2019 CPT-4 and HCPCS Codes Subject to CLIA Edits

cludes non-waived and non-PPMP testsaboratory certification codes are for informational purposes only.

PT only copyright 2018 American Medical Association. All rights reservedPT is a registered trademark of the American Medical Association.pplicable FARS/DFARS Apply to Government Use. ee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, re not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practiceedicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CCAFam

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

G0103 Psa, screening 310G0123 Screen cerv/vag thin layer 630G0124 Screen c/v thin layer by MD 630G0141 Scr c/v cyto,autosys and md 630G0143 Scr c/v cyto,thinlayer,rescr 630G0144 Scr c/v cyto,thinlayer,rescr 630G0145 Scr c/v cyto,thinlayer,rescr 630G0147 Scr c/v cyto, automated sys 630G0148 Scr c/v cyto, autosys, rescr 630G0306 CBC/diffwbc w/o platelet 400G0307 CBC without platelet 400G0328 Fecal blood scrn immunoassay 310, 400G0416 Prostate biopsy, any mthd 610G0416 TC Prostate biopsy, any mthd 610G0416 26 Prostate biopsy, any mthd 610G0432 EIA HIV-1/HIV-2 screen 140, 220G0433 ELISA HIV-1/HIV-2 screen 140, 220G0435 Oral HIV-1/HIV-2 screen 140, 220G0472 Hepatitis c antibody screening, for individual at high risk and

other covered indication(s)220

G0475 Hiv combination assay 140, 220G0476 Hpv combo assay ca screen 140G0480 Drug test def 1-7 classes 340G0481 Drug test def 8-14 classes 340G0482 Drug test def 15-21 classes 340G0483 Drug test def 22+ classes 340G0499 Hepb screen high risk indiv 220G0659 Drug test def simple all cl 340G9143 Warfarin respon genetic test 220, 310P3000 Screen pap by tech w md supv 630P3001 Screening pap smear by phys 630P7001 Culture bacterial urine 1100111T Long-chain omega-3 fatty acids in red blood cell membranes 3100001U Rbc dna hea 35 ag 11 bld grp 5100002U Onc clrct 3 ur metab alg plp 220, 3100003U Onc ovar 5 prtn ser alg scor 220, 3100005U Onco prst8 3 gene ur alg 220, 3100006U Detc ia meds 120+ analytes 3400007U Rx test prsmv ur w/def conf 340

CPT only copyright 2018 American Medical Association. All rights reserved. 2

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

0008U Hpylori detcj abx rstnc dna 1100009U Onc brst ca erbb2 amp/nonamp 220, 3100010U Nfct ds strn typ whl gen seq 1100011U Rx mntr lc-ms/ms oral fluid 3400012U Germln do gene reargmt detcj 220, 3100013U Onc sld org neo gene reargmt 220, 3100014U Hem hmtlmf neo gene reargmt 4000016U Onc hmtlmf neo rna bcr/abl1 220, 310, 4000017U Onc hmtlmf neo jak2 mut dna 220, 310, 4000018U MicroRNA gene analysis of thyroid nodule tissue - Effective

10/1/2017 220, 3100019U RNA gene analysis of tumor tissue - Effective 10/1/2017 220, 3100020U Rx test prsmv ur w/def conf - Discontinued 9/30/2018 3400021U Onc prst8 detcj 8 autoantb - Effective 10/1/2017 220, 3100022U Trgt gen seq dna&rna 23 gene - Effective 10/1/2017 220, 3100023U Onc aml dna detcj/nondetcj - Effective 10/1/2017 220, 310, 4000024U Glyca nuc mr spectrsc quan - Effective 1/1/2019 220, 3100025U Tenofovir liq chrom ur quan - Effective 1/1/2019 220, 3100026U Onc thyr dna&mrna 112 genes - Effective 1/1/2019 220, 3100027U Jak2 gene trgt seq alys - Effective 1/1/2019 310, 9000028U Cyp2d6 gene cpy nmr cmn vrnt - Discontinued 9/30/2018 220, 3100029U Rx metab advrs trgt seq alys - Effective 1/1/2019 220, 3100030U Rx metab warf trgt seq alys - Effective 1/1/2019 220, 3100031U Cyp1a2 gene - Effective 1/1/2019 220, 3100032U Comt gene - Effective 1/1/2019 220, 3100033U Htr2a htr2c genes - Effective 1/1/2019 220, 3100034U Tpmt nudt15 genes - Effective 1/1/2019 220, 3100035U Neuro csf prion prtn qual - Effective 4/1/2018 3100036U Xome tum & nml spec seq alys - Effective 4/1/2018 220, 3100037U Trgt gen seq dna 324 genes - Effective 4/1/2018 220, 3100038U Vitamin d srm microsamp quan - Effective 4/1/2018 3100039U Dna antb 2strand hi avidity - Effective 4/1/2018 2200040U Gene analysis (t(9;22)) for translocation analysis - Effective

