) (eg, drug metabolism), gene analysis, common
variants (eg, *2, *3, *4, *8, *17)
CYP2D6 (cytochrome P450, family 2, subfamily D,
polypeptide 6) (eg, drug metabolism), gene analysis, common
variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35,
*41, *1XN, *2XN, *4XN)
CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide
9) (eg, drug metabolism), gene analysis, common variants (eg,
*2, *3, *5, *6)
Cytogenomic (genome-wide) analysis for constitutional
chromosomal abnormalities; interrogation of genomic regions
for copy number variants, comparative genomic hybridization
[CGH] microarray analysis
$1,022.98
Cytogenomic (genome-wide) analysis for constitutional
chromosomal abnormalities; interrogation of genomic regions
for copy number and single nucleotide polymorphism (SNP)
variants, comparative genomic hybridization (CGH) microarray
analysis
CYP3A4 (cytochrome P450 family 3 subfamily A member 4)
(eg, drug metabolism), gene analysis, common variant(s) (eg,
*2, *22)
CYP3A5 (cytochrome P450 family 3 subfamily A member 5)
(eg, drug metabolism), gene analysis, common variants (eg, *2,
*3, *4, *5, *6, *7)
DPYD (dihydropyrimidine dehydrogenase) (eg, 5-
fluorouracil/5-FU and capecitabine drug metabolism), gene
analysis, common variant(s) (eg, *2A, *4, *5, *6)
BTK (Bruton's tyrosine kinase) (eg, chronic lymphocytic
leukemia) gene analysis, common variants (eg, C481S, C481R,
C481F)
DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1)
gene analysis; evaluation to detect abnormal (expanded) alleles
EGFR (epidermal growth factor receptor) (eg, non-small cell
lung cancer) gene analysis, common variants (eg, exon 19
LREA deletion, L858R, T790M, G719A, G719S, L861Q)
EZH2 (enhancer of zeste 2 polycomb repressive complex 2
subunit) (eg, myelodysplastic syndrome, myeloproliferative
neoplasms) gene analysis, full gene sequence
EZH2 (enhancer of zeste 2 polycomb repressive complex 2
subunit) (eg, diffuse large B-cell lymphoma) gene analysis,
common variant(s) (eg, codon 646)
F9 (coagulation factor IX) (eg, hemophilia B), full gene
sequence
DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1)
gene analysis; characterization of alleles (eg, expanded size)
F2 (prothrombin, coagulation factor II) (eg, hereditary
hypercoagulability) gene analysis, 20210G>A variant
F5 (coagulation factor V) (eg, hereditary hypercoagulability)
gene analysis, Leiden variant
FANCC (Fanconi anemia, complementation group C) (eg,
Fanconi anemia, type C) gene analysis, common variant (eg,
IVS4+4A>T)
FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X
syndrome, X-linked intellectual disability [XLID]) gene
analysis; evaluation to detect abnormal (eg, expanded) alleles
FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X
syndrome, X-linked intellectual disability [XLID]) gene
analysis; characterization of alleles (eg, expanded size and
promoter methylation status)
FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid
leukemia), gene analysis; internal tandem duplication (ITD)
variants (ie, exons 14, 15)
FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid
leukemia), gene analysis; tyrosine kinase domain (TKD)
variants (eg, D835, I836)
G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic
anemia, jaundice), gene analysis; common variant(s) (eg, A, A-)
G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic
anemia, jaundice), gene analysis; known familial variant(s)
G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic
anemia, jaundice), gene analysis; full gene sequence
G6PC (glucose-6-phosphatase, catalytic subunit) (eg, Glycogen
storage disease, type 1a, von Gierke disease) gene analysis,
common variants (eg, R83C, Q347X)
GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene
analysis, common variants (eg, N370S, 84GG, L444P,
IVS2+1G>A)
GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg,
nonsyndromic hearing loss) gene analysis; full gene sequence
GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg,
nonsyndromic hearing loss) gene analysis; known familial
variants
GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (eg,
nonsyndromic hearing loss) gene analysis, common variants
(eg, 309kb [del(GJB6-D13S1830)] and 232kb [del(GJB6-
D13S1854)])
HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay-Sachs
disease) gene analysis, common variants (eg, 1278insTATC,
1421+1G>C, G269S)
HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene
analysis, common variants (eg, C282Y, H63D)
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha
thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease),
gene analysis; common deletions or variant (eg, Southeast
Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2,
alpha20.5, Constant Spring)
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha
thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease),
gene analysis; known familial variant
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha
thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease),
gene analysis; full gene sequence
IKBKAP (inhibitor of kappa light polypeptide gene enhancer in
B-cells, kinase complex-associated protein) (eg, familial
dysautonomia) gene analysis, common variants (eg,
2507+6T>C, R696P)
IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and
lymphomas, B-cell), gene rearrangement analysis to detect
abnormal clonal population(s); amplified methodology (eg,
polymerase chain reaction)
IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and
lymphomas, B-cell), gene rearrangement analysis to detect
abnormal clonal population(s); direct probe methodology (eg,
Southern blot)
IGH@ (Immunoglobulin heavy chain locus) (eg, leukemia and
lymphoma, B-cell), variable region somatic mutation analysis
IGK@ (Immunoglobulin kappa light chain locus) (eg, leukemia
and lymphoma, B-cell), gene rearrangement analysis,
evaluation to detect abnormal clonal population(s)
Comparative analysis using Short Tandem Repeat (STR)
markers; patient and comparative specimen (eg, pre-transplant
recipient and donor germline testing, post-transplant non-
hematopoietic recipient germline [eg, buccal swab or other
germline tissue sample] and donor testing, twin zygosity
testing, or maternal cell contamination of fetal cells)
Comparative analysis using Short Tandem Repeat (STR)
