List of in-office lab work allowed
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1 Code Specific Body System QW Modifier QW Modifier Test Needed Basic metabolic panel QW Not Needed Basic metabolic panel QW Basic electrolyte panel QW Basic electrolyte panel QW Basic lipid panel QW Renal function panel QW
2 80178 lithium QW Urinalysis No QW Urinalysis QW Urinalysis QW Pregnancy No QW Blood test QW Blood test QW Protein Test QW Protein Test QW Blood test QW body fluid QW Pancreatitis test QW Liver Function QW Fecal Blood No QW Fecal Blood QW Fecal Blood No QW Fecal Blood QW Calcium QW Calcium QW carbo dioxide QW Chloride QW Cholesterol test QW CPK QW Kidney function QW Hormone QW Diabetes test QW Diabetes test QW Diabetes test QW Diabetes test QW Diabetes test No QW
3 82950 Diabetes test QW Diabetes test QW Diabetes test QW Diabetes test QW Liver Function QW Ovulation test QW OVulation test QW Blood count No QW Diabetes test QW Diabetes test QW Lactose intolerance QW Lead test QW Cholesterol test QW Cholesterol test QW Heart failure QW PH QW Alkaline phosphatase QW Electrolytes QW Protein QW Sodium QW Thyroid Hormone QW Liver Function QW Liver Function QW cholesterol test QW Urea nitrogen; quantitative QW Pregnancy QW Pregnancy No QW Blood count No QW Blood count QW Blood count QW Bleeding disoreders QW Bleeding disoreders QW ESR No QW Tumor antigen QW Monospot QW Monospot QW Lime disease QW HIV/AIDS QW Bacterail infection QW
4 87210 Bacterail infection QW Bacterail infection QW Bacterail infection QW Bacterail infection QW Bacterail infection QW Bacterail infection QW Bacterail infection QW
5 Tests Descriptions Separately Reimburseable to PCP and all INET work Provider at location 11 Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330), Carbon dioxide (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 (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Potassium (84132), Sodium (84295), Urea nitrogen (BUN) (84520) Electrolyte panel This panel must include the following: Carbon dioxide (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) 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)
6 lithium stat test 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; bacteriuria screen, except by culture or dipstick Urine pregnancy test, by visual color comparison methods Acetone or other ketone bodies, serum; quantitative Albumin; serum, plasma or whole blood Albumin; urine, microalbumin, quantitative Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay) Alcohol (ethanol); any specimen except breath Amines, vaginal fluid, qualitative Amylase test Bilirubin; total 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 Calcium; total Calcium; ionized Carbon dioxide (bicarbonate) Chloride; blood Cholesterol, serum or whole blood, total Creatine kinase (CK), (CPK); total Creatinine; blood Estrone hormone Glucose; quantitative, blood (except 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, blood by glucose monitoring device(s) cleared by the FDA specifically for home use
7 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, blood by glucose monitoring device(s) cleared by the FDA specifically for home use Glutamyltransferase, gamma (GGT) Gonadotropin; follicle stimulating hormone (FSH) Gonadotropin; luteinizing hormone (LH) Hemoglobin; by copper sulfate method, non-automated Hemoglobin; glycosylated (A1C) Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use Lactate (lactic acid) lead test Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) Lipoprotein, direct measurement; LDL cholesterol Natriuretic peptide ph; body fluid, not otherwise specified Phosphatase, alkaline; Potassium; serum, plasma or whole blood Protein, total, except by refractometry; serum, plasma or whole blood Sodium; serum, plasma or whole blood Thyroid stimulating hormone (TSH) Transferase; aspartate amino (AST) (SGOT) Transferase; alanine amino (ALT) (SGPT) Triglycerides Urine Gonadotropin, chorionic (hcg); qualitative Ovulation tests, by visual color comparison methods for human luteinizing hormone Blood count; spun microhematocrit Blood count; hematocrit (Hct) Blood count; hemoglobin (Hgb) Platelet, aggregation (in vitro), each agent Prothrombin time; Sedimentation rate, erythrocyte; non-automated Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen) Heterophile antibodies; screening Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (eg, reagent strip) Antibody; Borrelia burgdorferi (Lyme disease) HIV/AIDS Antibody 1 Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate
8 Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps) Infectious agent antigen detection by immunoassay with direct optical observation; Influenza Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus Infectious agent antigen detection by immunoassay with direct optical observation; Trichomonas vaginalis Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A Infectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid) yy y y y
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