4/1/2018 220, 310, 4000041U B brgdrferi antb 5 prtn igm - Effective 4/1/2018 2200042U B brgdrferi antb 12 prtn igg - Effective 4/1/2018 2200043U Tbrf b grp antb 4 prtn igm - Effective 4/1/2018 2200044U Tbrf b grp antb 4 prtn igg - Effective 4/1/2018 2200045U Onc brst dux carc is 12 gene - Effective 7/1/2018 220, 3100046U Flt3 gene itd variants quan - Effective 7/1/2018 220, 310, 4100047U Onc prst8 mrna 17 gene alg - Effective 7/1/2018 220, 3100048U Onc sld org neo dna 468 gene - Effective 7/1/2018 220, 3100049U Npm1 gene analysis quan - Effective 7/1/2018 220, 310, 410

CPT only copyright 2018 American Medical Association. All rights reserved. 3

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

0050U Trgt gen seq dna 194 genes - Effective 7/1/2018 220, 310, 4100051U Rx mntr lc-ms/ms ur 31 pnl - Effective 7/1/2018 3400052U Lpoprtn bld w/5 maj classes - Effective 7/1/2018 3100053U Onc prst8 ca fish alys 4 gen - Effective 7/1/2018 220, 3100054U Rx mntr 14+ drugs & sbsts - Effective 7/1/2018 3400055U Card hrt trnspl 96 dna seq - Effective 7/1/2018 220, 3100056U Hem aml dna gene reargmt - Effective 7/1/2018 4000057U Onc sld org neo mrna 51 gene - Effective 7/1/2018 220, 3100058U Onc merkel cll carc srm quan - Effective 7/1/2018 220, 3100059U Onc merkel cll carc srm +/- - Effective 7/1/2018 220, 3100060U Twn zyg gen seq alys chrms2 - Effective 7/1/2018 9000062U Ai sle igg&igm alys 80 bmrk - Effective 10/1/2018 220, 3100063U Neuro autism 32 amines alg - Effective 10/1/2018 220, 310, 9000064U Antb tp total&rpr ia qual - Effective 10/1/2018 2100065U Syfls tst nontreponemal antb - Effective 10/1/2018 2100066U Pamg-1 ia cervico-vag fluid - Effective 10/1/2018 3100067U Onc brst imhchem prfl 4 bmrk - Effective 10/1/2018 220, 3100068U Candida species pnl amp prb - Effective 10/1/2018 1200069U Onc clrct microrna mir-31-3p - Effective 10/1/2018 220, 3100070U Cyp2d6 gen com&slct rar vrnt - Effective 10/1/2018 220, 3100071U Cyp2d6 full gene sequence - Effective 10/1/2018 220, 3100072U Cyp2d6 gen cyp2d6-2d7 hybrid - Effective 10/1/2018 220, 3100073U Cyp2d6 gen cyp2d7-2d6 hybrid - Effective 10/1/2018 220, 3100074U Cyp2d6 nonduplicated gene - Effective 10/1/2018 220, 3100075U Cyp2d6 5' gene dup/mlt - Effective 10/1/2018 220, 3100076U Cyp2d6 3' gene dup/mlt - Effective 10/1/2018 220, 3100077U Ig paraprotein qual bld/ur - Effective 10/1/2018 3100078U Pain mgt opi use gnotyp pnl - Effective 10/1/2018 220, 3100080U Oncology (lung), mass spectrometric analysis of galectin-3-

binding protein and scavenger receptor cysteine-rich type 1 protein M130, with five clinical risk factors (age, smoking status, nodule diameter, nodule-spiculation status and nodule location), utilizing plasma, algorithm reported as a categorical probability of malignancy - Effective 1/1/2019