markers; each additional specimen (eg, additional cord blood
donor, additional fetal samples from different cultures, or
additional zygosity in multiple birth pregnancies) (List
separately in addition to code for primary procedure)
Chimerism (engraftment) analysis, post transplantation
specimen (eg, hematopoietic stem cell), includes comparison to
previously performed baseline analyses; without cell selection
Chimerism (engraftment) analysis, post transplantation
specimen (eg, hematopoietic stem cell), includes comparison to
previously performed baseline analyses; with cell selection (eg,
CD3, CD33), each cell type
HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha
thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease),
gene analysis; duplication/deletion variants
JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene
analysis, p.Val617Phe (V617F) variant
HTT (huntingtin) (eg, Huntington disease) gene analysis;
evaluation to detect abnormal (eg, expanded) alleles
KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene
homolog) (eg, gastrointestinal stromal tumor [GIST], acute
myeloid leukemia, melanoma), gene analysis, targeted sequence
analysis (eg, exons 8, 11, 13, 17, 18)
KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene
homolog) (eg, mastocytosis), gene analysis, D816 variant(s)
HTT (huntingtin) (eg, Huntington disease) gene analysis;
characterization of alleles (eg, expanded size)
KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg,
carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and
13)
KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg,
carcinoma) gene analysis; additional variant(s) (eg, codon 61,
codon 146)
$1,022.98
Cytogenomic neoplasia (genome-wide) microarray analysis,
interrogation of genomic regions for copy number and loss-of-
heterozygosity variants for chromosomal abnormalities
IGH@/BCL2 (t(14;18)) (eg, follicular lymphoma) translocation
analysis, major breakpoint region (MBR) and minor cluster
region (mcr) breakpoints, qualitative or quantitative
JAK2 (Janus kinase 2) (eg, myeloproliferative disorder)
targeted sequence analysis (eg, exons 12 and 13)
IFNL3 (interferon, lambda 3) (eg, drug response), gene
analysis, rs12979860 variant
FXN (frataxin) (eg, Friedreich ataxia) gene analysis; evaluation
to detect abnormal (expanded) alleles
FXN (frataxin) (eg, Friedreich ataxia) gene analysis;
characterization of alleles (eg, expanded size)
FXN (frataxin) (eg, Friedreich ataxia) gene analysis; full gene
sequence
MGMT (O-6-methylguanine-DNA methyltransferase) (eg,
glioblastoma multiforme) promoter methylation analysis
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2)
(eg, hereditary non-polyposis colorectal cancer, Lynch
syndrome) gene analysis; promoter methylation analysis
FXN (frataxin) (eg, Friedreich ataxia) gene analysis; known
familial variant(s)
MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene
analysis, common variants (eg, IVS3-2A>G, del6.4kb)
MTHFR (5,10-methylenetetrahydrofolate reductase) (eg,
hereditary hypercoagulability) gene analysis, common variants
(eg, 677T, 1298C)
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2)
(eg, hereditary non-polyposis colorectal cancer, Lynch
syndrome) gene analysis; full sequence analysis
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2)
(eg, hereditary non-polyposis colorectal cancer, Lynch
syndrome) gene analysis; known familial variants
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2)
(eg, hereditary non-polyposis colorectal cancer, Lynch
syndrome) gene analysis; duplication/deletion variants
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1)
(eg, hereditary non-polyposis colorectal cancer, Lynch
syndrome) gene analysis; full sequence analysis
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1)
(eg, hereditary non-polyposis colorectal cancer, Lynch
syndrome) gene analysis; known familial variants
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1)
(eg, hereditary non-polyposis colorectal cancer, Lynch
syndrome) gene analysis; duplication/deletion variants
MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-
polyposis colorectal cancer, Lynch syndrome) gene analysis;
full sequence analysis
MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-
polyposis colorectal cancer, Lynch syndrome) gene analysis;
known familial variants
MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-
polyposis colorectal cancer, Lynch syndrome) gene analysis;
duplication/deletion variants
Microsatellite instability analysis (eg, hereditary non-polyposis
colorectal cancer, Lynch syndrome) of markers for mismatch
repair deficiency (eg, BAT25, BAT26), includes comparison of
neoplastic and normal tissue, if performed
MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome)
gene analysis; full sequence analysis
MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome)
gene analysis; known familial variant
MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome)
gene analysis; duplication/deletion variants
MYD88 (myeloid differentiation primary response 88) (eg,
Waldenstrom's macroglobulinemia, lymphoplasmacytic
leukemia) gene analysis, p.Leu265Pro (L265P) variant
NUDT15 (nudix hydrolase 15) (eg, drug metabolism) gene
analysis, common variant(s) (eg, *2, *3, *4, *5, *6)
PALB2 (partner and localizer of BRCA2) (eg, breast and
pancreatic cancer) gene analysis; full gene sequence
PALB2 (partner and localizer of BRCA2) (eg, breast and
pancreatic cancer) gene analysis; known familial variant
PIK3CA (phosphatidylinositol-4, 5-biphosphate 3-kinase,
catalytic subunit alpha) (eg, colorectal and breast cancer) gene
analysis, targeted sequence analysis (eg, exons 7, 9, 20)
NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene
analysis, exon 12 variants
NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog)
(eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg,
codons 12 and 13) and exon 3 (eg, codon 61)
PABPN1 (poly[A] binding protein nuclear 1) (eg,
oculopharyngeal muscular dystrophy) gene analysis, evaluation
to detect abnormal (eg, expanded) alleles
PCA3/KLK3 (prostate cancer antigen 3 [non-protein
coding]/kallikrein-related peptidase 3 [prostate specific
antigen]) ratio (eg, prostate cancer)
PDGFRA (platelet-derived growth factor receptor, alpha
