Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111 www.mass.gov/dma

MASSHEALTH
TRANSMITTAL LETTER FPA-33
August 2002
TO:      Family Planning Agencies Participating in MassHealth FROM:      Wendy E. Warring, Commissioner
RE:      Family Planning Agency Manual (Family Planning HCPCS)
The federal government has revised the HCFA Common Procedure Coding System (HCPCS) for MassHealth billing.
This letter transmits changes for your provider manual that contain the new and revised codes. The revised Subchapter 6 is effective for dates of service on or after June 1, 2002. The codes introduced under the 2002 HCPCS code book are effective for dates of service on or after June 1, 2002. We will accept either the new or the old codes for dates of service through August 31, 2002. For dates of service on or after September 1, 2002, you must use the new codes to receive payment.
If you wish to obtain a fee schedule, you may purchase Division of Health Care Finance and Policy regulations from either the Massachusetts State Bookstore or from the Division of Health Care Finance and Policy (see addresses and telephone numbers below). You must contact them first to find out the price of the publication. The Division of Health Care Finance and Policy also has the regulations available on disk. The regulation title is 114.3 CMR 12.00: Family Planning Services.

Massachusetts State Bookstore State House, Room 116 Boston, MA 02133 Telephone: 617-727-2834 www.mass.gov/sec/spr

Division of Health Care Finance and Policy Two Boylston Street Boston, MA 02116 Telephone: 617-988-3100 www.mass.gov/dhcfp

MassHealth
Transmittal Letter FPA-33 August 2002 Page 2
NEW MATERIAL
(The pages listed here contain new or revised language.)
Family Planning Agency Manual
Pages vi and 6-1 through 6-12
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Family Planning Agency Manual
Pages vi and 6-1 through 6-12 — transmitted by Transmittal Letter FPA-32

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
FAMILY PLANNING AGENCY MANUAL	SUBCHAPTER NUMBER AND TITLE
TABLE OF CONTENTS	PAGE
vi	

	TRANSMITTAL LETTER
FPA-33	DATE
06/01/02	
6. SERVICE CODES AND DESCRIPTIONS
Definitions 		6-1
Service Codes and Descriptions: Visits 		6-1
Service Codes and Descriptions: Contraceptive Supplies and Drugs 		6-2
Service Codes and Descriptions: Medical and Surgery Procedures 		6-2
Service Codes and Descriptions: Laboratory Services 		6-3
Organ or Disease-Oriented Panels 		6-3
Urinalysis 		6-4
Chemistry 		6-4
Hematology and Coagulation 		6-6
Immunology 		6-6
Transfusion Medicine 		6-8
Microbiology 		6-8
Anatomic Pathology 		6-10
Cytopathology 		6-10
Cytogenetic Studies 		6-11
Surgical Pathology 		6-11
Miscellaneous 		6-12
Appendix A.     DIRECTORY 		A-1
Appendix B.     ENROLLMENT CENTERS 		B-1
Appendix C.     THIRD-PARTY-LIABILITY CODES 		C-1
Appendix W     EPSDT SERVICES: MEDICAL PROTOCOL AND
PERIODICITY SCHEDULE 		W-1
Appendix X.     FAMILY ASSISTANCE COPAYMENTS AND DEDUCTIBLES 		X-1
Appendix Y.     REVS CODES/MESSAGES 		Y-1
Appendix Z.     EPSDT SERVICES LABORATORY CODES 		Z-1

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
FAMILY PLANNING AGENCY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-1	