220, 310

0081U Oncology (uveal melanoma), mRNA, gene-expression profiling by real-time RT-PCR of 15 genes (12 content and 3 housekeeping genes), utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported as risk of metastasis - Effective 1/1/2019

220, 310

CPT only copyright 2018 American Medical Association. All rights reserved. 4

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

0082U Drug test(s), definitive, 90 or more drugs or substances, definitive chromatography with mass spectrometry, and presumptive, any number of drug classes, by instrument chemistry analyzer (utilizing immunoassay), urine, report of presence or absence of each drug, drug metabolite or substance with description and severity of significant interactions per date of service - Effective 1/1/2019

340

0083U Oncology, response to chemotherapy drugs using motility contrast tomography, fresh or frozen tissue, reported as likelihood of sensitivity or resistance to drugs or drug combinations - Effective 1/1/2019

220, 310

17311 Mohs, 1 stage, h/n/hf/g 61017312 Mohs addl stage 61017313 Mohs, 1 stage, t/a/l 61017314 Mohs, addl stage, t/a/l 61017315 Mohs surg, addl block 61078110 Plasma volume, single 80078110 TC Plasma volume, single 80078110 26 Plasma volume single 80078111 Plasma volume, multiple 80078111 TC Plasma volume, multiple 80078111 26 Plasma volume multiple 80078120 Red cell mass, single 80078120 TC Red cell mass, single 80078120 26 Red cell mass single 80078121 Red cell mass, multiple 80078121 TC Red cell mass, multiple 80078121 26 Red cell mass multiple 80078122 Blood volume 80078122 TC Blood volume 80078122 26 Blood volume 80078130 Red cell survival study 80078130 TC Red cell survival study 80078130 26 Red cell survival study 80078191 Platelet survival 80078191 TC Platelet survival 80078191 26 Platelet survival 80078270 Vit B-12 absorption exam - Discontinued 12/31/2018 80078270 TC Vit B-12 absorption exam - Discontinued 12/31/2018 80078270 26 Vit B-12 absorption exam - Discontinued 12/31/2018 80078271 Vit B-12 absorp exam, int fac - Discontinued 12/31/2018 80078271 TC Vit B-12 absorp exam, int fac - Discontinued 12/31/2018 80078271 26 Vit b-12 absrp exam int fac - Discontinued 12/31/2018 80078272 Vit B-12 absorp, combined - Discontinued 12/31/2018 80078272 TC Vit B-12 absorp, combined - Discontinued 12/31/2018 80078272 26 Vit b-12 absorp combined - Discontinued 12/31/2018 80080047 Metabolic panel ionized ca 31080048 Metabolic panel total ca 31080050 General health panel - Not payable by Medicare 310, 330, 400

