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 LAB-22 July 2002
TO:      Independent Clinical Laboratories Participating in MassHealth FROM:      Wendy E. Warring, Commission
RE:      Independent Clinical Laboratory Manual (Laboratory 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 April 30, 2002. The codes introduced under the 2002 HCPCS code book are effective for dates of service on or after April 30, 2002. We will accept either the new or the old codes for dates of service through July 28, 2002. For dates of service on or after July 29, 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 for laboratory is 114.3 CMR 20.00: Laboratory.

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 LAB-22 July 2002 Page 2
NEW MATERIAL
(The pages listed here contain new or revised language.)
Independent Clinical Laboratory Manual
Pages vi and 6-1 through 6-36
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Independent Clinical Laboratory Manual
Pages vi, 6-1 through 6-28, and 6-31 through 6-36 — transmitted by Transmittal Letter LAB-20
Pages 6-29 and 6-30 — transmitted by Transmittal Letter LAB-21

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
INDEPENDENT CLINICAL LABORATORY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-1	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code       Service Description
PATHOLOGY AND LABORATORY
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.
80048      Basic metabolic panel (This panel must include the following: Calcium (82310), Carbon dioxide (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Potassium (84132), Sodium (84295), and Urea Nitrogen (BUN) (84520).)
80050	General health panel (This panel must include the following: Comprehensive metabolic panel
(80054), Hemogram, automated, and manual differential WBC count (CBC) (85022) or Hemogram and platelet count, automated, and automated complete differential WBC count (CBC) (85025), and Thyroid stimulating hormone (TSH) (84443).)
80051	Electrolyte panel (This panel must include the following: Carbon dioxide (82374), Chloride
(82435), Potassium (84132), and Sodium (84295).)
80053      Comprehensive metabolic panel (This panel must include the following: Albumin (82040),
Bilirubin, total (82247), Calcium (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), and Urea Nitrogen (BUN) (84520).)
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).)
80069      Renal function panel (This panel must include the following: Albumin (82040), Calcium (82310), Carbon dioxide (bicarbonate) (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Phosphorus inorganic (phosphate) (84100), Potassium (84132), Sodium (84295), and Urea nitrogen (BUN) (84520).)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
INDEPENDENT CLINICAL LABORATORY MANUAL	SUBCHAPTER NUMBER AND TITLE
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6-2	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
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).)
80090 TORCH antibody panel (This panel must include the following tests: Antibody, cytomegalovirus (CMV) (86644), Antibody, herpes simplex, non-specific type test (86694), Antibody, rubella (86762), and Antibody, toxoplasma (86777).)
DRUG TESTING
The following list contains examples of drugs or classes of drugs that are commonly assayed by qualitative screen, followed by confirmation with a second method.
Alcohols
Amphetamines
Barbiturates
Benzodiazepines
Cocaine and metabolites
Methadones
Methaqualones
Opiates
Phencyclidines
Phenothiazines
Propoxyphenes
Tetrahydrocannabinoids
Tricyclic antidepressants
Confirmed drugs may also be quantitated. Qualitative screening tests are coded by procedure, not method or analyte. For example, if chromatography is being used, code each combination of stationary and mobile phases separately using 80100 if the analysis is designed to detect multiple drug classes or 80101 if the procedure is capable of detecting a single class of drugs.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
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6-3	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code       Service Description
Use 80102 for each procedure necessary for confirmation, e.g., if confirmation of three drugs by chromatography requires three stationary or mobile phases, use 80102 three times. However, if multiple drugs can be confirmed using a single analysis, use 80102 only once. For quantitation of drugs screened, use the appropriate code in the chemistry section (82000-84999) or the therapeutic drug assay section (80150-80299).
The following codes (80100-80103) should be used for testing of other drugs which may not be listed above:
80100	Drug screen, qualitative; multiple drug classes chromatographic method, each procedure
80101	single drug class method (e.g., immunoassay, enzyme assay), each drug class
 80102	Drug confirmation, each procedure
 80103	Tissue preparation for drug analysis (I.C.)
THERAPEUTIC DRUG ASSAYS
The material for examination may be from any source. Examination is quantitative. For nonquantitative testing, see drug testing (80100-80103).
80150	Amikacin
80152	Amitriptyline
80154	Benzodiazepines
80156	Carbamazepine; total
80157	free
80158	Cyclosporine
80160	Desipramine
80162	Digoxin
80164	Dipropylacetic acid (valproic acid)
80166	Doxepin
80168	Ethosuximide
80170	Gentamicin
 80172	Gold
 80173	Haloperidol
80174	Imipramine
80176	Lidocaine
80178	Lithium
80182	Nortriptyline
 80184	Phenobarbital
 80185	Phenytoin; total
80186	free
80188      Primidone

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
INDEPENDENT CLINICAL LABORATORY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-4	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code       Service Description
80190	Procainamide
80192	with metabolites (e.g., n-acetyl procainamide)
80194	Quinidine
 80196	Salicylate
 80197	Tacrolimus
 80198	Theophylline

 80200	Tobramycin
 80201	Topiramate
80202	Vancomycin
80299	Quantitation of drug, not elsewhere specified
EVOCATIVE/SUPPRESSION TESTING
80400      ACTH stimulation panel; for adrenal insufficiency (This panel must include the following:
Cortisol (82533 x 2).)
80402	for 21 hydroxylase deficiency (This panel must include the following: Cortisol (82533 x 2)
and 17 hydroxyprogesterone (83498 x 2).)
80406	for 3 beta-hydroxydehydrogenase deficiency (This panel must include the following:
Cortisol (82533 x 2) and 17 hydroxypregnenolone (84143 x 2).) (I.C.) 80408      Aldosterone suppression evaluation panel (e.g., saline infusion) (This panel must include the
following: Aldosterone (82088 x 2) and Renin (84244 x 2).) 80410      Calcitonin stimulation panel (e.g., calcium, pentagastrin) (This panel must include the
following: Calcitonin (82308 x 3).) 80412      Corticotropic releasing hormone (CRH) stimulation panel (This panel must include the
following: Cortisol (82533 x 6) and Adrenocorticotropic hormone (ACTH) (82024 x 6).)
80414	Chorionic gonadotropin stimulation panel; testosterone response (This panel must include the
following: Testosterone (84403 x 2 on three pooled blood samples).)
80415	estradiol response (This panel must include the following: Estradiol (82670 x 2 on three
pooled blood samples).)
 80416	Renal vein renin stimulation panel (e.g., captopril) (This panel must include the following: Renin (84244 x 6).)
 80417	Peripheral vein renin stimulation panel (e.g., captopril) (This panel must include the following: Renin (84244 x 2).)
 80418	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), and Thyroid stimulating hormone (TSH) (84443 x 4).)
80420 Dexamethasone suppression panel, 48 hour (This panel must include the following: Free cortisol, urine (82530 x 2), Cortisol (82533 x 2), and Volume measurement for timed collection (81050 x 2).) (For single dose dexamethasone, use 82533.)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
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6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-5	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code       Service Description
80422      Glucagon tolerance panel; for insulinoma (This panel must include the following: Glucose
(82947 x 3) and insulin (83525 x 3).)
80424	for pheochromocytoma (This panel must include the following: Catecholamines, fractionated
(82384 x 2).) 80426      Gonadatropin releasing hormone stimulation panel (This panel must include the following:
Follicle stimulating hormone (FSH) (83001 x 4) and Luteinizing hormone (LH) (83002 x 4).) 80428      Growth hormone stimulation panel (e.g., arginine infusion, l-dopa administration). (This panel
must include the following: Human growth hormone (HGH) (83003 x 4).) 80430      Growth hormone suppression panel (glucose administration) (This panel must include the
following: Glucose (82947 x 3) and Human growth hormone (HGH) (83003 x 4).) 80432      Insulin-induced C-peptide suppression panel (This panel must include the following: Insulin
(83525), C-peptide (84681 x 5), and Glucose (82947 x 5).)
80434	Insulin tolerance panel; for ACTH insufficiency (This panel must include the following:
Cortisol (82533 x 5) and Glucose (82947 x 5).)
80435	for growth hormone deficiency (This panel must include the following: Glucose (82947 x 5)
and Human growth hormone (HGH) (83003 x 5).)
80436	Metyrapone panel (This panel must include the following: Cortisol (82533 x 2) and 11
deoxycortisol (82634 x 2).)
80438	Thyrotropin releasing hormone (TRH) stimulation panel; one hour (This panel must include
the following: Thyroid stimulating hormone (TSH) (84443 x 3).)
 80439	two hours (This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 4).)
 80440	for hyperprolactinemia (This panel must include the following: Prolactin (84146 x 3).)
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; non-automated, with microscopy
 81001	automated, with microscopy
 81002	non-automated, without microscopy
 81003	automated, without microscopy
81005      Urinalysis; qualitative or semiquantitative, except immunoassays
81007	bacteriuria screen, except by culture or dipstick (specify type)
81015	microscopic only
81020	two or three glass test
81025      Urine pregnancy test, by visual color comparison methods 81050      Volume measurement for timed collection, each 81099      Unlisted urinalysis procedure (I.C.)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
INDEPENDENT CLINICAL LABORATORY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-6	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code       Service Description
CHEMISTRY