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FPA-33	DATE
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601 Definitions
 (A)	New Patient — a patient who has not received any professional services from the provider within the past three years.
 (B)	Established Patient — a patient who has received professional services from the provider within the past three years.
602 Service Codes and Descriptions: Visits
Service
Code       Service Description
New Patient
99201      Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components:
 -	a problem-focused history;
 -	a problem-focused examination; and
 -	straightforward medical decisionmaking (brief service) 99203      Office or other outpatient visit for the evaluation and management of a new patient, which requires
these three key components:
 -	a detailed history;
 -	a detailed examination; and
 -	medical decisionmaking of low complexity 99205      Office or other outpatient visit for the evaluation and management of a new patient, which requires
these three key components:
 -	a comprehensive history;
 -	a comprehensive examination; and
 -	medical decisionmaking of high complexity (comprehensive service)
Established Patient
99211      Office or other outpatient visit for the evaluation and management of an established patient, that
may not require the presence of a physician (minimal service) 99213      Office or other outpatient visit for the evaluation and management of an established patient, which
requires at least two of these three key components:
 -	an expanded problem-focused history;
 -	an expanded problem-focused examination;
 -	medical decisionmaking of low complexity (limited service) 99215      Office or other outpatient visit for the evaluation and management of an established patient, which
requires at least two of these three key components:
 -	a comprehensive history;
 -	a comprehensive examination;
 -	medical decisionmaking of high complexity (comprehensive service)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
FAMILY PLANNING AGENCY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
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FPA-33	DATE
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603 Service Codes and Descriptions: Contraceptive Supplies and Drugs
Service
Code       Service Description
A4261	Cervical cap (I.C.)
J1055	Injection, medroxyprogesterone acetate for contraceptive use, 150 mg. (Depo-Provera) (I.C.)
J1056	Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg./25 mg. (Lunelle) (I.C.)
S4989	Contraceptive intrauterine device (I.C.)
S4993	Contraceptive pills for birth control
X1051	Diaphragm (including applicator and contraceptive cream or jelly)
X1052	Condoms (three)
X1054	Contraceptive jelly
X1056	Contraceptive cream
X1057	Contraceptive film (three)
X1058	Contraceptive foam
X1059	Female condoms with lubricant (three)
X1060	Female condoms with lubricant (six)
X1061	Contraceptive suppositories (package of 12)
X1063	Cervical sponges (three)
X1069	Medications and injectables related to family planning services, with the exception of Rho (D)
human immune globulin and contraceptive injectables, such as Depo-Provera (the Division
will pay for these items at the provider's cost) (I.C.)
604 Service Codes and Descriptions: Medical and Surgery Procedures
Service
Code       Service Description
11975	Insertion, implantable contraceptive capsules (global rate for Norplant System of Contraception,
includes counseling prior to insertion, the price of the Norplant device, the insertion procedure, and one follow-up visit)
 11976	Removal, implantable contraceptive capsules (S.P.)
 11977	Removal with reinsertion, implantable contraceptive capsules (global rate for Norplant System of
Contraception, includes the price of the Norplant device, removal of an old device, insertion
of a new device, and one follow-up visit) 19100      Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) 49080      Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial 55250      Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen
examination(s) (Consent for Sterilization form CS-18 or CS-21 required) 55450      Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure) (Consent for
Sterilization form CS-18 or CS-21 required) 56420      Incision and drainage of Bartholin’s gland abscess 56501      Destruction of lesion(s), vulva; simple (e.g., laser surgery, electrosurgery, cryosurgery,
chemosurgery) 56605      Biopsy of vulva or perineum (separate procedure); one lesion 57061      Destruction of vaginal lesion(s); simple (e.g., laser surgery, electrosurgery, cryosurgery,
chemosurgery)