CPT only copyright 2018 American Medical Association. All rights reserved. 5

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

80051 Electrolyte panel 31080053 Comprehen metabolic panel 31080055 Obstetric panel - Not valid for Medicare 210, 220, 400, 53080061 Lipid panel 31080069 Renal function panel 31080074 Acute hepatitis panel 22080076 Hepatic function panel 31080081 Obstetric panel 210, 220, 400, 510, 52080150 Assay of amikacin 34080155 Drug assay caffeine 34080156 Assay, carbamazepine, total 34080157 Assay, carbamazepine, free 34080158 Drug assay cyclosporine 34080159 Drug assay clozapine 34080162 Assay of digoxin total 34080163 Assay of digoxin free 34080164 Assay dipropylacetic acd tot 34080165 Dipropylacetic acid free 34080168 Assay of ethosuximide 34080169 Drug screen quant everolimus 34080170 Assay of gentamicin 34080171 Drug screen quant gabapentin 34080173 Assay of haloperidol 34080175 Drug screen quan lamotrigine 34080176 Assay of lidocaine 34080177 Drug scrn quan levetiracetam 34080178 Assay of lithium 34080180 Drug scrn quan mycophenolate 34080183 Drug scrn quant oxcarbazepin 34080184 Assay of phenobarbital 34080185 Assay of phenytoin, total 34080186 Assay of phenytoin, free 34080188 Assay of primidone 34080190 Assay of procainamide 34080192 Assay of procainamide 34080194 Assay of quinidine 34080195 Assay of sirolimus 34080197 Assay of tacrolimus 34080198 Assay of theophylline 34080199 Drug screen quant tiagabine 34080200 Assay of tobramycin 34080201 Assay of topiramate 34080202 Assay of vancomycin 34080203 Drug screen quant zonisamide 34080299 Quantitative assay, drug 34080305 Drug test prsmv dir opt obs 34080306 Drug test prsmv instrmnt 34080307 Drug test prsmv chem anlyzr 34080320 Drug screen quantalcohols - Not payable by Medicare 34080321 Alcohols biomarkers 1or 2 - Not payable by Medicare 340

CPT only copyright 2018 American Medical Association. All rights reserved. 6

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

80322 Alcohols biomarkers 3/more - Not payable by Medicare 34080323 Alkaloids nos - Not payable by Medicare 34080324 Drug screen amphetamines 1/2 - Not payable by Medicare 34080325 Amphetamines 3or 4 - Not payable by Medicare 34080326 Amphetamines 5 or more - Not payable by Medicare 34080327 Anabolic steroid 1 or 2 - Not payable by Medicare 33080328 Anabolic steroid 3 or more - Not payable by Medicare 33080329 Analgesics non-opioid 1 or 2 - Not payable by Medicare 34080330 Analgesics non-opioid 3-5 - Not payable by Medicare 34080331 Analgesics non-opioid 6/more - Not payable by Medicare 34080332 Antidepressants class 1 or 2 - Not payable by Medicare 34080333 Antidepressants class 3-5 - Not payable by Medicare 34080334 Antidepressants class 6/more - Not payable by Medicare 34080335 Antidepressant tricyclic 1/2 - Not payable by Medicare 34080336 Antidepressant tricyclic 3-5 - Not payable by Medicare 34080337 Tricyclic & cyclicals 6/more - Not payable by Medicare 34080338 Antidepressant not specified - Not payable by Medicare 34080339 Antiepileptics nos 1-3 - Not payable by Medicare 34080340 Antiepileptics nos 4-6 - Not payable by Medicare 34080341 Antiepileptics nos 7/more - Not payable by Medicare 34080342 Antipsychotics nos 1-3 - Not payable by Medicare 34080343 Antipsychotics nos 4-6 - Not payable by Medicare 34080344 Antipsychotics nos 7/more - Not payable by Medicare 34080345 Drug screening barbiturates - Not payable by Medicare 34080346 Benzodiazepines1-12 - Not payable by Medicare 34080347 Benzodiazepines 13 or more - Not payable by Medicare 34080348 Drug screening buprenorphine - Not payable by Medicare 34080349 Cannabinoids natural - Not payable by Medicare 34080350 Cannabinoids synthetic 1-3 - Not payable by Medicare 34080351 Cannabinoids synthetic 4-6 - Not payable by Medicare 34080352 Cannabinoid synthetic 7/more - Not payable by Medicare 34080353 Drug screening cocaine - Not payable by Medicare 34080354 Drug screening fentanyl - Not payable by Medicare 34080355 Gabapentin non-blood - Not payable by Medicare 34080356 Heroin metabolite - Not payable by Medicare 34080357 Ketamine and norketamine - Not payable by Medicare 34080358 Drug screening methadone - Not payable by Medicare 34080359 Methylenedioxyamphetamines - Not payable by Medicare 34080360 Methylphenidate - Not payable by Medicare 34080361 Opiates 1 or more - Not payable by Medicare 34080362 Opioids & opiate analogs 1/2 - Not payable by Medicare 34080363 Opioids & opiate analogs 3/4 - Not payable by Medicare 34080364 Opioid &opiate analog 5/more - Not payable by Medicare 34080365 Drug screening oxycodone - Not payable by Medicare 34080366 Drug screening pregabalin - Not payable by Medicare 34080367 Drug screening propoxyphene - Not payable by Medicare 34080368 Sedative hypnotics - Not payable by Medicare 34080369 Skeletal muscle relaxant 1/2 - Not payable by Medicare 34080370 Skel musc relaxant 3 or more - Not payable by Medicare 34080371 Stimulants synthetic - Not payable by Medicare 340