82000 82003 82009 82010 82013 82016 82017 82024 82030 82040 82042 82043 82044 82055 82085 82088 82101 82103 82104 82105 82106 82108 82120 82127 82128 82131 82135 82136 82139 82140 82143

The material for examination may be from any source. 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.
Acetaldehyde, blood
Acetaminophen
Acetone or other ketone bodies, serum; qualitative
quantitative Acetylcholinesterase Acylcarnitines; qualitative, each specimen
quantitative, each specimen Adrenocorticotropic hormone (ACTH) Adenosine; 5-monophosphate, cyclic (cyclic AMP) Albumin; serum
urine or other source, quantitative, each specimen
urine, microalbumin, quantitative
urine, microalbumin, semiquantitative (e.g., reagent strip assay) Alcohol (ethanol); any specimen except breath Aldolase Aldosterone
Alkaloids, urine, quantitative Alpha-1-antitrypsin; total
phenotype Alpha-fetoprotein; serum
amniotic fluid Aluminum
Amines, vaginal fluid, qualitative Amino acids; single, qualitative, each specimen
multiple, qualitative, each specimen
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)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
INDEPENDENT CLINICAL LABORATORY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-7	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
82145	Amphetamine or methamphetamine
82150	Amylase
82154	Androstanediol glucuronide (I.C.)
82157	Androstenedione
82160	Androsterone
82163	Angiotensin II
82164	Angiotensin I - converting enzyme (ACE)
82172	Apolipoprotein, each
82175	Arsenic
82180	Ascorbic acid (vitamin C), blood
82190	Atomic absorption spectroscopy, each analyte
82205	Barbiturates, not elsewhere specified
82232	Beta-2 microglobulin
82239	Bile acids; total
82240	cholylglycine
82247	Bilirubin; total
82248	direct
82252            feces, qualitative
82261	Biotinidase, each specimen
82270	Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous
determinations
82273	other sources
82274	Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3
simultaneous determinations
82286	Bradykinin
82300	Cadmium
 82306	Calcifediol (25-OH vitamin D-3)
 82307	Calciferol (vitamin D)
82308	Calcitonin
82310	Calcium; total
82330	ionized
82331	after calcium infusion test
82340	urine quantitative, timed specimen
82355	Calculus; qualitative analysis
82360	quantitative analysis, chemical
82365	infrared spectroscopy
82370	x-ray diffraction
 82373	Carbohydrate deficient transferrin
 82374	Carbon dioxide (bicarbonate)
 82375	Carbon monoxide (carboxyhemoglobin); quantitative
82376	qualitative
 82378	Carcinoembryonic antigen (CEA)
 82379	Carnitine (total and free), quantitative, each specimen

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
INDEPENDENT CLINICAL LABORATORY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-8	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
82380	Carotene
82382	Catecholamines; total urine
82383	blood
82384	fractionated
82387	Cathepsin-D
82390	Ceruloplasmin
82397	Chemiluminescent assay
82415	Chloramphenicol
82435	Chloride; blood
82436	urine
82438            other source
82441	Chlorinated hydrocarbons, screen
82465	Cholesterol, serum or whole blood, total
82480	Cholinesterase; serum
82482            RBC
 82485	Chondroitin B sulfate, quantitative
 82486	Chromatography, qualitative; column (e.g., gas liquid or HPLC), analyte not elsewhere specified

 82487	paper, 1-dimensional, analyte not elsewhere specified
 82488	paper, 2-dimensional, analyte not elsewhere specified
 82489	thin layer, analyte not elsewhere specified
82491	Chromatography, quantitative, column (e.g., gas liquid or HPLC); single analyte not elsewhere
specified, single stationary and mobile phase
82492	multiple analytes, single stationary and mobile phase
82495	Chromium
82507	Citrate
82520	Cocaine or metabolite
82523	Collagen cross links, any method
82525	Copper
82528	Corticosterone
82530	Cortisol; free
82533	total
 82540	Creatine
 82541	Column chromatography/mass spectrometry (e.g., GC/MS, or HPLC/MS), analyte not elsewhere specified; qualitative, single stationary and mobile phase

 82542	quantitative, single stationary and mobile phase
 82543	stable isotope dilution, single analyte, quantitative, single stationary and mobile phase
82544	stable isotope dilution, multiple analytes, quantitative, single stationary and mobile phase
82550	Creatine kinase (CK), (CPK); total
 82552	isoenzymes
 82553	MB fraction only
 82554	isoforms

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
INDEPENDENT CLINICAL LABORATORY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-9	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
82565	Creatinine; blood
82570	other source
82575	clearance
82585	Cryofibrinogen
82595	Cryoglobulin, qualitative or semi-quantitative (e.g., cryocrit)
82600	Cyanide
82607	Cyanocobalamin (vitamin B-12)
82608	unsaturated binding capacity
82615	Cystine and homocystine, urine, qualitative
82626	Dehydroepiandrosterone (DHEA)
82627	Dehydroepiandrosterone-sulfate (DHEA-S)
82633	Desoxycorticosterone, 11-
82634	Deoxycortisol, 11-
82638	Dibucaine number
82646	Dihydrocodeinone
82649	Dihydromorphinone
82651	Dihydrotestosterone (DHT)
82652	Dihydroxyvitamin D, 1,25-
82654	Dimethadione
82657	Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive
substrate, each specimen
82658	radioactive substrate, each specimen
82664	Electrophoretic technique, not elsewhere specified
82666	Epiandrosterone
82668	Erythropoietin
 82670	Estradiol
 82671	Estrogens; fractionated
82672	total
82677	Estriol
82679	Estrone
82690	Ethchlorvynol
82693	Ethylene glycol
82696	Etiocholanolone
82705	Fat or lipids, feces; qualitative
82710            quantitative
82715	Fat differential, feces, quantitative
82725	Fatty acids, nonesterified
82726	Very long chain fatty acids
82728	Ferritin

