INTERIM CPT CODE SCHEDULE CPT

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Loreen Cori Bradley
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1 Order Processing & Distribution / Inventory Management Cryoprecipitated Antihemophilic Factor P Cryoprecipitated Antihemophilic Factor - Pooled/6 Units P9012 x Platelet Concentrate, Leukoreduced P Platelet Concentrate, Leukoreduced, Irradiated P Plasma, Cryo Depleted P Plasma, Fresh Frozen/250 cc P Deglycerolized Red Blood Cells P Deglycerolized-Autologous Red Blood Cells x 1, x Frozen Red Blood Cells P9021 x 1, x Frozen-Autologous Red Blood Cells x 1, x Autologous Red Blood Cells/Unit Collected Rejuvenated Red Blood Cells P9021 x 1, x Rejuvenated Frozen Red Blood Cells P9021 x 1, x 1, x Rejuvenated Frozen-Autologous Red Blood Cells x 1, x 1, x Rejuvenated Deglycerolized Red Blood Cells P9039 x 1, x Rejuvenated Deglycerolized-Autologous Red Blood Cells x 1, x 1, x Resuspended Red Blood Cells P9017 x 1, P9021 x 1, x Red Blood Cells - Leukoreduced P Red Blood Cells, Leukoreduced, Frozen P9016 x 1, x Red Blood Cells, Leukoreduced, CMV negative P Red Blood Cells, Leukoreduced, Irradiated P Red Blood Cells, Leukoreduced, Irradiated, CMV negative P Red Blood Cells, Washed, Leukoreduced P9022 x 1, x Red Blood Cells, Leukoreduced, Irradiated, Washed P9040 x 1, x Red Blood Cells, Leukoreduced, Frozen, Deglycerol, Washed P Red Blood Cells, Frozen/deglycerolized, Washed, Leukoreduced, Irradiated P Pediatric/Divided Red Blood Cells P Assigned Pediatric 8-Pack P Preparation of Red Blood Cells, Deglycerolized Preparation of Red Blood cells, Frozen Preparation of Red Blood cells, Rejuvenated Irradiation of Components/Invoice Preparation of Platelets, Reduced Volume/Invoice Preparation of Red Blood Cells, Plasma Reduced Preparation of Red Blood Cells, Washed Preparation of Platelets, Washed/Invoice Preparation of CMV Negative Pooling of Platelet Concentrate Pooling of Cryoprecipitated AHF, Plasma, Resuspended RBC Thawing of Plasma, FFP 250cc, FFP 50 cc, Cryo Depleted Bacterial Testing per whole blood platelet pool (or unit) none available Plasma by Apheresis P Platelets by Apheresis: Directed P9034 x 1, x 1, x Platelets by Apheresis LR, Standard P Platelets by Apheresis, LR, Irradiated P9037

2 Platelets by Apheresis, LR, CMV negative, Irradiated P Platelets by Apheresis, LR, HLA-matched P Buffy Coat by Apheresis Granulocytes by Apheresis P9050 Compatibility Testing Laboratory Type Confirm Unit - No charge Crossmatch - Antiglobulin none available Retrospective Xmatch Antiglobulin Crossmatch - Immediate Spin ABO Compatible Crossmatch, Potential Donor, ABO compatible Crossmatch, Potential Donor, ABO incompatible Crossmatch - Electronic Retrospective Crossmatch Electronic - New Uncrossmatched Handling Fee none available Emergency Testing or Release ( billed per order) none available ABO Rh x 1, x ABO Rh, Confirmatory none available Indirect Antiglobulin Test Direct Antiglobulin Test Fetal Maternal Screen Investigation of Transfusion Reaction Investigation of Limited Transfusion Reaction none available Patient Services Therapeutic Plasma Exchange Therapeutic Plasma Exchange (Mobile) Therapeutic Plasma Exchange (N/E) Therapeutic Plateletpheresis Therapeutic Plateletpheresis (Mobile) Therapeutic Red Cell Exchange Therapeutic Red Cell Exchange (N/E) Therapeutic Red Cell Exchange (Mobile) Therapeutic Leukapheresis Therapeutic Leukapheresis (Mobile) Leukapheresis P Travel (Procedures Outside King County) none available Emergency Request none available Nursing Wait Time/Per Hour none available Stem Cell, Collection Stem Cell, Collection/ Processing/Storage x 1, x 1, x Stem Cell, Collection (Mobile) x 1, x 1, x 1, x Administration - Red Blood Cells Administration - Factor Concentrates Administration - Platelets/Cryo AHF/Plasma Blood Sample Drawing Central Line Dressing Change 99211

3 Blood Collection Services Therapeutic Phlebotomy Genomics Testing Laboratory Red Cell Genotyping for Single Antigen (per antigen system) X Rh Genotyping - multiplex (C,D) X Red Cell Typing for MNS System X Multiple red cell antigen Genotyping - multiplex X RhD zygosity includes CDE Systems X RhD Evaluation (weak or partial D eval) X ABO Blood Group by PCR X6 Red Cell Reference Laboratory % ABO Antibody Titration Rh Phenotype (D,C,E,C antigen typing (E If Indicated) Patient Phenotype Single Antigen (Per Antigen) Screening of antigen-negative units (Per Antigen/Per Unit) Screening of compatible RBC units (Per Unit) Red Cell Antibody Panel (Per Panel) Autoabsorption Alloabsorption Elution Neutralization Red Cell Separation for Phenotyping Chemical Treatment Red Cells Enzyme Treatment Red Cells Chemical Treatment Serum Patient Phenotype/Common x Donath-Landsteiner x 1, x Thermal Amplitude x 3, x Immunohematology After Hours Surcharge none available Red Cell Phenotype/Per Negative Antigen Hemoglobin S Screen Kleihauer-Betke Stain Rare Unit Search Fee none available Rare Unit Fee none available Donor Testing Laboratory Hepatitis B Surface Antigen Test HB Surface Antigen none available Anti-Hepatitis C Virus Test HCV Confirmatory (RIBA) Anti-Hepatitis B Core Antigen Test Serologic Test for Syphilis (STS) Anti-Cytomegalovirus (CMV) Test Chagas Testing (T. cruzi antibody) none available Chagas Confirmatory Testing none available Anti-HIV 1/2 Antibody Test 86703