polypeptide) (eg, gastrointestinal stromal tumor [GIST]), gene
analysis, targeted sequence analysis (eg, exons 12, 18)
PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic
acid receptor alpha) (eg, promyelocytic leukemia) translocation
analysis; common breakpoints (eg, intron 3 and intron 6),
qualitative or quantitative
PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic
acid receptor alpha) (eg, promyelocytic leukemia) translocation
analysis; single breakpoint (eg, intron 3, intron 6 or exon 6),
qualitative or quantitative
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg,
hereditary non-polyposis colorectal cancer, Lynch syndrome)
gene analysis; full sequence analysis
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg,
hereditary non-polyposis colorectal cancer, Lynch syndrome)
gene analysis; known familial variants
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg,
hereditary non-polyposis colorectal cancer, Lynch syndrome)
gene analysis; duplication/deletion variants
PLCG2 (phospholipase C gamma 2) (eg, chronic lymphocytic
leukemia) gene analysis, common variants (eg, R665W, S707F,
L845F)
PTEN (phosphatase and tensin homolog) (eg, Cowden
syndrome, PTEN hamartoma tumor syndrome) gene analysis;
full sequence analysis
PTEN (phosphatase and tensin homolog) (eg, Cowden
syndrome, PTEN hamartoma tumor syndrome) gene analysis;
known familial variant
PTEN (phosphatase and tensin homolog) (eg, Cowden
syndrome, PTEN hamartoma tumor syndrome) gene analysis;
duplication/deletion variant
PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-
Tooth, hereditary neuropathy with liability to pressure palsies)
gene analysis; duplication/deletion analysis
PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-
Tooth, hereditary neuropathy with liability to pressure palsies)
gene analysis; full sequence analysis
PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-
Tooth, hereditary neuropathy with liability to pressure palsies)
gene analysis; known familial variant
SEPT9 (Septin9) (eg, colorectal cancer) promoter methylation
analysis
SLCO1B1 (solute carrier organic anion transporter family,
member 1B1) (eg, adverse drug reaction), gene analysis,
common variant(s) (eg, *5)
SMN1 (survival of motor neuron 1, telomeric) (eg, spinal
muscular atrophy) gene analysis; dosage/deletion analysis (eg,
carrier testing), includes SMN2 (survival of motor neuron 2,
centromeric) analysis, if performed
SMPD1(sphingomyelin phosphodiesterase 1, acid lysosomal)
(eg, Niemann-Pick disease, Type A) gene analysis, common
variants (eg, R496L, L302P, fsP330)
SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide
N and ubiquitin protein ligase E3A) (eg, Prader-Willi syndrome
and/or Angelman syndrome), methylation analysis
SERPINA1 (serpin peptidase inhibitor, clade A, alpha-1
antiproteinase, antitrypsin, member 1) (eg, alpha-1-antitrypsin
deficiency), gene analysis, common variants (eg, *S and *Z)
TGFBI (transforming growth factor beta-induced) (eg, corneal
dystrophy) gene analysis, common variants (eg, R124H,
R124C, R124L, R555W, R555Q)
RUNX1 (runt related transcription factor 1) (eg, acute myeloid
leukemia, familial platelet disorder with associated myeloid
malignancy), gene analysis, targeted sequence analysis (eg,
exons 3-8)
TPMT (thiopurine S-methyltransferase) (eg, drug metabolism),
gene analysis, common variants (eg, *2, *3)
SMN1 (survival of motor neuron 1, telomeric) (eg, spinal
muscular atrophy) gene analysis; full gene sequence
SMN1 (survival of motor neuron 1, telomeric) (eg, spinal
muscular atrophy) gene analysis; known familial sequence
variant(s)
MPL (MPL proto-oncogene, thrombopoietin receptor) (eg,
myeloproliferative disorder) gene analysis; common variants
(eg, W515A, W515K, W515L, W515R)
MPL (MPL proto-oncogene, thrombopoietin receptor) (eg,
myeloproliferative disorder) gene analysis; sequence analysis,
exon 10
TRB@ (T cell antigen receptor, beta) (eg, leukemia and
lymphoma), gene rearrangement analysis to detect abnormal
clonal population(s); using amplification methodology (eg,
polymerase chain reaction)
TRB@ (T cell antigen receptor, beta) (eg, leukemia and
lymphoma), gene rearrangement analysis to detect abnormal
clonal population(s); using direct probe methodology (eg,
Southern blot)
TRG@ (T cell antigen receptor, gamma) (eg, leukemia and
lymphoma), gene rearrangement analysis, evaluation to detect
abnormal clonal population(s)
PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (eg,
spinocerebellar ataxia) gene analysis, evaluation to detect
abnormal (eg, expanded) alleles
TBP (TATA box binding protein) (eg, spinocerebellar ataxia)
gene analysis, evaluation to detect abnormal (eg, expanded)
alleles
TERT (telomerase reverse transcriptase) (eg, thyroid
carcinoma, glioblastoma multiforme) gene analysis, targeted
sequence analysis (eg, promoter region)
TYMS (thymidylate synthetase) (eg, 5-fluorouracil/5-FU drug
metabolism), gene analysis, common variant(s) (eg, tandem
repeat variant)
SF3B1 (splicing factor [3b] subunit B1) (eg, myelodysplastic
syndrome/acute myeloid leukemia) gene analysis, common
variants (eg, A672T, E622D, L833F, R625C, R625L)
SRSF2 (serine and arginine-rich splicing factor 2) (eg,
myelodysplastic syndrome, acute myeloid leukemia) gene
analysis, common variants (eg, P95H, P95L)
$1,022.98
Cytogenomic (genome-wide) analysis for constitutional
chromosomal abnormalities; interrogation of genomic regions
for copy number and loss-of-heterozygosity variants, low-pass
sequencing analysis
UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide
A1) (eg, drug metabolism, hereditary unconjugated
hyperbilirubinemia [Gilbert syndrome]) gene analysis, common
variants (eg, *28, *36, *37)
TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene
analysis; full gene sequence
TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene
analysis; targeted sequence analysis (eg, 4 oncology)
TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene
analysis; known familial variant
VKORC1 (vitamin K epoxide reductase complex, subunit 1)
(eg, warfarin metabolism), gene analysis, common variant(s)
(eg, -1639G>A, c.173+1000C>T)
U2AF1 (U2 small nuclear RNA auxiliary factor 1) (eg,
myelodysplastic syndrome, acute myeloid leukemia) gene
