LABORATORY MEDICINE CATEGORY LIST. CATEGORY I Laboratories, Vested Interest Laboratory and Hospitals

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1 LABORATORY MEDICINE CATEGORY LIST Updated to July 3, 2012 CATEGORY I Laboratories, Vested Interest Laboratory and Hospitals The following tests are restricted to laboratories, vested interest laboratories and hospital approved by the Medical Services Commission and accredited by the Diagnostic Accreditation Program Venepuncture Examination Eosinophils /Secretions/Excretions Haemoglobin cyanmethaemoglobin method, and/or haematocrit Haemoglobin other methods Secretion smear for eosinophils Sedimentation rate Candida Culture Fungus, direct examination, KOH preparation Stained Smear Trichomonas Antigen Test Trichomonas and/or Candida, direct examination Examination for pinworm ova Glucose semiquantitative (dipstick analysed visually or by reflectance meter) Occult Blood faeces Pregnancy Test, immunologic urine Urinalysis Complete diagnostic, sem-quant and micro Urinalysis Chemical or any part of (screening) Urinalysis Microscopic examination of centrifuged deposit ECG tracing, without interpretation (technical fee) Sperm, Seminal examination for presence or absence CATEGORY IIA HAEMATOLOGY includes Category I tests ABO Typing Clot retraction Direct antiglobulin (Coombs ) test, polyspecific performed other than as part of a cross-match procedure Eosinophil count Hematology Profile (to include automated Hbg, WBC, Hct, RBC indices and differential white cell count when indicated) Infectious mononucleosis - slide agglutination Latex test (rheumatoid factor) Partial thromboplastin time (PTT) substitution test 1

2 Platelet estimation on film Preparation of packed cells, per unit Preparation of plasma, per unit Prothrombin Time RBC antibody detection, per tube RBC morphology including platelet estimation Reticulyocyte count and/or Heinz bodies Rh(D) typing Sickle cell identification Thrombin time CATEGORY IIB MICROBIOLOGY includes Category I tests Antibiotic susceptibility test Biochemical identification of micro-organism per organism 90720** Routine culture Cervical Culture Vaginal Culture Uretheral Culture Combined Vagnio-Anorectal or Vaginal Culture Genital Culture Other Site Stool culture (to include Campylobacter identification) Biochemical identification of micro-organism in stool Molecular identification, stool isolate 90760* - Streptococci rapid test 90775** Throat or nose culture 90780** Throat or nose culture each additional culture Urine colony count culture CATEGORY IIC CLINICAL CHEMISTRY includes Category I tests Primary base fee Split base fee (collecting facility) Split base fee (referral facility) Acid phosphatase, total Acid phosphatase, fractions each Albumin serum/plasma Albumin transudate/exudate Alanine aminotransferase (ALT) Alkaline phosphatase Amylase cyst Amylase serum/plasma Amylase transudate/exudate 2

3 Amylase urine Aspartate aminotransferase (AST) Bicarbonate serum/plasma Bicarbonate urine Bile pigments and salts, qualitative urine Bilirubin, total serum/plasma Bilirubin, total transudate/exudate Bilirubin, direct Blood, qualitative gastric Calcium total, serum/plasma Calcium urine random Cells, count CSF and other body fluids Cell differential CSF and other body fluids Chloride serum/plasma Chloride urine random Chloride whole blood Cholesterol, total Creatine kinase (phosphokinase) Creatinine random urine Creatinine time urine collection Glucose gestational assessment Glucose Tolerance Test Gestational Protocol Glucose quantitative CSF Glucose joint fluid Glucose serum/plasma Glucose transudate/exudate Glucose urine 91715** Glucose tolerance test, 2 to 5 hours 91716** Glucose tolerance test 6 hr. or more Glutamyl transpeptidase (GTP) High density lipoproteins cholesterol (HDL cholesterol) Lactate dehydrogenase CSF Lactate dehydrogenase serum/plasma Lactate dehydrogenase transudate/exudate Potassium serum/plasma Potassium urine random Potassium whole blood Pregnancy Test Serum Proteins total, quantitative CSF etc Proteins timed urine collection Proteins total, joint fluid Proteins total, serum or plasma Proteins total, transudate/exudate Salicylates, qualitative, serum Salicylates, qualitative, urine 3