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
INDEPENDENT CLINICAL LABORATORY MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-10	

	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
82731	Fetal fibronectin, cervicovaginal secretions, semi-quantitative
82735	Fluoride
82742	Flurazepam
82746	Folic acid; serum
82747	RBC
82757	Fructose, semen
 82759	Galactokinase, RBC
 82760	Galactose
82775	Galactose-1-phosphate uridyl transferase; quantitative
82776	screen
82784	Gammaglobulin; IgA, IgD, IgG, IgM, each
82785	IgE
82787	immunoglobulin subclasses (IgG1, 2, 3, or 4), each
82800	Gases, blood, pH only
82803	Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2
saturation)
82805	with O2 saturation, by direct measurement, except pulse oximetry
82810	Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry
82820	Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen)
82926	Gastric acid, free and total, each specimen
82928	Gastric acid, free or total; each specimen
82938	Gastrin after secretin stimulation
82941	Gastrin
82943	Glucagon
 82945	Glucose, body fluid, other than blood
 82946	Glucagon tolerance test
 82947	Glucose; quantitative, blood (except reagent strip)
82948	blood, reagent strip
 82950	post-glucose dose (includes glucose)
 82951	tolerance test (GTT), three specimens (includes glucose)
 82952	tolerance test, each additional beyond three specimens
 82953	tolbutamide tolerance test
82955	Glucose-6-phosphate dehydrogenase (G6PD); quantitative
82960	screen
82963	Glucosidase, beta
82965	Glutamate dehydrogenase
82975	Glutamine (glutamic acid amide)
 82977	Glutamyltransferase, gamma (GGT)
 82978	Glutathione
 82979	Glutathione reductase, RBC
 82980	Glutethimide

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
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	TRANSMITTAL LETTER
LAB-22	DATE
04/30/02	
601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
82985	Glycated protein
83001	Gonadotropin; follicle-stimulating hormone (FSH)
83002	luteinizing hormone (LH)
83003	Growth hormone, human (HGH) (somatotropin)
83008	Guanosine monophosphate (GMP), cyclic
83010	Haptoglobin; quantitative
83012	phenotypes
83013	Helicobacter pylori; analysis for urease acitivity, non-radioactive isotope
83014	drug administration and sample collection
83015	Heavy metal (arsenic, barium, beryllium, bismuth, antimony, mercury); screen
83018	quantitative, each
83020	Hemoglobin fractionation and quantitation; electrophoresis (e.g., A2, S, C, and/or F)
83021	chromatography (e.g., A2, S, C, and/or F)
83026	Hemoglobin; by copper sulfate method, non-automated
83030	F (fetal), chemical
83033	F (fetal), qualitative
83036	glycated
83045	methemoglobin, qualitative
 83050	methemoglobin, quantitative
 83051	plasma 83055	sulfhemoglobin, qualitative 83060	sulfhemoglobin, quantitative 83065	thermolabile

 83068	unstable, screen
 83069	urine
83070	Hemosiderin; qualitative
83071	quantitative
83080	b-Hexosaminidase, each assay
83088	Histamine
83090	Homocystine
83150	Homovanillic acid (HVA)
83491	Hydroxycorticosteroids, 17- (17-OHCS)
 83497	Hydroxyindolacetic acid, 5- (HIAA)
 83498	Hydroxyprogesterone, 17-d
83499	Hydroxyprogesterone, 20-
83500	Hydroxyproline; free
83505	total
83516	Immunoassay for analyte other than infectious agent antibody or infectious agent antigen,
qualitative or semiquantitative; multiple step method
83518	single step method (e.g., reagent strip)

Commonwealth of Massachusetts
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	TRANSMITTAL LETTER
LAB-22	DATE
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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
83519	Immunoassay, analyte, quantitative; by radiopharmaceutical technique (e.g., RIA)
83520	not otherwise specified
83525	Insulin; total
83527	free (I.C.)
83528	Intrinsic factor
83540	Iron
83550	Iron-binding capacity
83570	Isocitric dehydrogenase (IDH)
83582	Ketogenic steroids, fractionation
83586	Ketosteroids, 17- (17-KS); total
83593	fractionation
83605	Lactate (lactic acid)
83615	Lactate dehydrogenase (LD), (LDH);
83625	isoenzymes, separation and quantitation
 83632	Lactogen, human placental (HPL) human chorionic somatomammotropin
 83633	Lactose, urine; qualitative
83634	quantitative
83655	Lead
83661	Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio
 83662	foam stability test
 83663	fluorescence polarization
83664	lamellar body density
83670	Leucine aminopeptidase (LAP)
83690	Lipase
83715	Lipoprotein, blood; electrophoretic separation and quantitation
83716	high resolution fractionation and quantitation of lipoprotein cholesterols (e.g., electrophoresis,
nuclear magnetic resonance, ultracentrifugation)
83718	Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
83719	direct measurement, VLDL cholesterol
83721	direct measurement, LDL cholesterol
83727	Luteinizing-releasing factor (LRH)
83735	Magnesium
83775	Malate dehydrogenase
83785	Manganese
83788	Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified;
qualitative, each specimen
83789	quantitative, each specimen
83805	Meprobamate
83825	Mercury, quantitative
83835	Metanephrines
83840	Methadone
 83857	Methemalbumin
 83858	Methsuximide

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601   Laboratory Service Codes and Descriptions

Service		
Code	Service Description	
83864	Mucopolysaccharides, acid; quantitative	
83866	screen	
83872	Mucin, synovial fluid (Ropes test)	
83873	Myelin basic protein, cerebrospinal fluid	
83874	Myoglobin	
83883	Nephelometry, each analyte not elsewhere specified	
83885	Nickel	
83887	Nicotine	
Molecular Diagnostics
The series of codes 83890-83912 is intended for use with molecular diagnostic techniques for analysis of nucleic acids. These services are coded by procedure rather than analyte. Code separately for each procedure used in an analysis. For example, a procedure requiring isolation of DNA, restriction endonuclease digestion, electrophoresis, and nucleic acid probe amplification would be coded 83890, 83892, 83894, and 83898.