CPT only copyright 2018 American Medical Association. All rights reserved. 7

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

80372 Drug screening tapentadol - Not payable by Medicare 34080373 Drug screening tramadol - Not payable by Medicare 34080374 Stereoisomer analysis - Not payable by Medicare 34080375 Drug/substance nos 1-3 - Not payable by Medicare 34080376 Drug/substance nos 4-6 - Not payable by Medicare 34080377 Drug/substance nos 7/more - Not payable by Medicare 34080400 Acth stimulation panel 33080402 Acth stimulation panel 33080406 Acth stimulation panel 33080408 Aldosterone suppression eval 33080410 Calcitonin stimul panel 33080412 CRH stimulation panel 33080414 Testosterone response 33080415 Estradiol response panel 33080416 Renin stimulation panel 33080417 Renin stimulation panel 33080418 Pituitary evaluation panel 33080420 Dexamethasone panel 33080422 Glucagon tolerance panel 310, 33080424 Glucagon tolerance panel 310, 33080426 Gonadotropin hormone panel 33080428 Growth hormone panel 33080430 Growth hormone panel 310, 33080432 Insulin suppression panel 310, 33080434 Insulin tolerance panel 310, 33080435 Insulin tolerance panel 310, 33080436 Metyrapone panel 33080438 TRH stimulation panel 33080439 TRH stimulation panel 33081003 Urinalysis, auto, w/o scope 32081005 Urinalysis 32081007 Urine screen for bacteria 11081099 Urinalysis test procedure 32081105 Hpa-1 genotyping 40081106 Hpa-2 genotyping 40081107 Hpa-3 genotyping 40081108 Hpa-4 genotyping 40081109 Hpa-5 genotyping 40081110 Hpa-6 genotyping 40081111 Hpa-9 genotyping 40081112 Hpa-15 genotyping 40081120 Idh1 common variants 220, 31081121 Idh2 common variants 220, 31081161 Dmd dup/delet analysis 220, 31081162 Brca1&2 seq & full dup/del 220, 31081163 Brca1&2 gene full seq alys - Effective 1/1/2019 220, 31081164 Brca1&2 gen ful dup/del alys - Effective 1/1/2019 220, 31081165 Brca1 gene full seq alys - Effective 1/1/2019 220, 31081166 Brca1 gene full dup/del alys - Effective 1/1/2019 220, 31081167 Brca2 gene full dup/del alys - Effective 1/1/2019 220, 310