analysis, common variants (eg, S34F, S34Y, Q157R, Q157P)
ZRSR2 (zinc finger CCCH-type, RNA binding motif and
serine/arginine-rich 2) (eg, myelodysplastic syndrome, acute
myeloid leukemia) gene analysis, common variant(s) (eg,
E65fs, E122fs, R448fs)
HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta
thalassemia, hemoglobinopathy); common variant(s) (eg, HbS,
HbC, HbE)
HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta
thalassemia, hemoglobinopathy); known familial variant(s)
HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta
thalassemia, hemoglobinopathy); duplication/deletion variant(s)
HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta
thalassemia, hemoglobinopathy); full gene sequence
HLA Class I and II typing, low resolution (eg, antigen
equivalents); HLA-A, -B, -C, -DRB1/3/4/5, and -DQB1
HLA Class I and II typing, low resolution (eg, antigen
equivalents); HLA-A, -B, and -DRB1 (eg, verification typing)
HLA Class I typing, low resolution (eg, antigen equivalents);
complete (ie, HLA-A, -B, and -C)
HLA Class I typing, low resolution (eg, antigen equivalents);
one locus (eg, HLA-A, -B, or -C), each
HLA Class I typing, low resolution (eg, antigen equivalents);
one antigen equivalent (eg, B*27), each
HLA Class II typing, low resolution (eg, antigen equivalents);
HLA-DRB1/3/4/5 and -DQB1
HLA Class II typing, low resolution (eg, antigen equivalents);
one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -
DPB1, or -DPA1), each
HLA Class II typing, low resolution (eg, antigen equivalents);
one antigen equivalent, each
HLA Class I and II typing, high resolution (ie, alleles or allele
groups), HLA-A, -B, -C, and -DRB1
HLA Class I typing, high resolution (ie, alleles or allele
groups); complete (ie, HLA-A, -B, and -C)
HLA Class I typing, high resolution (ie, alleles or allele
groups); one locus (eg, HLA-A, -B, or -C), each
HLA Class I typing, high resolution (ie, alleles or allele
groups); one allele or allele group (eg, B*57:01P), each
HLA Class II typing, high resolution (ie, alleles or allele
groups); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -
DQA1, -DPB1, or -DPA1), each
HLA Class II typing, high resolution (ie, alleles or allele
groups); one allele or allele group (eg, HLA-DQB1*06:02P),
each
Molecular pathology procedure, Level 1 (eg, identification of
single germline variant [eg, SNP] by techniques such as
restriction enzyme digestion or melt curve analysis)
Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1
methylated variant, or 1 somatic variant [typically using
nonsequencing target variant analysis], or detection of a
dynamic mutation disorder/triplet repeat)
Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10
methylated variants, or 2-10 somatic variants [typically using
non-sequencing target variant analysis], immunoglobulin and T-
cell receptor gene rearrangements, duplication/deletion variants
of 1 exon, loss of heterozygosity [LOH], uniparental disomy
[UPD])
Molecular pathology procedure, Level 4 (eg, analysis of single
exon by DNA sequence analysis, analysis of >10 amplicons
using multiplex PCR in 2 or more independent reactions,
mutation scanning or duplication/deletion variants of 2-5 exons)
Molecular pathology procedure, Level 5 (eg, analysis of 2-5
exons by DNA sequence analysis, mutation scanning or
duplication/deletion variants of 6-10 exons, or characterization
of a dynamic mutation disorder/triplet repeat by Southern blot
analysis)
Molecular pathology procedure, Level 6 (eg, analysis of 6-10
exons by DNA sequence analysis, mutation scanning or
duplication/deletion variants of 11-25 exons, regionally targeted
cytogenomic array analysis)
Molecular pathology procedure, Level 7 (eg, analysis of 11-25
exons by DNA sequence analysis, mutation scanning or
duplication/deletion variants of 26-50 exons)
Molecular pathology procedure, Level 8 (eg, analysis of 26-50
exons by DNA sequence analysis, mutation scanning or
duplication/deletion variants of >50 exons, sequence analysis of
multiple genes on one platform)
$1,763.75
Molecular pathology procedure, Level 9 (eg, analysis of >50
exons in a single gene by DNA sequence analysis)
Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys
Dietz syndrome, Ehler Danlos syndrome type IV, arterial
tortuosity syndrome); genomic sequence analysis panel, must
include sequencing of at least 9 genes, including FBN1,
TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10,
SMAD3, and MYLK
$1,190.70
Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys
Dietz syndrome, Ehler Danlos syndrome type IV, arterial
tortuosity syndrome); duplication/deletion analysis panel, must
include analyses for TGFBR1, TGFBR2, MYH11, and
COL3A1
$2,159.32
Ashkenazi Jewish associated disorders (eg, Bloom syndrome,
Canavan disease, cystic fibrosis, familial dysautonomia,
Fanconi anemia group C, Gaucher disease, Tay-Sachs disease),
genomic sequence analysis panel, must include sequencing of at
least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA,
HEXA, IKBKAP, MCOLN1, and SMPD1
Cardiac ion channelopathies (eg, Brugada syndrome, long QT
syndrome, short QT syndrome, catecholaminergic polymorphic
ventricular tachycardia); genomic sequence analysis panel, must
include sequencing of at least 10 genes, including ANK2,
CASQ2, CAV3, KCNE1, KCNE2, KCNH2, KCNJ2, KCNQ1,
RYR2, and SCN5A
Cardiac ion channelopathies (eg, Brugada syndrome, long QT
syndrome, short QT syndrome, catecholaminergic polymorphic
ventricular tachycardia); duplication/deletion gene analysis
panel, must include analysis of at least 2 genes, including
KCNH2 and KCNQ1
$4,215.36
Exome (eg, unexplained constitutional or heritable disorder or
syndrome); sequence analysis
$10,582.50
Exome (eg, unexplained constitutional or heritable disorder or
syndrome); sequence analysis, each comparator exome (eg,
parents, siblings) (List separately in addition to code for
primary procedure)
Exome (eg, unexplained constitutional or heritable disorder or
syndrome); re-evaluation of previously obtained exome
sequence (eg, updated knowledge or unrelated
condition/syndrome)
Drug metabolism (eg, pharmacogenomics) genomic sequence
analysis panel, must include testing of at least 6 genes,
including CYP2C19, CYP2D6, and CYP2D6
duplication/deletion analysis
$2,159.32