83890 83891 83892 83893 83894 83896 83897 83898
83901 83902 83903
83904 83905 83906 83912 83915 83916 83918 83919 83921 83925

Molecular diagnostics; molecular isolation or extraction
isolation or extraction of highly purified nucleic acid
enzymatic digestion
dot/slot blot production
separation by gel electrophoresis (e.g., agarose, polyacrylamide)
nucleic acid probe, each
nucleic acid transfer (e.g., Southern, Northern)
amplification of patient nucleic acid (e.g., PCR, LCR, RT-PCR), single primer pair, each
primer pair
amplification of patient nucleic acid, multiplex, each multiplex reaction
reverse transcription
mutation scanning, by physical properties (e.g., single strand conformational polymorphisms
(SSCP), heteroduplex, denaturing gradient gel electrophoresis (DGGE), RNA’ase A), single
segment, each
mutation identification by sequencing, single segment, each segment
mutation identification by allele specific transcription, single segment, each segment
mutation identification by allele specific translation, single segment, each segment
interpretation and report Nucleotidase 5-Oligoclonal immune (oligoclonal bands) Organic acids; total, quantitative, each specimen
qualitative, each specimen Organic acid, single, quantitative Opiates (e.g., morphine, meperidine)

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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
83930	Osmolality; blood
83935	urine
83937	Osteocalcin (bone g1a protein) (I.C.)
83945	Oxalate
83950	Oncoprotein, HER-2/neu
83970	Parathormone (parathyroid hormone)
83986	pH, body fluid, except blood
83992	Phencyclidine (PCP)
84022	Phenothiazine
84030	Phenylalanine (PKU), blood
84035	Phenylketones, qualitative
84060	Phosphatase, acid; total
84066	prostatic
84075	Phosphatase, alkaline;
84078	heat stable (total not included)
84080	isoenzymes
84081	Phosphatidylglycerol
84085	Phosphogluconate, 6-, dehydrogenase, RBC
84087	Phosphohexose isomerase
84100	Phosphorus inorganic (phosphate);
84105	urine
84106	Porphobilinogen, urine; qualitative
84110	quantitative
84119	Porphyrins, urine; qualitative
84120	quantitation and fractionation
84126	Porphyrins, feces; quantitative
84127	qualitative
84132	Potassium; serum
84133	urine
84134	Prealbumin
84135	Pregnanediol
84138	Pregnanetriol
84140	Pregnenolone (I.C.)
84143	17-hydroxypregnenolone (I.C.)
84144	Progesterone
84146	Prolactin
84150	Prostaglandin, each
 84152	Prostate specific antigen (PSA); complexed (direct measurement)
 84153	total
84154	free

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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
84155	Protein; total, except refractometry
84160	refractometric
84165	electrophoretic fractionation and quantitation
 84181	Western Blot, with interpretation and report, blood or other body fluid
 84182	Western Blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each
84202	Protoporphyrin, RBC; quantitative
84203	screen
84206	Proinsulin
84207	Pyridoxal phosphate (vitamin B-6)
84210	Pyruvate
84220	Pyruvate kinase
84228	Quinine
84233	Receptor assay; estrogen
84234	progesterone
84235	endocrine, other than estrogen or progesterone (specify hormone)
84238	non-endocrine (e.g., acetylcholine) (specify receptor)
84244	Renin
84252	Riboflavin (vitamin B-2)
84255	Selenium
84260	Serotonin
84270	Sex hormone binding globulin (SHBG)
84275	Sialic acid
84285	Silica
84295	Sodium; serum
84300	urine
84305	Somatomedin
84307	Somatostatin
84311	Spectrophotometry, analyte not elsewhere specified
84315	Specific gravity (except urine)
 84375	Sugars, chromatographic, TLC or paper chromatography
 84376	Sugars (mon-, di, and oligosaccharides); single qualitative, each specimen

 84377	multiple qualitative, each specimen
 84378	single quantitative, each specimen
84379	multiple quantitative, each specimen
84392	Sulfate, urine
84402	Testosterone; free
84403	total
84425	Thiamine (vitamin B-1)
84430	Thiocyanate
84432	Thyroglobulin

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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
84436	Thyroxine; total
84437	requiring elution (e.g., neonatal)
84439	free
 84442	Thyroxine binding globulin (TBG)
 84443	Thyroid-stimulating hormone (TSH)

 84445	Thyroid-stimulating immune globulins (TSI)
 84446	Tocopherol alpha (vitamin E)
84449	Transcortin (cortisol binding globulin) (I.C.)
84450	Transferase; aspartate amino (AST) (SGOT)
84460	alanine amino (ALT) (SGPT)
84466	Transferrin (I.C.)
 84478	Triglycerides
 84479	Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)
 84480	Triiodothyronine T3; total (TT-3)

 84481	free
 84482	reverse
84484	Troponin, quantitative
84485	Trypsin; duodenal fluid
84488	feces, qualitative
84490	feces, quantitative, 24-hour collection
84510	Tyrosine
84512	Troponin, qualitative
84520	Urea nitrogen; quantitative
84525	semiquantitative (e.g., reagent strip test)
84540	Urea nitrogen, urine
84545	Urea nitrogen, clearance
84550	Uric acid; blood
84560	other source
 84577	Urobilinogen, feces, quantitative
 84578	Urobilinogen, urine; qualitative 84580	quantitative, timed specimen 84583	semiquantitative
84585	Vanillylmandelic acid (VMA), urine
84586	Vasoactive intestinal peptide (VIP) (I.C.)
84588	Vasopressin (antidiuretic hormone, ADH)
84590	Vitamin A
84591	Vitamin, not otherwise specified
84597	Vitamin K
84600	Volatiles (e.g., acetic anhydride, carbon tetrachloride, dichloroethane, dichloromethane,
diethylether, isopropyl alcohol, methanol)
84620	Xylose absorption test, blood and/or urine

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601   Laboratory Service Codes and Descriptions

Service Code
84630 84681 84702 84703 84999

Service Description
Zinc
C-peptide
Gonadotropin, chorionic (hCG); quantitative
qualitative Unlisted chemistry procedure (I.C.)

HEMATOLOGY AND COAGULATION
85002	Bleeding time
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
 85044	reticulocyte count, manual
 85045	reticulocyte count, flow cytometry
 85046	reticulocytes, hemoglobin concentration 85048	white blood cell (WBC)
85060	Blood smear, peripheral, interpretation by physician with written report
85097	Bone marrow, smear interpretation
85130	Chromogenic substrate assay
85170	Clot retraction
85175	Clot lysis time, whole blood dilution
85210	Clotting; factor II, prothrombin, specific
85220	factor V (AcG or proaccelerin), labile factor
85230	factor VII (proconvertin, stable factor)
85240	factor VIII (AHG), one stage
 85244	factor VIII related antigen
 85245	factor VIII, VW factor, ristocetin cofactor

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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
 85246	factor VIII, VW factor antigen
 85247	factor VIII, von Willebrand factor, multimetric analysis 85250	factor IX (PTC or Christmas) 85260            factor X (Stuart-Prower) 85270            factor XI (PTA) 85280	factor XII (Hageman)

 85290	factor XIII (fibrin stabilizing)
 85291	factor XIII (fibrin stabilizing), screen solubility
 85292	prekallikrein assay (Fletcher factor assay)
 85293	high molecular weight kininogen assay (Fitzgerald factor assay)
85300	Clotting inhibitors or anticoagulants; antithrombin III, activity
 85301	antithrombin III, antigen assay
 85302	protein C, antigen
 85303	protein C, activity