Commonwealth of Massachusetts
Division of Medical Assistance
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604	Service Codes and Descriptions: Medical and Surgery Procedures (cont.)
Service
Code       Service Description
57100	Biopsy of vaginal mucosa; simple (separate procedure)
57452	Colposcopy (vaginoscopy) (separate procedure)
57454	with biopsy(ies) of the cervix and/or endocervical curettage
57460	with loop electrode excision procedure of the cervix
57500	Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate
procedure)
57505	Endocervical curettage (not done as part of a dilation and curettage)
57510	Cautery of cervix; electro or thermal
57511	cryocautery, initial or repeat
57513	laser ablation
57520     Conization of cervix, with or without fulguration, with or without dilation and curettage, with or
without repair; cold knife or laser
57522	loop electrode excision
58100     Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical
dilation, any method (separate procedure)
605	Service Codes and Descriptions: Laboratory Services
ORGAN OR DISEASE-ORIENTED PANELS
These panels were developed for coding purposes only and should not be interpreted as clinical parameters. The tests listed with each panel identify the defined components of that panel. These panel components are not intended to limit the performance of other tests. If one performs tests in addition to those specifically indicated for a particular panel, those tests should be reported separately in addition to the panel code.
Service
Code       Service Description
80055      Obstetric panel (This panel must include the following: hemogram, automated, and manual differential WBC count (CBC) (85022) or hemogram and platelet count, automated, and automated complete differential WBC count (CBC) (85025), hepatitis B surface antigen (HBsAg) (87340), antibody, rubella (86762), syphilis test, qualitative (e.g., VDRL, RPR, ART) (86592), antibody screen, RBC, each serum technique (86850), blood typing, ABO (86900), and blood typing, Rh (D) (86901).)
80061      Lipid panel (This panel must include the following: cholesterol, serum, total (82465), lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718), and triglycerides (84478).)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
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6 SERVICE CODES AND DESCRIPTIONS	PAGE
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FPA-33	DATE
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605   Service Codes and Descriptions: Laboratory Services (cont.)
Service
Code       Service Description
80074      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), and hepatitis C antibody (86803).)
80076      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), and transferase, aspartate amino (AST) (SGOT) (84450).)
URINALYSIS
81000	Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes,
nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents;
nonautomated, with microscopy
 81001	automated, with microscopy
 81002	nonautomated, without microscopy
 81003	automated, without microscopy
81005	Urinalysis; qualitative or semiquantitative, except immunoassays
81007	bacteriuria screen, except by culture or dipstick
81025	Urine pregnancy test, by visual color comparison methods
81099	Unlisted urinalysis procedure
CHEMISTRY
The material for examination may be from any source. The examination is quantitative unless specified. Clinical information derived from the results of laboratory data that is mathematically calculated (e.g., free thyroxine index (T7)) is considered part of the test procedure and therefore is not a separately reportable service.
82040      Albumin; serum
82247	Bilirubin; total
82248	direct
82270      Blood, occult; by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous
determinations
82273	other sources
82310	Calcium; total
82465	Cholesterol, serum or whole blood, total
82540	Creatine
82550	Creatine kinase (CK), (CPK); total
82565	Creatinine; blood
82570	other source
82607	Cyanocobalamin (vitamin B-12)
82627	Dehydroepiandrosterone-sulfate (DHEA-S)
82670	Estradiol

Commonwealth of Massachusetts
Division of Medical Assistance
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FPA-33	DATE
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605   Service Codes and Descriptions: Laboratory Services (cont.)
Service
Code	Service Description
82671	Estrogens; fractionated
82672	total
82677	Estriol
82679	Estrone
82746	Folic acid; serum
82947	Glucose; quantitative, blood (except reagent strip)
82950	post-glucose dose (includes glucose)
82951	tolerance test (GTT), three specimens (includes glucose)
82955	Glucose-6-phosphate dehydrogenase (G6PD); quantitative
82960	screen
83001	Gonadotropin; follicle-stimulating hormone (FSH)
83002	luteinizing hormone (LH)
83003	Growth hormone, human (HGH) (somatotropin)
83036	Hemoglobin; glycated
83491	Hydroxycorticosteroids, 17- (17-OHCS)
83540	Iron
83550	Iron-binding capacity
83586	Ketosteroids, 17- (17-KS); total
83593	fractionation
83615	Lactate dehydrogenase (LD), (LDH)
83625	isoenzymes, separation and quantitation
83718	Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
84060	Phosphatase, acid; total
84066	prostatic
84075	Phosphatase, alkaline
84078	heat stable (total not included)
84080	isoenzymes
84132	Potassium; serum
84144	Progesterone
84146	Prolactin
84155	Protein; total, except refractometry
84160	refractometric
84165	electrophoretic fractionation and quantitation
84295	Sodium; serum
84300	urine
84402	Testosterone; free
84403	total
84436	Thyroxine; total
84437	requiring elution (e.g., neonatal)
84439	free
84443	Thyroid-stimulating hormone (TSH)
84450	Transferase; aspartate amino (AST) (SGOT)
84460        alanine amino (ALT) (SGPT)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
FAMILY PLANNING AGENCY MANUAL	SUBCHAPTER NUMBER AND TITLE
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	TRANSMITTAL LETTER
FPA-33	DATE
06/01/02	
605   Service Codes and Descriptions: Laboratory Services (cont.)
Service
Code	Service Description
 84478	Triglycerides
 84479	Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)
84480	Triiodothyronine T3; total (TT-3)
84520	Urea nitrogen; quantitative
84550	Uric acid; blood
84590	Vitamin A
84702	Gonadotropin, chorionic (hCG); quantitative
84703	qualitative
HEMATOLOGY AND COAGULATION
85007	Blood count; manual differential WBC count (includes RBC morphology and platelet estimation)
 85008	manual blood smear examination without differential parameters
 85009	differential WBC count, buffy coat