4 Sodium random urine Sodium serum/plasma Sodium whole blood Triglycerides serum/plasma Triglycerides transudate/exudate Urea amniotic fluid Urea CSF Urea serum/plasma Urea urine random Urea whole blood Uric acid random urine Uric acid serum/plasma Uric acid synovial fluid Urinalysis, macroscopic, to include any/all of dipstick, specific gravity, visual Urinalysis, microscopic Microalbumin, semiquantitative Urobilin, qualitative urine Urobilinogen, qualitative urine CATEGORY III includes Categories I & II plus remainder of tests in the payment schedule unless specifically excluded (certain fee items could be restricted to specialty sites) The following fee items are specifically excluded from Category III: CATEGORY IIG CYTOGENETICS Cytogenetic analysis of short term blood culture (lymphocytes) Cytogenetic analysis of bone marrow/malignant effusion Cytogenetic analysis of chorionic villus sampling Cytogenetic analysis of cultured amniotic fluid Cytogenetic analysis of cultured tissue (skin, amnion etc) Cytogenetic analysis of prenatal foetal blood sample Cytogenetic analysis of solid tumours Cytogenetic analysis using fluorescent in-situ hybridization Cytogenetic analysis/fluorescence in situ, single Cytogenetic analysis/fluorescence, uncultured Special staining (Giemsa II, DAPI/SCE, NOR) Special banding (Q-, R-, C-) Amniotic cell culture grown for biochemical analysis only Chromosomal breakage studies Investigation of chromosomal mosaicism High resolution chromosome analysis 4

5 CATEGORY IIV VIROLOGY Serological tests - 1 to 3 antigens Serological tests - 4 or more antigens Smear or section for electron microscopy Virus isolation Hepatitis B virus (HBV) identification by nucleic acid amplification, direct-quantification BK Polyoma virus identification by nucleic acid amplification, directquantification Cytomegalovirus viral (CMV) identification by nucleic acid amplification, direct-quantification HBV drug resistance mutation analysis CATEGORY IIS SPECIALIZED Factor V Leiden/PGM 1 st Gene Factor V Leiden/PGM 2 nd Gene Acid Fast organisms culture Acetyl CoA: a-glucosaminide-n-acetyl transferase, white blood cells Acid Lipase, white blood cells Acylcarnitine profiling Alpha-iduronidase, white blood cells Alpha-mannosidase, white blood cells Anti-endomysium antibodies Apoprotein E genotyping Aryl sulfatase A fibroblasts Aryl sulfatase A white blood cells Aryl sulfatase B fibroblasts Aryl sulfatase B white blood cells Aryl sulfatase C fibroblasts Aryl sulfatase C white blood cells B-galactosidase fibroblasts B-galactosidase white blood cells B-glucosidase fibroblasts B-glucosidase white blood cells Beta-glucuronidase, white blood cells Beta-mannosidase, white blood cells Culturing skin fibroblasts for biochemical or DNA analysis Faecal chymotrypsin Fecal Elastase Galactocerebrosidase fibroblasts 5

6 Galactocerebrosidase white blood cells Glutathione peroxidase Heparan sulfamidase, white blood cells Hexosaminidase serum Hexosaminidase, white blood cells I g A Anti-gliadin antibodies I g F- I (Somatomedin C) Mitochondrial preparation muscle N-acetyl-Galactosamine-6-sulfate sulfatase, white blood cells Organic Acids Pyruvate Carboxylase, fibroblasts Pyruvate Dehydrogenase, fibroblasts Respiratory chain enzymes - muscle Secretin-Pancreozymin Test Sphingomyelinase fibroblasts Sphingomyelinase white blood cells Transferrin Isoelectric focusing (qualitative) Very long chain fatty acids Vitamin A Vitamin B Vitamin B Vitamin B Vitamin E White blood cell preparation for lysosomal enzyme testing Cytogenetic analysis/fluorescence, subtelomeric 6