 85305	protein S, total
 85306	protein S, free
85307	Activated Protein C (APC) resistance assay
85335	Factor inhibitor test
85337	Thrombomodulin
85345	Coagulation time; Lee and White
85347	activated
85348	other methods
85360	Euglobulin lysis
85362	Fibrin(ogen) degradation (split) products (FDP)(FSP); agglutination slide; semiquantitative
85366	paracoagulation
85370	quantitative
85378	Fibrin degradation products, D-dimer; semiquantitative
85379	quantitative
85384	Fibrinogen; activity
85385	antigen
85390	Fibrinolysins or coagulopathy screen, interpretation and report
85400	Fibrinolytic factors and inhibitors; plasmin
85410	alpha-2 antiplasmin
85415	plasminogen activator
85420	plasminogen, except antigenic assay
85421	plasminogen, antigenic assay
85441	Heinz bodies; direct
85445	induced, acetyl phenylhydrazine
85460	Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis (Kleihauer-Betke)
85461	rosette
85475	Hemolysin, acid
85520	Heparin assay
85525	Heparin neutralization
85530	Heparin-protamine tolerance test

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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
85536	Iron stain, peripheral blood
85540	Leukocyte alkaline phosphatase with count
85547	Mechanical fragility, RBC
85549	Muramidase
85555	Osmotic fragility, RBC; unincubated
85557	incubated
85576	Platelet; aggregation (in vitro), each agent
85585	estimation on smear, only
85590	manual count
85595	automated count
85597	Platelet neutralization
85610	Prothrombin time;
85611	substitution, plasma fractions, each
85612	Russell viper venom time (includes venom); undiluted
85613	diluted
85635	Reptilase test
85651	Sedimentation rate, erythrocyte; non-automated
85652	automated
85660	Sickling of RBC, reduction
85670	Thrombin time; plasma
85675	titer
85705	Thromboplastin inhibition; tissue
85730	Thromboplastin time, partial (PTT); plasma or whole blood
85732	substitution, plasma fractions, each
85810	Viscosity
85999	Unlisted hematology and coagulation procedure (I.C.)
IMMUNOLOGY
86000	Agglutinins, febrile (e.g., Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain
spotted fever, scrub typhus), each antigen
86001	Allergen specific IgG; quantitative or semiquantitative, each allergen
86003	Allergen specific IgE; quantitative or semiquantitative, each allergen
86005	qualitative, multiallergen screen (dipstick, paddle, or disk)
86021	Antibody identification; leukocyte antibodies
 86022	platelet antibodies
 86023	platelet-associated immunoglobulin assay
86038	Antinuclear antibodies (ANA);
86039	titer
86060	Antistreptolysin 0; titer
86063	screen

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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
86140	C-reactive protein;
86141	high sensitivity (hsCRP)
 86146	Beta 2 Glycoprotein I antibody, each
 86147	Cardiolipin (phospholipid) antibody, each Ig class
 86148	Anti-phosphatidylserine (phospholipid) antibody

 86155	Chemotaxis assay, specify method
 86156	Cold agglutinin; screen
86157	titer
86160	Complement; antigen, each component
86161	functional activity, each component
86162	total hemolytic (CH50)
86171	Complement fixation tests, each antigen
86185	Counterimmunoelectrophoresis, each antigen
86215	Deoxyribonuclease, antibody
86225	Deoxyribonucleic acid (DNA), antibody; native or double stranded
86226	single stranded
86235	Extractable nuclear antigen, antibody to, any method (e.g., nRNP, SS-A, SS-B, Sm, RNP,
Sc170, J01), each antibody
86243	Fc receptor
86255	Fluorescent noninfectious agent antibody; screen, each antibody
86256	titer, each antibody
86277	Growth hormone, human (HGH), antibody
86280	Hemagglutination inhibition test (HAI)
86294	Immunoassay for tumor antigen, qualitative or semiquantitative (e.g., bladder tumor antigen)
86300	Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)
86301	CA 19-9
86304	CA 125
86308	Heterophile antibodies; screening
 86309	titer
 86310	titers after absorption with beef cells and guinea pig kidney

 86316	Immunoassay for tumor antigen; other antigen, quantitative (e.g.,CA 50, 72-4, 549), each
 86317	Immunoassay for infectious agent antibody, quantitative, not otherwise specified
 86318	Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method
(e.g., reagent strip)
86320	Immunoelectrophoresis; serum
86325	other fluids (e.g., urine, cerobrospinal fluid) with concentration
86327	crossed (two-dimensional assay)
86329	Immunodiffusion; not elsewhere specified
86331	gel diffusion, qualitative (Ouchterlony), each antigen or antibody
86332	Immune complex assay
86334	Immunofixation electrophoresis

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601   Laboratory Service Codes and Descriptions
Service
Code       Service Description
 86336	Inhibin A
 86337	Insulin antibodies

 86340	Intrinsic factor antibodies
 86341	Islet cell antibody (I.C.)

 86343	Leukocyte histamine release test (LHR)
 86344	Leukocyte phagocytosis 86353      Lymphocyte transformation, mitogen (phytomitogen) or antigen-induced blastogenesis
86359	T cells; total count (I.C.)
 86360	absolute CD4 and CD8 count, including ratio
 86361	absolute CD4 count
86376	Microsomal antibodies (e.g., thyroid or liver-kidney), each
86378	Migration inhibitory factor test (MIF)
86382	Neutralization test, viral
86384	Nitroblue tetrazolium dye test (NTD)
86403	Particle agglutination; screen, each antibody
86406	titer, each antibody
86430	Rheumatoid factor; qualitative
86431	quantitative
86485	Skin test; candida
86490	coccidioidomycosis (I.C.)
86510	histoplasmosis (I.C.)
86586	unlisted antigen, each
86590	Streptokinase, antibody
86592	Syphilis test; qualitative (e.g., VDRL, RPR, ART)
86593	quantitative
The following codes (86602-86804) 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. For example, a test for antibody to an enterovirus is coded as 86658. Coxsackieviruses are enteroviruses, but there are no codes for the individual species of enterovirus. If assays are performed for antibodies to coxsackie A and B species, each assay should be separately coded. Similarly, if multiple assays are performed for antibodies of different immunoglobulin classes, each assay should be coded separately.

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601   Laboratory Service Codes and Descriptions

Service		
Code	Service Description	
86602	Antibody; actinomyces	
86603	adenovirus	
86606	Aspergillus	
86609	bacterium, not elsewhere specified	
86611	Bartonella	
86612	Blastomyces	
86615	Bordetella	
86617	Borrelia burgdorferi (Lyme disease) confirmatory test (e.g., Western blot or immunoblot)	
86618	Borrelia burgdorferi (Lyme disease)	
86619	Borrelia (relapsing fever)	
86622	Brucella	
86625	Campylobacter	
86628	Candida	
86631	Chlamydia	
86632	Chlamydia, IgM	
86635	Coccidioides	
86638	Coxiella Brunetii (Q fever)	
86641	Cryptococcus	
86644	cytomegalovirus (CMV)	
86645	cytomegalovirus (CMV), IgM	
86648	Diphtheria	
86651	encephalitis, California (La Crosse)	
86652	encephalitis, Eastern equine	
86653	encephalitis, St. Louis	
86654	encephalitis, Western equine	
86658	enterovirus (e.g., coxsackie, echo, polio)	
86663	Epstein-Barr (EB) virus, early antigen (EA)	
86664	Epstein-Barr (EB) virus, nuclear antigen (EBNA)	
86665	Epstein-Barr (EB) virus, viral capsid (VCA)	
86666	Ehrlichia	
86668	Francisella Tularensis	
86671	fungus, not elsewhere specified	
86674	Giardia Lamblia	
86677	Helicobacter pylori	
86682	helminth, not elsewhere specified	
86684	Hemophilus influenza	
86687	HTLV-I	
86688	HTLV-II	
86689	HTLV or HIV antibody, confirmatory test (e.g., Western blot)	
86692	hepatitis, delta agent	
86694	herpes simplex, non-specific type test	
86695	herpes simplex, type 1	
86696	herpes simplex, type 2	