4 HIV 1/2 Confirmatory Anti-HTLV I/-II Test x 1, x HTLV-I/-II Confirmatory Donor HCV NAT Test Donor HIV NAT Test Donor HBV NAT Test none available Donor WNV NAT Test none available Discriminatory by Ampliscreen none available Epstein Barr Virus VCA-IgG none available Epstein Barr Virus NA-IgG none available Toxoplasma-IgG none available Processing Fee none available Hemostasis Reference Laboratory STAT Fee - Hemostasis none available Bleeding Time Surgicutt Thrombin Time Thrombin Time 1:1 Mix Tissue Thromboplastin Inhibition Time (TTIT) Prothrombin Time Prothrombin Time 1:1 Mix APTT Platelet Count (for PFA analysis) Factor XIII Activity Fibrinogen Activity APTT 1:1 Mix Reptilase Time Ristocetin Cofactor (VWF Activity) D-dimer (semi quantitative) FDP in Plasma (semi-quantitatine) Factor II Activity Factor V Activity Factor VII Activity Factor VIII Activity Factor IX Activity Faxtor X Activity Factor XI Activity Factor XII Activity Factor VIII Activity Chromogenic ** Heparin by Anti-Xa Prekallikrein (Fletcher Factor Assay) vwf Multimer Factor VIIa rtf Collagen Binding Assay D-Dimer (quantitative) Factor Xa Activity Chromogenic Factor VIII Inhibitor Bethesda Titer - Human 85335

5 Factor Inhibitor Bethesda Titer (per factor) Factor VIII Inhibitor Screen x Factor Inhibitor Screens (per factor) x STACLOT-LA (Hexagonal PL) drvvt Screen drvvt Confirmation Antithrombin III Activity Protein C Activity Protein S Activity Antiplasmin Plasminogen Activity APC Resistance Activity Ratio APC Resistance Activity Ratio for Factor V Leiden Platelet Aggregation (X6 agonists) x RIPA (ristocetin-induced platelet aggregation x ADP-induced aggegation x Aspirin Resistance Aggregation x Platelet Function Assay (PFA) Epinephrine/Collagen Platelet Function Assay (PFA) ADP/Collagen DNA Hemophilia A Mutation Evaluation DNA/Factor V Leiden (APC Resistance) Mutation DNA/Factor II (Prothrombin) Mutation DNA/Factor VIII Inversion DNA/Factor II and Factor V Leiden Mutations Combined 81240, DNA MTHFR C677T Mutation DNA von Willebrand Disease Type 2A/2B / 2M DNA von Willebrand Disease Type 2N DNA Hemophilia B Mutation Evaluation Genotype for known Hemophilia / VWD mutation ADAMTS 13 Activity ADAMTS 13 Inhibitor PAI 1 Activity Factor VIII Chromogenic Cryo Platelet Immunology Laboratory Platelet Alloantibody Workup (Basic) Platelet Alloantibody Workup (Advanced) x Platelet Autoantibody Test x 2, x Platelet Drug Antibody Test x 4, x Platelet Heparin Antibody Test x Hep/PF4 IgG HIT ELISA PF4 HIT CONFIRMATION Post-Transfusion Purpura (PTP) Workup x 12, x 2, x 1, x Neonatal Thrombocytopenia Evaluation x 12, x 4, x 1, x Platelet Typing for Single Platelet Antigen 81400

6 Immunogenetics / HLA Laboratory Deceased Donor Workup - Local none available Deceased Donor Workup - Import 81370, B-27 Typing HLA-A*29 Typing HLA-B*51 Typing HLA-B*57:01 Typing HLA-B*58:01 Typing HLA-B*15:02 Typing HLA Antibody Detection Unit HLA Antibody Screen HLA Antibody Specificity 86832, HLA Antibody Specificity Monitoring DSA 86834, HLA Antibody Specificity Monitoring DSA 86834, MICA Antibody Specificity Complement-fixing HLA Antibody Specificity 86832, Complement-fixing HLA Antibody Monitoring DSA 86834, Complement-fixing HLA Antibody Monitoring DSA STAT 86834, HLA Class I (A, B, C) Typing HLA Class II (DR, DQ) Typing HLA Class II (DR, DQ) Typing HLA Class II (DR, DQ) Typing x Specimen Processing/Storage (Serum) Specimen Processing/Storage (Cells) Lymphocyte Crossmatch x Lymphocyte Crossmatch - STAT x 2, x Lymphocyte Crossmatch - Cytotoxicity x High Resolution Typing, HLA-A High Resolution Typing, HLA-A High Resolution Typing, HLA-B High Resolution Typing, HLA-C High Resolution Typing, HLA-DPA High Resolution Typing, HLA-DPB High Resolution Typing, HLA-DQA High Resolution Typing, HLA-DQB High Resolution Typing, HLA-DRB

MEDICAID PURCHASING ADMINISTRATION (MPA) Blood Bank Services Billing Instructions

MEDICAID PURCHASING ADMINISTRATION (MPA) Blood Bank Services Billing Instructions About This Publication This publication supersedes all previous Department Blood Bank Services Billing Instructions published