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

81170 Abl1 gene 220, 310, 90081171 Aff2 gene detc abnor alleles - Effective 1/1/2019 220, 31081172 Aff2 gene charac alleles - Effective 1/1/2019 220, 31081173 Ar gene full gene sequence - Effective 1/1/2019 310, 33081174 Ar gene known famil variant - Effective 1/1/2019 310, 33081175 Asxl1 full gene sequence 220, 31081176 Asxl1 gene target seq alys 220, 31081177 Atn1 gene detc abnor alleles - Effective 1/1/2019 220, 31081178 Atxn1 gene detc abnor allele - Effective 1/1/2019 220, 31081179 Atxn2 gene detc abnor allele - Effective 1/1/2019 220, 31081180 Atxn3 gene detc abnor allele - Effective 1/1/2019 220, 31081181 Atxn7 gene detc abnor allele - Effective 1/1/2019 220, 31081182 Atxn8os gen detc abnor allel - Effective 1/1/2019 220, 31081183 Atxn10 gene detc abnor allel - Effective 1/1/2019 220, 31081184 Cacna1a gen detc abnor allel - Effective 1/1/2019 220, 31081185 Cacna1a gene full gene seq - Effective 1/1/2019 220, 31081186 Cacna1a gen known famil vrnt - Effective 1/1/2019 220, 31081187 Cnbp gene detc abnor allele - Effective 1/1/2019 220, 31081188 Cstb gene detc abnor allele - Effective 1/1/2019 220, 31081189 Cstb gene full gene sequence - Effective 1/1/2019 220, 31081190 Cstb gene known famil vrnt - Effective 1/1/2019 220, 31081200 Aspa gene 220, 31081201 Apc gene full sequence 220, 31081202 Apc gene known fam variants 220, 31081203 Apc gene dup/delet variants 220, 31081204 Ar gene charac alleles - Effective 1/1/2019 310, 33081205 Bckdhb gene 220, 31081206 Bcr/abl1 gene major bp 220, 310, 90081207 Bcr/abl1 gene minor bp 220, 310, 90081208 Bcr/abl1 gene other bp 220, 310, 90081209 Blm gene 220, 310 81210 Braf gene 220, 31081211 Brca1&2 seq & com dup/del - Discontinued 12/31/2018 220, 31081212 Brca1&2 185&5385&6174 var 220, 31081213 Brca1&2 uncom dup/del var - Discontinued 12/31/2018 220, 31081214 Brca1 full seq & com dup/del - Discontinued 12/31/2018 220, 31081215 Brca1 gene known fam variant 220, 31081216 Brca2 gene full sequence 220, 31081217 Brca2 gene known fam variant 220, 31081218 Cebpa gene full sequence 220, 310, 90081219 Calr gene com variants 220, 310, 90081220 Cftr gene com variants 220, 31081221 Cftr gene known fam variants 220, 31081222 Cftr gene dup/delet variants 220, 31081223 Cftr gene full sequence 220, 31081224 Cftr gene intron poly t 220, 31081225 Cyp2c19 gene com variants 220, 31081226 Cyp2d6 gene com variants 220, 31081227 Cyp2c9 gene com variants 220, 31081228 Cytogen micrarray copy nmbr 220, 310, 900

CPT only copyright 2018 American Medical Association. All rights reserved. 9

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

81229 Cytogen m array copy no&snp 220, 310, 90081230 Cyp3a4 gene common variants 220, 31081231 Cyp3a5 gene common variants 220, 31081232 Dpyd gene common variants 220, 31081233 Btk gene common variants - Effective 1/1/2019 220, 31081234 Dmpk gene detc abnor allele - Effective 1/1/2019 220, 31081235 Egfr gene com variants 220, 31081236 Ezh2 gene full gene sequence - Effective 1/1/2019 220, 31081237 Ezh2 gene common variants - Effective 1/1/2019 220, 31081238 F9 full gene sequence 40081239 Dmpk gene charac alleles - Effective 1/1/2019 220, 31081240 F2 gene 40081241 F5 gene 40081242 Fancc gene 220, 40081243 Fmr1 gene detection 220, 90081244 Fmr1 gene charac alleles 220, 90081245 Flt3 gene 220, 310, 90081246 Flt3 gene analysis 220, 310, 90081247 G6pd gene alys cmn variant 310, 40081248 G6pd known familial variant 310, 40081249 G6pd full gene sequence 310, 40081250 G6pc gene 220, 31081251 Gba gene 220, 31081252 Gjb2 gene full sequence 220, 31081253 Gjb2 gene known fam variants 220, 31081254 Gjb6 gene com variants 220, 31081255 Hexa gene 220, 31081256 Hfe gene 310, 40081257 Hba1/hba2 gene 310, 40081258 Hba1/hba2 gene fam vrnt 310, 40081259 Hba1/hba2 full gene sequence 310, 40081260 Ikbkap gene 31081261 Igh gene rearrange amp meth 220, 310, 90081262 Igh gene rearrang dir probe 220, 310, 90081263 Igh vari regional mutation 220, 310, 90081264 Igk rearrangeabn clonal pop 220, 310, 90081265 Str markers specimen anal 010, 22081266 Str markers spec anal addl 010, 22081267 Chimerism anal no cell selec 010, 22081268 Chimerism anal w/cell select 010, 22081269 Hba1/hba2 gene dup/del vrnts 310, 40081270 Jak2 gene 220, 310, 90081271 Htt gene detc abnor alleles - Effective 1/1/2019 220, 31081272 Kit gene targeted seq analys 220, 310, 90081273 Kit gene analys d816 variant - 220, 310, 90081274 Htt gene charac alleles - Effective 1/1/2019 220, 31081275 Kras gene variants exon 2 220, 310, 90081276 Kras gene addl variants 220, 310, 90081283 Ifnl3 gene - Effective 1/1/2018 220, 31081284 Fxn gene detc abnor alleles - Effective 1/1/2019 220, 310