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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
86698	histoplasma
 86701	HIV-1
 86702	HIV-2
 86703	HIV-1 and HIV-2, single assay
86704	Hepatitis B core antibody (HBcAb); total
86705	IgM antibody
 86706	Hepatitis B surface antibody (HBsAb)
 86707	Hepatitis Be antibody (HBeAb)
 86708	Hepatitis A antibody (HAAb); total
86709	IgM antibody
86710	Antibody; influenza virus
86713	Legionella
86717	Leishmania
86720	Leptospira
86723	Listeria monocytogenes
86727	lymphocytic choriomeningitis
86729	Lymphogranuloma Venereum
86732	mucormycosis
86735	mumps
86738            Mycoplasma
86741            Neisseria meningitidis
86744            Nocardia
86747	parvovirus
86750            Plasmodium (malaria)
86753            protozoa, not elsewhere specified
 86756	respiratory syncytial virus
 86757	Rickettsia 86759	rotavirus 86762	rubella 86765	rubeola 86768            Salmonella 86771	Shigella 86774            tetanus

 86777	Toxoplasma
 86778	Toxoplasma, IgM
86781	Treponema Pallidum, confirmatory test (e.g., FTA-abs)
86784	trichinella
86787	varicella-zoster
86790	virus, not elsewhere specified
86793	Yersinia
86800	Thyroglobulin antibody
86803	Hepatitis C antibody;
86804	confirmatory test (e.g., immunoblot)

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601   Laboratory Service Codes and Descriptions
Service
Code	Service Description
Tissue Typing
86805	Lymphocytotoxicity assay, visual crossmatch; with titration
86806	without titration
86807	Serum screening for cytotoxic percent reactive antibody (PRA); standard method
86808	quick method
86812	HLA typing; A, B, or C (e.g., A10, B7, B27), single antigen
86813	A, B, or C, multiple antigens
 86816	DR/DQ, single antigen
 86817	DR/DQ, multiple antigens

 86821	lymphocyte culture, mixed (MLC)
 86822	lymphocyte culture, primed (PLC)
86849	Unlisted immunology procedure (I.C.)
TRANSFUSION MEDICINE
86850	Antibody screen, RBC, each serum technique (I.C.)
86860	Antibody elution (RBC), each elution (I.C.)
86870	Antibody identification, RBC antibodies, each panel for each serum technique (I.C.)
86880	Antihuman globulin test (Coombs test); direct, each antiserum
 86885	indirect, qualitative, each antiserum
 86886	indirect, titer, each antiserum
86900	Blood typing; ABO
86901	Rh (D) (I.C.)
 86903	antigen screening for compatible blood unit using reagent serum, per unit screened
 86904	antigen screening for compatible unit using patient serum, per unit screened
 86905	RBC antigens, other than ABO or Rh (D), each
86906	Rh phenotyping, complete
86915	Bone marrow or peripheral stem cell harvest, modification or treatment to eliminate cell type(s)
(e.g., T-cells, metastatic carcinoma) (I.C.)
86920	Compatibility test each unit; immediate spin technique (I.C.)
 86921	incubation technique (I.C.)
 86922	antiglobulin technique (I.C.)
86940	Hemolysins and agglutinins; auto, screen, each
86941	incubated
86970	Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility
testing; incubation with chemical agents or drugs, each
 86971	incubation with enzymes, each
 86972	by density gradient separation
86975	Pretreatment of serum for use in RBC antibody identification; incubation with drugs, each
 86976	by dilution
 86977	incubation with inhibitors, each
 86978	by differential red-cell absorption using patient RBCs or RBCs of known phenotype, each absorption
86999	Unlisted transfusion medicine procedure (I.C.)

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601   Laboratory Service Codes and Descriptions
Service
Code       Service Description
MICROBIOLOGY
87001      Animal inoculation, small animal; with observation
87003	with observation and dissection
87015      Concentration (any type), for infectious agents
87040      Culture, bacterial; blood, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)
 87045	feces, with isolation and preliminary examination (e.g., KIA, LIA), Salmonella and Shigella species
 87046	stool, additional pathogens, isolation and preliminary examination (e.g., Campylobacter, Yersinia, Vibrio, E. coli 0157), each plate

 87070	any other source except urine, blood, or stool, with isolation and presumptive identification of isolates
 87071	quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood, or stool
87073	quantitative, anaerobic with isolation and presumptive identification of isolates, any source
except urine, blood, or stool
 87075	any source, anaerobic with isolation and presumptive identification of isolates
 87076	anaerobic isolate, additional methods required for definitive identification, each isolate
87077	aerobic isolate, additional methods required for definitive identification, each isolate
87081	Culture, presumptive, pathogenic organisms, screening only;
87084	with colony estimation from density chart
87086	Culture, bacterial; quantitative, colony count, urine
87088	with isolation and presumptive identification of isolates, urine
87101	Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or
nail
 87102	other source (except blood)
 87103	blood
87106	Culture, fungi, definitive identification, each organism; yeast (Use in addition to codes 87101,
87102, or 87103 when appropriate.)
87107	mold
 87109	Culture, mycoplasma, any source
 87110	Culture, chlamydia, any source 87116      Culture, tubercle or other acid-fast bacilli (e.g., TB, AFB, mycobacteria) any source, with
isolation
and presumptive identification of isolates 87118      Culture, mycobacteria, definitive identification, each isolate 87140      Culture, typing; immunofluorescent method, each antiserum
87143	gas-liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method
87147	immunologic method, other than immunofluorescence (e.g., agglutination grouping), per
antiserum
87149	identification by nucleic acid probe
87152	identification by pulse field gel typing
87158	other methods

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Service Code

Service Description

87164      Dark field examination, any source (e.g., penile, vaginal, oral, skin); includes specimen
collection
87166	without collection
87168	Macroscopic examination; arthropod
87169	parasite
87172      Pinworm exam (e.g., cellophane tape prep)
 87176	Homogenization, tissue, for culture
 87177	Ova and parasites, direct smears, concentration and identification 87181      Susceptibility studies, antimicrobial agent; agar dilution method, per agent (e.g., antibiotic
gradient strip)
 87184	disk method, per plate (12 or fewer agents)
 87185	enzyme detection (e.g., beta lactamase), per enzyme
 87186	microdilution or agar dilution (minimum inhibitory concentration (MIC) or breakpoint), each multiantimicrobial, per plate
 87187	microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure.)
87188	macrobroth dilution method, each agent
87190	mycobacteria, proportion method, each agent
 87197	Serum bactericidal titer (Schlicter test)
 87198	Cytomegalovirus, direct fluorescent antibody (DFA)
 87199	Enterovirus, direct fluorescent antibody (DFA)
87205	Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types
 87206	fluorescent and/or acid-fast stain for bacteria, fungi, parasites, viruses, or cell types
 87207	special stain for inclusion bodies or intracellular parasites (e.g., malaria, coccidia, microsporidia, cytomegalovirus, herpes viruses)
87210	wet mount for infectious agents (e.g., saline, India ink, KOH preps)
87220      Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite
ova or mites (e.g., scabies) 87230      Toxin or antitoxin assay, tissue culture (e.g., Clostridium difficile toxin) 87250      Virus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection
 87252	tissue culture inoculation, observation, and presumptive identification by cytopathic effect
 87253	tissue culture, additional studies or definitive identification (e.g., hemabsorption, neutralization, immunofluorescence stain), each isolate
 87254	shell vial, includes identification with immunofluorescence stain, each virus
Infectious agents by antigen detection, direct fluorescence microscopy; or nucleic acid probe techniques should be reported as precisely as possible. The most specefic code possible should be reported. If there is no specific agent code, the general methodology code (e.g., 87299, 87449, 87450, 87797, 87798, 87799, 87899) should be used. For identification of antibodies to many of the listed infectious agents, see 86602-86804.
87260      Infectious agent antigen detection by immunofluorescent technique; adenovirus
87265	Bordetella pertussis/parapertussis
87270	Chlamydia trachomatis