Epilepsy genomic sequence analysis panel, must include
analyses for ALDH7A1, CACNA1A, CDKL5, CHD2,
GABRG2, GRIN2A, KCNQ2, MECP2, PCDH19, POLG,
PRRT2, SCN1A, SCN1B, SCN2A, SCN8A, SLC2A1,
SLC9A6, STXBP1, SYNGAP1, TCF4, TPP1, TSC1, TSC2,
and ZEB2
Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X)
genomic sequence analysis panel, circulating cell-free fetal
DNA in maternal blood, must include analysis of chromosomes
13, 18, and 21
Fetal chromosomal microdeletion(s) genomic sequence analysis
(eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating
cell-free fetal DNA in maternal blood
$4,436.89
Genome (eg, unexplained constitutional or heritable disorder or
syndrome); sequence analysis
$2,389.84
Genome (eg, unexplained constitutional or heritable disorder or
syndrome); sequence analysis, each comparator genome (eg,
parents, siblings) (List separately in addition to code for
primary procedure)
$2,061.52
Genome (eg, unexplained constitutional or heritable disorder or
syndrome); re-evaluation of previously obtained genome
sequence (eg, updated knowledge or unrelated
condition/syndrome)
$1,433.05
Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome,
Pendred syndrome); genomic sequence analysis panel, must
include sequencing of at least 60 genes, including CDH23,
CLRN1, GJB2, GPR98, MTRNR1, MYO7A, MYO15A,
PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C,
USH1G, USH2A, and WFS1
Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome,
Pendred syndrome); duplication/deletion analysis panel, must
include copy number analyses for STRC and DFNB1 deletions
in GJB2 and GJB6 genes
Hereditary breast cancer-related disorders (eg, hereditary breast
cancer, hereditary ovarian cancer, hereditary endometrial
cancer); genomic sequence analysis panel, must include
sequencing of at least 10 genes, always including BRCA1,
BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN,
STK11, and TP53
Hereditary breast cancer-related disorders (eg, hereditary breast
cancer, hereditary ovarian cancer, hereditary endometrial
cancer); duplication/deletion analysis panel, must include
analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11
Hereditary retinal disorders (eg, retinitis pigmentosa, Leber
congenital amaurosis, cone-rod dystrophy), genomic sequence
analysis panel, must include sequencing of at least 15 genes,
including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B,
PRPF31, PRPH2, RDH12, RHO, RP1, RP2, RPE65, RPGR,
and USH2A
Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN
hamartoma syndrome, Cowden syndrome, familial
adenomatosis polyposis); genomic sequence analysis panel,
must include sequencing of at least 10 genes, including APC,
BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN,
SMAD4, and STK11
Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN
hamartoma syndrome, Cowden syndrome, familial
adenomatosis polyposis); duplication/deletion analysis panel,
must include analysis of at least 5 genes, including MLH1,
MSH2, EPCAM, SMAD4, and STK11
Hereditary neuroendocrine tumor disorders (eg, medullary
thyroid carcinoma, parathyroid carcinoma, malignant
pheochromocytoma or paraganglioma); genomic sequence
analysis panel, must include sequencing of at least 6 genes,
including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL
Hereditary neuroendocrine tumor disorders (eg, medullary
thyroid carcinoma, parathyroid carcinoma, malignant
pheochromocytoma or paraganglioma); duplication/deletion
analysis panel, must include analyses for SDHB, SDHC,
SDHD, and VHL
Hereditary cardiomyopathy (eg, hypertrophic cardiomyopathy,
dilated cardiomyopathy, arrhythmogenic right ventricular
cardiomyopathy), genomic sequence analysis panel, must
include sequencing of at least 5 cardiomyopathy-related genes
(eg, DSG2, MYBPC3, MYH7, PKP2, TTN)
$2,931.35
Nuclear encoded mitochondrial genes (eg, neurologic or
myopathic phenotypes), genomic sequence panel, must include
analysis of at least 100 genes, including BCS1L, C10orf2,
COQ2, COX10, DGUOK, MPV17, OPA1, PDSS2, POLG,
POLG2, RRM2B, SCO1, SCO2, SLC25A4, SUCLA2,
SUCLG1, TAZ, TK2, and TYMP
$2,159.32
Inherited bone marrow failure syndromes (IBMFS) (eg,
Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan
anemia, Shwachman-Diamond syndrome, GATA2 deficiency
syndrome, congenital amegakaryocytic thrombocytopenia)
sequence analysis panel, must include sequencing of at least 30
genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB,
FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI,
FANCL, GATA1, GATA2, MPL, NHP2, NOP10, PALB2,
RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24,
RPS26, RPS7, SBDS, TERT, and TINF2
$1,890.39
Noonan spectrum disorders (eg, Noonan syndrome, cardio-
facio-cutaneous syndrome, Costello syndrome, LEOPARD
syndrome, Noonan-like syndrome), genomic sequence analysis
panel, must include sequencing of at least 12 genes, including
BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS,
PTPN11, RAF1, RIT1, SHOC2, and SOS1
$2,159.32
Genetic testing for severe inherited conditions (eg, cystic
fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom
syndrome, Canavan disease, Fanconi anemia type C,
mucolipidosis type VI, Gaucher disease, Tay-Sachs disease],
beta hemoglobinopathies, phenylketonuria, galactosemia),
genomic sequence analysis panel, must include sequencing of at
least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B,
BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC,
GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP,
MCOLN1, PAH)
Solid organ neoplasm, genomic sequence analysis panel, 5-50
genes, interrogation for sequence variants and copy number
variants or rearrangements, if performed; DNA analysis or
combined DNA and RNA analysis
Hereditary peripheral neuropathies (eg, Charcot-Marie-Tooth,
spastic paraplegia), genomic sequence analysis panel, must
include sequencing of at least 5 peripheral neuropathy-related
genes (eg, BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST,
SPG11, SPTLC1)
Solid organ neoplasm, genomic sequence analysis panel, 5-50
genes, interrogation for sequence variants and copy number
variants or rearrangements, if performed; RNA analysis
Hematolymphoid neoplasm or disorder, genomic sequence
analysis panel, 5-50 genes, interrogation for sequence variants,