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

81285 Fxn gene charac alleles - Effective 1/1/2019 220, 31081286 Fxn gene full gene sequence - Effective 1/1/2019 220, 31081287 Mgmt gene methylation anal 220, 31081288 Mlh1 gene 220, 31081289 Fxn gene known famil variant - Effective 1/1/2019 220, 31081290 Mcoln1 gene 220, 31081291 Mthfr gene 40081292 Mlh1 gene full seq 220, 31081293 Mlh1 gene known variants 220, 31081294 Mlh1 gene dup/delete variant 220, 31081295 Msh2 gene full seq 220, 31081296 Msh2 gene known variants 220, 31081297 Msh2 gene dup/delete variant 220, 31081298 Msh6 gene full seq 220, 31081299 Msh6 gene known variants 220, 31081300 Msh6 gene dup/delete variant 220, 31081301 Microsatellite instability 220, 31081302 Mecp2 gene full seq 220, 31081303 Mecp2 gene known variant 220, 31081304 Mecp2 gene dup/delet variant 220, 31081305 Myd88 gene p.leu265pro vrnt - Effective 1/1/2019 220, 31081306 Nudt15 gene common variants - Effective 1/1/2019 220, 31081310 Npm1 gene 220, 310, 90081311 Nras gene variants exon 2&3 220, 310, 90081312 Pabpn1 gene detc abnor allel - Effective 1/1/2019 220, 31081313 Pca3/klk3 antigen 220, 31081314 Pdgfra gene 220, 31081315 Pml/raralpha com breakpoints 220, 310, 90081316 Pml/raralpha 1 breakpoint 220, 310, 90081317 Pms2 gene full seq analysis 220, 310, 90081318 Pms2 known familial variants 220, 310, 90081319 Pms2 gene dup/delet variants 220, 310, 90081320 Plcg2 gene common variants - Effective 1/1/2019 220, 31081321 Pten gene full sequence 220, 31081322 Pten gene known fam variant 220, 31081323 Pten gene dup/delet variant 220, 31081324 Pmp22 gene dup/delet 220, 31081325 Pmp22 gene full sequence 220, 31081326 Pmp22 gene known fam variant 220, 31081327 Sept9 gen prmtr mthyltn alys 220, 31081328 Slco1b1 gene com variants 220, 31081329 Smn1 gene dos/deletion alys - Effective 1/1/2019 220, 31081330 Smpd1 gene common variants 220, 31081331 Snrpn/ube3a gene 220, 31081332 Serpina1 gene 220, 31081333 Tgfbi gene common variants - Effective 1/1/2019 220, 31081334 Runx1 gene targeted seq alys 220, 31081335 Tpmt gene com variants 220, 31081336 Smn1 gene full gene sequence - Effective 1/1/2019 220, 31081337 Smn1 gen nown famil seq vrnt - Effective 1/1/2019 220, 310