 85013	spun microhematocrit
 85014	other than spun hematocrit 85018	hemoglobin

 85021	hemogram, automated (RBC, WBC, Hgb, Hct, and indices only)
 85022	hemogram, automated, and manual differential WBC count (CBC)
 85023	hemogram and platelet count, automated, and manual differential WBC count (CBC)
 85024	hemogram and platelet count, automated, and automated partial differential WBC count (CBC)
 85025	hemogram and platelet count, automated, and automated complete differential WBC count (CBC)
85027	hemogram and platelet count, automated
85031	Blood count; hemogram, manual, complete CBC (RBC, WBC, Hgb, Hct, differential and indices)
85041	red blood cell (RBC) only
85610	Prothrombin time
85651	Sedimentation rate, erythrocyte; nonautomated
85652	automated
85660	Sickling of RBC, reduction
IMMUNOLOGY
86038	Antinuclear antibodies (ANA)
86171	Complement fixation tests, each antigen
86235	Extractable nuclear antigen, antibody to, any method (e.g., nRNP, SS-A, SS-B, Sm, RNP,
Sc170, J01), each antibody
86280	Hemagglutination inhibition test (HAI)
86308	Heterophile antibodies; screening
86309	titer
86310	titers after absorption with beef cells and guinea pig kidney
86317	Immunoassay for infectious agent antibody, quantitative, not elsewhere specified

Commonwealth of Massachusetts
Division of Medical Assistance
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FPA-33	DATE
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605   Service Codes and Descriptions: Laboratory Services (cont.)

Service Code
86318
86592 86593
86628 86631 86632 86687 86688 86689 86692 86694 86695 86696 86704 86705 86706 86707 86708 86709 86762 86781 86803 86804

Service Description
Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method
(e.g., reagent strip) Syphilis test; qualitative (e.g., VDRL, RPR, ART)
quantitative
The following codes (86628-86804) are qualitative or semiquantitative immunoassays performed by multiple step methods for the detection of antibodies to infectious agents. For immunoassays by single step method (e.g., reagent strips), use code 86318. Procedures for the identification of antibodies should be coded as precisely as possible. For example, an antibody to a virus could be coded with increasing specificity for virus, family, genus, species, or type. In some cases, further precision may be added to codes by specifying the class of immunoglobulin being detected. When multiple tests are done to detect antibodies to organisms classified more precisely than the specificity allowed by available codes, it is appropriate to code each as a separate service.
Antibody; candida
chlamydia
chlamydia, IgM
HTLV-I
HTLV-II
HTLV or HIV antibody, confirmatory test (e.g., Western Blot)
hepatitis, delta agent
herpes simplex, non-specific type test
herpes simplex, type 1
herpes simplex, type 2 Hepatitis B core antibody (HBcAb); total
IgM antibody Hepatitis B surface antibody (HBsAb) Hepatitis Be antibody (HBeAb) Hepatitis A antibody (HAAb); total
IgM antibody Antibody; rubella
treponema pallidum, confirmatory test (e.g., FTA-abs) Hepatitis C antibody
confirmatory test (e.g., immunoblot)

Commonwealth of Massachusetts
Division of Medical Assistance
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FPA-33	DATE
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605   Service Codes and Descriptions: Laboratory Services (cont.)