and copy number variants or rearrangements, or isoform
expression or mRNA expression levels, if performed; DNA
analysis or combined DNA and RNA analysis
Hematolymphoid neoplasm or disorder, genomic sequence
analysis panel, 5-50 genes, interrogation for sequence variants,
and copy number variants or rearrangements, or isoform
expression or mRNA expression levels, if performed; RNA
analysis
$2,574.72
Solid organ or hematolymphoid neoplasm or disorder, 51 or
greater genes, genomic sequence analysis panel, interrogation
for sequence variants and copy number variants or
rearrangements, or isoform expression or mRNA expression
levels, if performed; DNA analysis or combined DNA and
RNA analysis
$2,574.72
Solid organ or hematolymphoid neoplasm or disorder, 51 or
greater genes, genomic sequence analysis panel, interrogation
for sequence variants and copy number variants or
rearrangements, or isoform expression or mRNA expression
levels, if performed; RNA analysis
Solid organ neoplasm, genomic sequence analysis panel,
interrogation for sequence variants; DNA analysis,
microsatellite instability
Solid organ neoplasm, genomic sequence analysis panel,
interrogation for sequence variants; DNA analysis, copy
number variants and microsatellite instability
Solid organ neoplasm, genomic sequence analysis panel,
interrogation for sequence variants; DNA analysis or combined
DNA and RNA analysis, copy number variants, microsatellite
instability, tumor mutation burden, and rearrangements
$1,134.97
Whole mitochondrial genome (eg, Leigh syndrome,
mitochondrial encephalomyopathy, lactic acidosis, and stroke-
like episodes [MELAS], myoclonic epilepsy with ragged-red
fibers [MERFF], neuropathy, ataxia, and retinitis pigmentosa
[NARP], Leber hereditary optic neuropathy [LHON]), genomic
sequence, must include sequence analysis of entire
mitochondrial genome with heteroplasmy detection
Solid organ neoplasm, genomic sequence analysis panel, cell-
free nucleic acid (eg, plasma), interrogation for sequence
variants; DNA analysis or combined DNA and RNA analysis,
copy number variants and rearrangements
Solid organ neoplasm, genomic sequence analysis panel, cell-
free nucleic acid (eg, plasma), interrogation for sequence
variants; DNA analysis, copy number variants, and
microsatellite instability
Solid organ neoplasm, genomic sequence analysis panel, cell-
free nucleic acid (eg, plasma), interrogation for sequence
variants; DNA analysis or combined DNA and RNA analysis,
copy number variants, microsatellite instability, tumor mutation
burden, and rearrangements
Whole mitochondrial genome large deletion analysis panel (eg,
Kearns-Sayre syndrome, chronic progressive external
ophthalmoplegia), including heteroplasmy detection, if
performed
X-linked intellectual disability (XLID) (eg, syndromic and non-
syndromic XLID); genomic sequence analysis panel, must
include sequencing of at least 60 genes, including ARX, ATRX,
CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C,
L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and
SLC16A2
X-linked intellectual disability (XLID) (eg, syndromic and non-
syndromic XLID); duplication/deletion gene analysis, must
include analysis of at least 60 genes, including ARX, ATRX,
CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C,
L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and
SLC16A2
IC
Unlisted molecular pathology procedure
Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers
using immunoassays, utilizing serum, prognostic algorithm
reported as a disease activity score
Coronary artery disease, mRNA, gene expression profiling by
real-time RT-PCR of 23 genes, utilizing whole peripheral
blood, algorithm reported as a risk score
Oncology (ovarian), biochemical assays of two proteins (CA-
125 and HE4), utilizing serum, with menopausal status,
algorithm reported as a risk score
Oncology (ovarian), biochemical assays of five proteins (CA-
125, apolipoprotein A1, beta-2 microglobulin, transferrin, and
pre-albumin), utilizing serum, algorithm reported as a risk score
Oncology (tissue of origin), microarray gene expression
profiling of > 2000 genes, utilizing formalin-fixed paraffin-
embedded tissue, algorithm reported as tissue similarity scores
Endocrinology (type 2 diabetes), biochemical assays of seven
analytes (glucose, HbA1c, insulin, hs-CRP, adiponectin,
ferritin, interleukin 2-receptor alpha), utilizing serum or plasma,
algorithm reporting a risk score
Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence
analysis of selected regions using maternal plasma, algorithm
reported as a risk score for each trisomy
Fetal congenital abnormalities, biochemical assays of two
proteins (PAPP-A, hCG [any form]), utilizing maternal serum,
algorithm reported as a risk score
$1,311.67
Fetal congenital abnormalities, biochemical assays of three
proteins (PAPP-A, hCG [any form], DIA), utilizing maternal
serum, algorithm reported as a risk score
Fetal congenital abnormalities, biochemical assays of three
analytes (AFP, uE3, hCG [any form]), utilizing maternal serum,
algorithm reported as a risk score
Fetal congenital abnormalities, biochemical assays of four
analytes (AFP, uE3, hCG [any form], DIA) utilizing maternal
serum, algorithm reported as a risk score (may include
additional results from previous biochemical testing)
Fetal congenital abnormalities, biochemical assays of five
analytes (AFP, uE3, total hCG, hyperglycosylated hCG, DIA)
utilizing maternal serum, algorithm reported as a risk score
Infectious disease, bacterial vaginosis, quantitative real-time
amplification of RNA markers for Atopobium vaginae,
Gardnerella vaginalis, and Lactobacillus species, utilizing
vaginal-fluid specimens, algorithm reported as a positive or
negative result for bacterial vaginosis
Infectious disease, bacterial vaginosis and vaginitis, quantitative
real-time amplification of DNA markers for Gardnerella
vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial
Vaginosis Associated Bacteria-2 (BVAB-2), and Lactobacillus
species (L. crispatus and L. jensenii), utilizing vaginal-fluid
specimens, algorithm reported as a positive or negative for high
likelihood of bacterial vaginosis, includes separate detection of
Trichomonas vaginalis and/or Candida species (C. albicans, C.
tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata,
Candida krusei, when reported
Liver disease, analysis of 3 biomarkers (hyaluronic acid [HA],
procollagen III amino terminal peptide [PIIINP], tissue inhibitor
of metalloproteinase 1 [TIMP-1]), using immunoassays,
utilizing serum, prognostic algorithm reported as a risk score
and risk of liver fibrosis and liver-related clinical events within
5 years
$3,415.50
Oncology (breast), mRNA, gene expression profiling by real-
time RT-PCR of 11 genes (7 content and 4 housekeeping),
utilizing formalin-fixed paraffin-embedded tissue, algorithms
reported as percentage risk for metastatic recurrence and
likelihood of benefit from extended endocrine therapy
$3,415.50
Oncology (breast), mRNA, gene expression profiling by real-
time RT-PCR of 21 genes, utilizing formalin-fixed paraffin
embedded tissue, algorithm reported as recurrence score
$2,213.69
Oncology (breast), mRNA gene expression profiling by hybrid
capture of 58 genes (50 content and 8 housekeeping), utilizing
formalin-fixed paraffin-embedded tissue, algorithm reported as
a recurrence risk score
$3,415.50
Oncology (breast), mRNA, microarray gene expression
profiling of 70 content genes and 465 housekeeping genes,
utilizing fresh frozen or formalin-fixed paraffin-embedded
tissue, algorithm reported as index related to risk of distant
metastasis
$3,415.50
Oncology (breast), mRNA, gene expression profiling by RT-
PCR of 12 genes (8 content and 4 housekeeping), utilizing
formalin-fixed paraffin-embedded tissue, algorithm reported as
recurrence risk score
$3,415.50
Oncology (breast), mRNA, next-generation sequencing gene
expression profiling of 70 content genes and 31 housekeeping
genes, utilizing formalin-fixed paraffin-embedded tissue,
algorithm reported as index related to risk to distant metastasis
$2,747.92
Oncology (colon), mRNA, gene expression profiling by real-
time RT-PCR of 12 genes (7 content and 5 housekeeping),
utilizing formalin-fixed paraffin-embedded tissue, algorithm
reported as a recurrence score
Oncology (colorectal) screening, quantitative real-time target
and signal amplification of 10 DNA markers (KRAS mutations,
promoter methylation of NDRG4 and BMP3) and fecal
hemoglobin, utilizing stool, algorithm reported as a positive or
negative result
$6,343.33
Oncology (cutaneous melanoma), mRNA, gene expression
profiling by real-time RT-PCR of 31 genes (28 content and 3
housekeeping), utilizing formalin-fixed paraffin-embedded
tissue, algorithm reported as recurrence risk, including
likelihood of sentinel lymph node metastasis
Oncology (gynecologic), live tumor cell culture and
chemotherapeutic response by DAPI stain and morphology,
predictive algorithm reported as a drug response score; first
single drug or drug combination
Oncology (gynecologic), live tumor cell culture and
chemotherapeutic response by DAPI stain and morphology,
predictive algorithm reported as a drug response score; each
additional single drug or drug combination (List separately in
addition to code for primary procedure)
$2,531.86
Oncology (lung), mass spectrometric 8-protein signature,
including amyloid A, utilizing serum, prognostic and predictive
algorithm reported as good versus poor overall survival
Oncology (high-grade prostate cancer), biochemical assay of
four proteins (Total PSA, Free PSA, Intact PSA, and human
kallikrein-2 [hK2]), utilizing plasma or serum, prognostic
algorithm reported as a probability score
$3,307.03
Oncology (tumor of unknown origin), mRNA, gene expression
profiling by real-time RT-PCR of 92 genes (87 content and 5
housekeeping) to classify tumor into main cancer type and
subtype, utilizing formalin-fixed paraffin-embedded tissue,
algorithm reported as a probability of a predicted main cancer
type and subtype
$3,415.50
Oncology (prostate), mRNA gene expression profiling by real-
time RT-PCR of 46 genes (31 content and 15 housekeeping),
utilizing formalin-fixed paraffin-embedded tissue, algorithm
reported as a disease-specific mortality risk score
$3,415.50
Oncology (prostate), mRNA, microarray gene expression
profiling of 22 content genes, utilizing formalin-fixed paraffin-
embedded tissue, algorithm reported as metastasis risk score
$3,174.75
Oncology (thyroid), mRNA, gene expression analysis of 10,196
genes, utilizing fine needle aspirate, algorithm reported as a
categorical result (eg, benign or suspicious)
$1,790.21
Oncology (prostate), promoter methylation profiling by real-
time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing
formalin-fixed paraffin-embedded tissue, algorithm reported as
a likelihood of prostate cancer detection on repeat biopsy
$6,857.46
Oncology (uveal melanoma), mRNA, gene expression profiling
by real-time RT-PCR of 15 genes (12 content and 3
housekeeping), utilizing fine needle aspirate or formalin-fixed
paraffin-embedded tissue, algorithm reported as risk of
metastasis
$4,867.95
Pulmonary disease (idiopathic pulmonary fibrosis [IPF]),
mRNA, gene expression analysis of 190 genes, utilizing
transbronchial biopsies, diagnostic algorithm reported as
categorical result (eg, positive or negative for high probability
of usual interstitial pneumonia [UIP])
Transplantation medicine (allograft rejection, pediatric liver and
small bowel), measurement of donor and third-party-induced
CD154+T-cytotoxic memory cells, utilizing whole peripheral
blood, algorithm reported as a rejection risk score
$2,857.28
Cardiology (heart transplant), mRNA, gene expression profiling
by real-time quantitative PCR of 20 genes (11 content and 9
housekeeping), utilizing subfraction of peripheral blood,
algorithm reported as a rejection risk score
Infectious disease, chronic hepatitis C virus (HCV) infection,
six biochemical assays (ALT, A2-macroglobulin,
apolipoprotein A-1, total bilirubin, GGT, and haptoglobin)
utilizing serum, prognostic algorithm reported as scores for
fibrosis and necroinflammatory activity in liver
IC
Unlisted multianalyte assay with algorithmic analysis
G0027
Semen analysis; presence and/or motility of sperm excluding
Huhner
G0327
ESRD related services for home dialysis (less than full month),
per day; for patients twenty years of age and over
G0103
Prostate cancer screening; prostate specific antigen test (PSA)
G0123
Screening cytopathology, cervical or vaginal (any reporting
system), collected in preservative fluid, automated thin layer
preparation, screening by cytotechnologist under physician
supervision
G0143
Screening cytopathology, cervical or vaginal (any reporting
system), collected in preservative fluid, automated thin layer
preparation, with manual screening and rescreening by
cytotechnologist under physician supervision
G0144
Screening cytopathology, cervical or vaginal (any reporting
system), collected in preservative fluid, automated thin layer
preparation, with screening by automated system, under
physician supervision
G0145
Screening cytopathology, cervical or vaginal (any reporting
system), collected in preservative fluid, automated thin layer
preparation, with screening by automated system and manual
rescreening under physician supervision
G0147
Screening cytopathology smears, cervical or vaginal, performed
by automated system under physician supervision
G0148
Screening cytopathology smears, cervical or vaginal, performed
by automated system with manual rescreening
G0306
Complete CBC, automated (HgB, HCT, RBC, WBC, without
platelet count) and automated WBC differential count
G0307
Complete CBC, automated (HgB, HCT, RBC, WBC; without
platelet count)
G0328
Colorectal cancer screening; fecal occult blood test,
immunoassay, one to three simultaneous determinations
G0432
Infectious agent antibody detection by enzyme immunoassay
(EIA) technique, HIV-1 and/or HIV-2, screening
G0433
Infectious agent antibody detection by enzyme-linked
immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2,
screening
G0435
Infectious agent antibody detection by rapid antibody test, HIV-