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Service
Code	Service Description
 87272	cryptosporidium/giardia
 87273	Herpes simplex virus type 2
 87274	Herpes simplex virus type 1
 87275	influenza B virus
 87276	influenza A virus
 87277	Legionella micdadei
 87278	Legionella pneumophila
 87279	Parainfluenza virus, each type
 87280	respiratory syncytial virus
 87281	Pneumocystis carinii 87283	Rubeola 87285	Treponema pallidum 87290	Varicella zoster virus
87299	not otherwise specified, each organism
 87300	Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum
 87301	Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; adenovirus enteric types 40/41
87320	Chlamydia trachomatis
87324	Clostridium difficile toxin(s) A
 87327	Cryptococcus neoformans
 87328	cryptosporidium/giardia 87332	cytomegalovirus

 87335	Escherichia coli 0157
 87336	Entamoeba histolytica dispar group
 87337	Entamoeba histolytica group
 87338	Helicobacter pylori, stool
 87339	Helicobacter pylori
 87340	hepatitis B surface antigen (HBsAg)
 87341	hepatitis B surface antigen (HBsAg) neutralization 87350	hepatitis Be antigen (HBeAg) 87380	hepatitis, delta agent 87385	Histoplasma capsulatum

 87390	HIV-1
 87391	HIV-2 87400	influenza, A or B, each 87420	respiratory syncytial virus 87425	rotavirus 87427	Shiga-like toxin 87430	Streptococcus, group A
87449	Infectious agent antigen detection by enzyme immunoassay technique, qualitative or
semiquantitative; multiple step method, not otherwise specified, each organism
 87450	single step method, not otherwise specified, each organism
 87451	multiple step method, polyvalent for multiple organisms, each polyvalent antiserum

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Service
Code       Service Description
87470	Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella
quintana, direct probe technique
 87471	Bartonella henselae and Bartonella quintana, amplified probe technique
 87472	Bartonella henselae and Bartonella quintana, quantification

 87475	Borrelia burgdorferi, direct probe technique
 87476	Borrelia burgdorferi, amplified probe technique
 87477	Borrelia burgdorferi, quantification

 87480	Candida species, direct probe technique
 87481	Candida species, amplified probe technique
 87482	Candida species, quantification

 87485	Chlamydia pneumoniae, direct probe technique
 87486	Chlamydia pneumoniae, amplified probe technique
 87487	Chlamydia pneumoniae, quantification

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

 87495	cytomegalovirus, direct probe technique
 87496	cytomegalovirus, amplified probe technique
 87497	cytomegalovirus, 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

 87525	hepatitis G, direct probe technique
 87526	hepatitis G, amplified probe technique
 87527	hepatitis G, quantification
 87528	herpes simplex virus, direct probe technique
 87529	herpes simplex virus, amplified probe technique
 87530	herpes simplex virus, quantification
 87531	herpes virus-6, direct probe technique
 87532	herpes virus-6, amplified probe technique
 87533	herpes virus-6, 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

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Service
Code       Service Description
 87540	Legionella pneumophila, direct probe technique
 87541	Legionella pneumophila, amplified probe technique
 87542	Legionella pneumophila, quantification

 87550	Mycobacteria species, direct probe technique
 87551	Mycobacteria species, amplified probe technique
 87552	Mycobacteria species, quantification

 87555	Mycobacteria tuberculosis, direct probe technique
 87556	Mycobacteria tuberculosis, amplified probe technique
 87557	Mycobacteria tuberculosis, quantification

 87560	Mycobacteria avium-intracellulare, direct probe technique
 87561	Mycobacteria avium-intracellulare, amplified probe technique
 87562	Mycobacteria avium-intracellulare, quantification

 87580	Mycoplasma pneumoniae, direct probe technique
 87581	Mycoplasma pneumoniae, amplified probe technique
 87582	Mycoplasma pneumoniae, quantification

 87590	Neisseria gonorrhoeae, direct probe technique
 87591	Neisseria gonorrhoeae, amplified probe technique
 87592	Neisseria gonorrhoeae, quantification

 87620	papillomavirus, human, direct probe technique
 87621	papillomavirus, human, amplified probe technique
 87622	papillomavirus, human, quantification

 87650	Streptococcus, group A, direct probe technique
 87651	Streptococcus, group A, amplified probe technique
 87652	Streptococcus, group A, quantification
87797	Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe
technique, each organism
 87798	amplified probe technique, each organism
 87799	quantification, each organism
87800	Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s)
technique
87801	amplified probe(s) technique
87802	Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus,
group B
 87803	Clostridium difficile toxin A
 87804	influenza
87810	Infectious agent detection by immunoassay with direct optical observation; Chlamydia trachomatis
87850	Neisseria gonorrhoeae
87880	Streptococcus, group A
87899	not otherwise specified
87901	Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV 1, reverse transcriptase
and protease (P.A. required for third and subsequent tests performed within a calendar year)
87902	Hepatitis C virus

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Service
Code       Service Description
87903	Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue
culture analysis, HIV 1; first through 10 drugs tested (P.A.)
87904	each additional one through five drugs tested (List separately in addition to code for primary
procedure.) (Use 87904 in conjunction with 87903.) (P.A.)
87999      Unlisted microbiology procedure (I.C.) (P.A.)
ANATOMIC PATHOLOGY
Cytopathology
88104      Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation
 88106	filter method only with interpretation
 88107	smears and filter preparation with interpretation
88108	Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique)
88130      Sex chromatin identification; Barr bodies
88140	peripheral blood smear, polymorphonuclear drumsticks
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.
88141	Cytopathology, cervical or vaginal (any reporting system); requiring interpretation by physician
(List separately in addition to code for technical service.)
88142	Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid,
automated thin layer preparation; manual screening under physician supervision
 88143	with manual screening and rescreening under physician supervision
 88144	with manual screening and computer-assisted rescreening under physician supervision
 88145	with manual screening and computer-assisted rescreening using cell selection and review under physician supervision
88147	Cytopathology smears, cervical or vaginal; screening by automated system under physician
supervision
88148	screening by automated system with manual rescreening under physician supervision