Service Code

Service Description

TRANSFUSION MEDICINE

86850 86900 86901 86906
87070
87075 87081 87086 87088 87101
87102 87103 87110 87140 87164 87177 87181
87184 87186
87188 87205 87206 87207
87210 87220
87252
87253

Antibody screen, RBC, each serum technique Blood typing; ABO
Rh (D) (I.C.)
Rh phenotyping, complete
MICROBIOLOGY
Culture, bacterial; any other source except urine, blood or stool, with isolation and presumptive
identification of isolates
any source; anaerobic with isolation and presumptive identification of isolates Culture, presumptive, pathogenic organisms, screening only Culture, bacterial; quantitative colony count, urine
with isolation and presumptive identification of isolates, urine Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or
nail
other source (except blood)
blood Culture, chlamydia, any source
Culture, typing; immunofluorescent method, each antiserum
Dark field examination, any source (e.g., penile, vaginal, oral, skin); includes specimen collection Ova and parasites, direct smears, concentration and identification Susceptibility studies, antimicrobial agent; agar dilution method, per agent (e.g., antibiotic
gradient strip)
disk method, per plate (12 or fewer disks)
microdilution or agar dilution (minimum inhibitory concentration (MIC) or breakpoint), each
multiantimicrobial, per plate
macrobroth dilution method, each agent Smear, primary source, with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types
fluorescent and/or acid-fast stain for bacteria, fungi, parasites, viruses, or cell types
special stain for inclusion bodies or intracellular parasites (e.g., malaria, coccidia,
microsporidia, cytomegalovirus, herpes viruses)
wet mount for infectious agents (e.g., saline, India ink, KOH preps) Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova
or mites (e.g., scabies) Virus isolation; tissue culture inoculation, observation, and presumptive identification by
cytopathic effect
tissue culture, additional studies or definitive identification (e.g., hemabsorption,
neutralization, immunofluoresence stain), each isolate

Commonwealth of Massachusetts
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605   Service Codes and Descriptions: Laboratory Services (cont.)
Service
Code	Service Description
Infectious agents by antigen detection, immunofluorescence microscopy, or nucleic acid probe techniques should be reported as precisely as possible. The most specific code possible should be reported. For identification of antibodies to many of the listed infectious agents, see 86602-86804.
87270	Infectious agent antigen detection by immunofluorescent technique; chlamydia trachomatis
 87273	herpes simplex virus type 2
 87274	herpes simplex virus type 1 87285	treponema pallidum 87320	Infectious agent antigen detection by enzyme immunoassay technique, qualitative or
semiquantitative, multiple step method; chlamydia trachomatis
87340	hepatitis B surface antigen (HBsAg)
87350	hepatitis Be antigen (HBeAg)
87380	hepatitis, delta agent
 87390	HIV-1
 87391	HIV-2
87480	Infectious agent detection by nucleic acid (DNA or RNA); candida species, direct probe technique
 87481	candida species, amplified probe technique
 87482	candida species, quantification

 87490	chlamydia trachomatis, direct probe technique
 87491	chlamydia trachomatis, amplified probe technique
 87492	chlamydia trachomatis, quantification

 87510	gardnerella vaginalis, direct probe technique
 87511	gardnerella vaginalis, amplified probe technique
 87512	gardnerella vaginalis, quantification

 87515	hepatitis B virus, direct probe technique
 87516	hepatitis B virus, amplified probe technique
 87517	hepatitis B virus, quantification

 87520	hepatitis C, direct probe technique
 87521	hepatitis C, amplified probe technique
 87522	hepatitis C, quantification

 87528	herpes simplex virus, direct probe technique
 87529	herpes simplex virus, amplified probe technique
 87530	herpes simplex virus, quantification

 87534	HIV-1, direct probe technique
 87535	HIV-1, amplified probe technique
 87536	HIV-1, quantification
 87537	HIV-2, direct probe technique
 87538	HIV-2, amplified probe technique
 87539	HIV-2, quantification

Commonwealth of Massachusetts
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605   Service Codes and Descriptions: Laboratory Services (cont.)