1 and/or HIV-2, screening
G0471
Collection of venous blood by venipuncture or urine sample by
catheterization from an individual in a skilled nursing facility
(SNF) or by a laboratory on behalf of a home health agency
(HHA)
G0472
Hepatitis C antibody screening for individual at high risk and
other covered indication(s)
G0475
HIV antigen/antibody, combination assay, screening
G0476
Infectious agent detection by nucleic acid (DNA or RNA);
human papillomavirus HPV), high-risk types (e.g., 16, 18, 31,
33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer
screening, must be performed in addition to pap test
G0480
Drug test(s), definitive, utilizing (1) drug identification methods
able to identify individual drugs and distinguish between
structural isomers (but not necessarily stereoisomers),
including, but not limited to, GC/MS (any type, single or
tandem) and LC/MS (any type, single or tandem and excluding
immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and
enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable
isotope or other universally recognized internal standards in all
samples (e.g., to control for matrix effects, interferences and
variations in signal strength), and (3) method or drug-specific
calibration and matrix-matched quality control material (e.g., to
control for instrument variations and mass spectral drift);
qualitative or quantitative, all sources, includes specimen
validity testing, per day; 1-7 drug class(es), including
metabolite(s) if performed
G0481
Drug test(s), definitive, utilizing (1) drug identification methods
able to identify individual drugs and distinguish between
structural isomers (but not necessarily stereoisomers),
including, but not limited to, GC/MS (any type, single or
tandem) and LC/MS (any type, single or tandem and excluding
immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and
enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable
isotope or other universally recognized internal standards in all
samples (e.g., to control for matrix effects, interferences and
variations in signal strength), and (3) method or drug-specific
calibration and matrix-matched quality control material (e.g., to
control for instrument variations and mass spectral drift);
qualitative or quantitative, all sources, includes specimen
validity testing, per day; 8-14 drug class(es), including
metabolite(s) if performed
G0482
Drug test(s), definitive, utilizing (1) drug identification methods
able to identify individual drugs and distinguish between
structural isomers (but not necessarily stereoisomers),
including, but not limited to, GC/MS (any type, single or
tandem) and LC/MS (any type, single or tandem and excluding
immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and
enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable
isotope or other universally recognized internal standards in all
samples (e.g., to control for matrix effects, interferences and
variations in signal strength), and (3) method or drug-specific
calibration and matrix-matched quality control material (e.g., to
control for instrument variations and mass spectral drift);
qualitative or quantitative, all sources, includes specimen
validity testing, per day; 15-21 drug class(es), including
metabolite(s) if performed
G0483
Drug test(s), definitive, utilizing (1) drug identification methods
able to identify individual drugs and distinguish between
structural isomers (but not necessarily stereoisomers),
including, but not limited to, GC/MS (any type, single or
tandem) and LC/MS (any type, single or tandem and excluding
immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and
enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable
isotope or other universally recognized internal standards in all
samples (e.g., to control for matrix effects, interferences and
variations in signal strength), and (3) method or drug-specific
calibration and matrix-matched quality control material (e.g., to
control for instrument variations and mass spectral drift);
qualitative or quantitative, all sources, includes specimen
validity testing, per day; 22 or more drug class(es), including
metabolite(s) if performed
G0499
Hepatitis B screening in nonpregnant, high-risk individual
includes hepatitis B surface antigen (HBSAG), antibodies to
HBSAG (anti-HBS) and antibodies to hepatitis B core antigen
(anti-HBC), and is followed by a neutralizing confirmatory test,
when performed, only for an initially reactive HBSAG result
G0659
Drug test(s), definitive, utilizing drug identification methods
able to identify individual drugs and distinguish between
structural isomers (but not necessarily stereoisomers), including
but not limited to, GC/MS (any type, single or tandem) and
LC/MS (any type, single or tandem), excluding immunoassays
(e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods
(e.g., alcohol dehydrogenase), performed without method or
drug-specific calibration, without matrix-matched quality
control material, or without use of stable isotope or other
universally recognized internal standard(s) for each drug, drug
metabolite or drug class per specimen; qualitative or
quantitative, all sources, includes specimen validity testing, per
day, any number of drug classes
G2023
Specimen collection for Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-
19]), any specimen source
G2023 CG
Specimen collection for Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-
19]), any specimen source
G2024
Specimen collection for severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-
19]) from an individual in a SNF or by a laboratory on behalf of
a HHA, any specimen source
G2024 CG
Specimen collection for severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-
19]) from an individual in a SNF or by a laboratory on behalf of
a HHA, any specimen source
G9143
Warfarin responsiveness testing by genetic technique using any
method, any number of specimen(s)
P2028
Cephalin flocculation, blood
P2029
Congo red, blood
P2031
Hair analysis (excluding arsenic)
P2033
Thymol turbidity, blood
P2038
Mucoprotein, blood (seromucoid) (medical necessity
procedure)
P3000
Screening Papanicolaou smear, cervical or vaginal, up to three
smears, by technician under physician supervision
P9604
Travel allowance, one way in connection with medically
necessary laboratory specimen collection drawn from
homebound or nursing homebound patient; prorated trip charge
P9612
Catheterization for collection of specimen, single patient, all
places of service
P9615
Catheterization for collection of specimen(s) (multiple patients)
Q0111
Wet mounts, including preparations of vaginal, cervical or skin
specimens
Q0112
All potassium hydroxide (KOH) preparations
Q0113
Pinworm examinations
Q0114
Fern test
Q0115
Postcoital direct, qualitative examinations of vaginal or cervical
mucous
U0001
CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-
PCR Diagnostic Panel
U0002
2019-nCoV coronavirus, SARS-CoV-2/2019-nCoV (COVID-
19), any technique, multiple types or subtypes (includes all
targets), non-CDC
U0003
Infectious agent detection by nucleic acid (DNA or RNA);
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2) (coronavirus disease [COVID-19]), amplified probe
technique, making use of high throughput technologies as
described by CMS-2020-01-R
U0004
2019-nCoV coronavirus, SARS-CoV-2/2019-nCoV (COVID-
19), any technique, multiple types or subtypes (includes all
targets), non-CDC, making use of high throughput technologies
as described by CMS-2020-01-R
U0005
Infectious agent detection by nucleic acid (DNA or RNA);
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2) (coronavirus disease [COVID-19]), amplified probe
technique, CDC or non-CDC, making use of high throughput
technologies, completed within 2 calendar days from date of
specimen collection (list separately in addition to either HCPCS
code U0003 or U0004) as described by CMS-2020-01-R2