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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
88172	Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine
adequacy of specimen(s) (I.C.)
88173	interpretation and report
88180	Flow cytometry; each cell surface, cytoplasmic or nuclear marker (I.C.)
88182	cell cycle or DNA analysis (I.C.)
88199	Unlisted cytopathology procedure (I.C.)
Cytogenetic Studies
88230	Tissue culture for non-neoplastic disorders; lymphocyte
88233	skin or other solid tissue biopsy
88235	amniotic fluid or chorionic villus cells
88237	Tissue culture for neoplastic disorders; bone marrow, blood cells
88239	solid tumor
 88240	Cryopreservation, freezing and storage of cells, each cell line
 88241	Thawing and expansion of frozen cells, each aliquot 88245      Chromosome analysis for breakage syndromes; baseline Sister Chromatid Exchange (SCE),
20-25 cells
 88248	baseline breakage, score 50-100 cells, count 20 cells, 2 karyotypes, (e.g., for ataxia telangiectasia, Fanconi anemia, fragile X)
 88249	score 100 cells, clastogen stress (e.g., diepoxybutane, mitomycin C, ionizing radiation, UV radiation)
88261	Chromosome analysis; count 5 cells, 1 karyotype, with banding
 88262	count 15-20 cells, 2 karyotypes, with banding
 88263	count 45 cells for mosaicism, 2 karyotypes, with banding
 88264	analyze 20-25 cells

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Service
Code       Service Description
88267      Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, 1 karyotype, with
banding 88269      Chromosome analysis, in situ for amniotic fluid cells, count cells from 6-12 colonies, 1
karyotype, with banding
88271	Molecular cytogenetics; DNA probe, each (e.g., FISH)
 88272	chromosomal in situ hybridization, analyze 3-5 cells (e.g., for derivatives and markers)
 88273	chromosomal in situ hybridization, analyze 10-30 cells (e.g., for microdeletions)
 88274	interphase in situ hybridization, analyze 25-99 cells
88275	interphase in situ hybridization, analyze 100-300 cells
88280	Chromosome analysis; additional karyotypes, each study
88283	additional specialized banding technique (e.g., NOR, C-banding)
88285	additional cells counted, each study
88289	additional high resolution study
88291	Cytogenetics and molecular cytogenetics, interpretation and report
88299	Unlisted cytogenetic study (I.C.)
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
88311	Decalcification procedure (List separately in addition to code for surgical pathology
examination.)
88312	Special stains (List separately in addition to code for surgical pathology examination.); Group I
for microorganisms (e.g., Gridley, acid fast, methenamine silver), each
 88313	Group II, all other (e.g., iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each
 88314	histochemical staining with frozen section(s)

 88318	Determinative histochemistry to identify chemical components (e.g., copper, zinc)
 88319	Determinative histochemistry or cytochemistry to identify enzyme constituents, each 88342      Immunocytochemistry (including tissue immunoperoxidase), each antibody
88346	Immunofluorescent study, each antibody; direct method
88347	indirect method
88348	Electron microscopy; diagnostic
88349	scanning

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Service
Code	Service Description
88355	Morphometric analysis; skeletal muscle
88356	nerve
88358	tumor
88362	Nerve-teasing preparations
88365	Tissue in situ hybridization, interpretation and report
88371	Protein analysis of tissue by Western Blot, with interpretation and report;
88372	immunological probe for band identification, each
88380	Microdissection (e.g., mechanical, laser capture)
88399	Unlisted surgical pathology procedure (I.C.)
OTHER PROCEDURES
89050	Cell count, miscellaneous body fluids (e.g., cerebrospinal fluid, joint fluid), except blood;
89051	with differential count
89060	Crystal identification by light microscopy with or without polarizing lens analysis, any body
fluid (except urine)
89100	Duodenal intubation and aspiration; single specimen (e.g., simple bile study or afferent loop
culture) plus appropriate test procedure (I.C.)
89105	collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single
or double lumen tube
89125	Fat stain, feces, urine, or respiratory secretions
89130	Gastric intubation and aspiration, diagnostic, each specimen, for chemical analyses or
cytopathology;
89132	after stimulation
89135	Gastric intubation, aspiration, and fractional collections (e.g., gastric secretory study); one hour
89136	two hours
89140	two hours including gastric stimulation (e.g., histalog, pentagastrin)
89141	three hours, including gastric stimulation
89160	Meat fibers, feces
89190	Nasal smear for eosinophils
89350	Sputum, obtaining specimen, aerosol induced technique (separate procedure)
89355	Starch granules, feces
89360	Sweat collection by iontophoresis
89365	Water load test
89399	Unlisted miscellaneous pathology test (I.C.)

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Service
Code       Service Description
MEDICINE
CARDIOVASCULAR
Cardiography
93000      Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
93005	tracing only, without interpretation and report
93010	interpretation and report only
93012      Telephonic transmission of post-symptom electrocardiogram rhythm strip(s), per 30-day period of time; tracing only (I.C.)
93014	physician review with interpretation and report only (I.C.)
93015	Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise,
continuous electrocardiographic monitoring, and/or pharmacological stress; with physician
supervision, with interpretation and report
93018	interpretation and report only
93024      Ergonovine provocation test (I.C.)
93040	Rhythm ECG, one to three leads; with interpretation and report
 93041	tracing only without interpretation and report
 93042	interpretation and report only
93224	Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording
and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation (I.C.)
 93225	recording (includes hook-up, recording, and disconnection) (I.C.)
 93226	scanning analysis with report (I.C.)
 93227	physician review and interpretation (I.C.)
93230	Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording
and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; includes recording, microprocessor-based analysis with report, physician review and interpretation (I.C.)
 93231	recording (includes hook-up, recording, and disconnection) (I.C.)
 93232	microprocessor-based analysis with report (I.C.)
 93233	physician review and interpretation (I.C.)
93235	Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and
non-continuous recording, and real-time data analysis utilizing a device capable of producing intermittent full-sized waveform tracings, possibly patient activated; includes monitoring and real-time data analysis with report, physician review and interpretation (I.C.)
 93236	monitoring and real-time data analysis with report (I.C.)
 93237	physician review and interpretation (I.C.) 93268      Patient demand single or multiple event recording with presymptom memory loop, per 30-day
period of time; includes transmission, physician review and interpretation (I.C.) 93278      Signal-averaged electrocardiography (SAECG), with or without ECG (I.C.)

601   Laboratory Service Codes and Descriptions Service Description
Service Code
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93724
93731
93732 93734
93735
93799

Other Vascular Studies
Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic
recording, programming of device, induction and termination of tachycardia via implanted
pacemaker, and interpretation of recordings) Electronic analysis of dual-chamber pacemaker system (includes evaluation of programmable
parameters at rest and during activity where applicable, using electrocardiographic recording
and interpretation of recordings at rest and during exercise, analysis of event markers and
device response); without reprogramming
with reprogramming Electronic analysis of single-chamber pacemaker system (includes evaluation of programmable
parameters at rest and during activity where applicable, using electrocardiographic recording
and interpretation of recordings at rest and during exercise, analysis of event markers and
device response); without reprogramming
with reprogramming
Other Procedures
Unlisted cardiovascular service or procedure (I.C.)

SUPPLEMENTARY
G0001     Routine venipuncture for collection of specimen(s) (single home-bound, nursing-facility patient)
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.

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