Service Code
87590 87591 87592 87620 87621 87622 87810 87850

Service Description
neisseria gonorrhoeae, direct probe technique neisseria gonorrhoeae, amplified probe technique neisseria gonorrhoeae, quantification papillomavirus, human, direct probe technique papillomavirus, human, amplified probe technique papillomavirus, human, quantification Infectious agent detection by immunoassay with direct optical observation; chlamydia trachomatis neisseria gonorrhoeae

ANATOMIC PATHOLOGY
Cytopathology

88104
88106 88107 88108 88130
88141
88142
88143 88144 88145
88147
88148

Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with
interpretation
filter method only with interpretation
smears and filter preparation with interpretation Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique) Sex chromatin identification; Barr bodies
Codes 88141-88155, 88164-88167 are used to report cervical or vaginal screening by various methods and to report physician interpretation services. Use codes 88150-88154 to report Pap smears that are examined using non-Bethesda reporting. Use codes 88164-88167 to report Pap smears that are examined using the Bethesda System of reporting. Use codes 88142-88145 to report specimens collected in fluid medium with automated thin layer preparation that are examined using any system of reporting (Bethesda or non-Bethesda). Within each of these three code families choose the one code that describes the screening method(s) used. Codes 88141 and 88155 should be reported in addition to the screening code chosen when the additional services are provided.
Cytopathology, cervical or vaginal (any reporting system); requiring interpretation by physician
(List separately in addition to code for technical service.) Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid,
automated thin layer preparation; manual screening under physician supervision
with manual screening and rescreening under physician supervision
with manual screening and computer-assisted rescreening under physician supervision
with manual screening and computer-assisted rescreening using cell selection and review
under physician supervision Cytopathology smears, cervical or vaginal; screening by automated system under physician
supervision
screening by automated system with manual rescreening under physician supervision

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605   Service Codes and Descriptions: Laboratory Services (cont.)
Service
Code       Service Description
88150      Cytopathology, slides, cervical or vaginal; manual screening under physician supervision
 88152	with manual screening and computer-assisted rescreening under physician supervision
 88153	with manual screening and rescreening under physician supervision
 88154	with manual screening and computer-assisted rescreening using cell selection and review under physician supervision
88155	Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (e.g., maturation index,
karyopyknotic index, estrogenic index) (List separately in addition to code(s) for other
technical and interpretation services.)
88160	Cytopathology, smears, any other source; screening and interpretation
 88161	preparation, screening, and interpretation
 88162	extended study involving over 5 slides and/or multiple stains (I.C.)
88164	Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under
physician supervision
 88165	with manual screening and rescreening under physician supervision
 88166	with manual screening and computer-assisted rescreening under physician supervision 86167            with manual screening and computer-assisted rescreening using cell selection and review
under physician supervision 88199      Unlisted cytopathology procedure (I.C.)
Cytogenetic Studies
88261	Chromosome analysis; count five cells, one karyotype, with banding
88262	count 15 to 20 cells, 2 karyotypes, with banding
88267      Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, 1 karyotype, with
banding
88280      Chromosome analysis; additional karyotypes, each study
88285	additional cells counted, each study
SURGICAL PATHOLOGY
Codes 88300 through 88309 are further clarified in the Current Procedural Terminology (CPT) code book.
88300	Level I - surgical pathology, gross examination only
88302	Level II - surgical pathology, gross and microscopic examination
88304	Level III - surgical pathology, gross and microscopic examination
88305	Level IV - surgical pathology, gross and microscopic examination
88307	Level V - surgical pathology, gross and microscopic examination
88309	Level VI - surgical pathology, gross and microscopic examination

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FPA-33	DATE
06/01/02	
605   Service Codes and Descriptions: Laboratory Services (cont.)
Service
Code       Service Description
MISCELLANEOUS
89050      Cell count, miscellaneous body fluids (e.g., cerebrospinal fluid, joint fluid), except blood
This publication contains codes that are copyrighted by the American Medical Association. Certain terms used in the service descriptions for HCPCS codes are defined in the Current Procedural Terminology (CPT) code book.