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

81340 Trb@ gene rearrange amplify 220, 310, 90081341 Trb@ gene rearrange dirprobe 220, 310, 90081342 Trg gene rearrangement anal 220, 310, 90081343 Ppp2r2b gen detc abnor allel - Effective 1/1/2019 220, 31081344 Tbp gene detc abnor alleles - Effective 1/1/2019 220, 31081345 Tert gene targeted seq alys - Effective 1/1/2019 220, 31081346 Tyms gene com variants 220, 31081350 Ugt1a1 gene 220, 31081355 Vkorc1 gene 220, 40081361 Hbb gene com variants 310, 40081362 Hbb gene known fam variant 310, 40081363 Hbb gene dup/del variants 310, 40081364 Hbb full gene sequence 310, 40081370 Hla i & ii typing lr 01081371 Hla i & ii type verify lr 01081372 Hla i typing complete lr 01081373 Hla i typing 1 locus lr 01081374 Hla i typing 1 antigen lr 01081375 Hla ii typing ag equiv lr 01081376 Hla ii typing 1 locus lr 01081377 Hla ii type 1 ag equiv lr 01081378 Hla i & ii typing hr 01081379 Hla i typing complete hr 01081380 Hla i typing 1 locus hr 01081381 Hla i typing 1 allele hr 01081382 Hla ii typing 1 loc hr 01081383 Hla ii typing 1 allele hr 01081400 Mopath procedure level 1 61081401 Mopath procedure level 2 220, 310, 400, 61081402 Mopath procedure level 3 220, 310, 61081403 Mopath procedure level 4 220, 310, 400, 61081404 Mopath procedure level 5 61081405 Mopath procedure level 6 220, 310, 400, 61081406 Mopath procedure level 7 61081407 Mopath procedure level 8 61081408 Mopath procedure level 9 61081410 Aortic dysfunction/dilation 220, 31081411 Aortic dysfunction/dilation 220, 31081412 Ashkenazi jewish assoc dis 220, 31081413 Car ion chnnlpath inc 10 gns 220, 31081414 Car ion chnnlpath inc 2 gns 220, 31081415 Exome sequence analysis 220, 31081416 Exome sequence analysis 220, 31081417 Exome re-evaluation 220, 31081420 Fetal chrmoml aneuploidy 220, 90081422 Fetal chrmoml microdeltj 220, 31081425 Genome sequence analysis 220, 31081426 Genome sequence analysis 220, 31081427 Genome re-evaluation 220, 31081430 Hearing loss sequence analys 220, 310

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

81431 Hearing loss dup/del analys 220, 31081432 Hrdtry brst ca-rlatd dsordrs 220, 31081433 Hrdtry brst ca-rlatd dsordrs 220, 31081434 Hereditary retinal disorders 220, 31081435 Hereditary colon ca dsordrs 220, 31081436 Hereditary colon ca dsordrs 220, 31081437 Heredtry nurondcrn tum dsrdr 220, 31081438 Heredtry nurondcrn tum dsrdr 220, 31081439 Inherited cardmypthy 5 gns 220, 31081440 Mitochondrial gene 220, 31081442 Noonan spectrum disorders 220, 31081443 Genetic tstg severe inh cond - Effective 1/1/2019 220, 31081445 Targeted genomic seq analys 220, 31081448 Hrdtry perph neurphy panel 220, 31081450 Targeted genomic seq analys 220, 31081455 Targeted genomic seq analys 220, 31081460 Whole mitochondrial genome 220, 31081465 Whole mitochondrial genome 220, 31081470 X-linked intellectual dblt 220, 90081471 X-linked intellectual dblt 220, 90081479 Unlisted molecular pathology 010, 220, 310, 61081490 Autoimmune rheumatoid arthr 220, 31081493 Cor artery disease mrna 220, 31081500 Onco (ovar) two proteins 31081503 Onco (ovar) five proteins 31081504 Oncology tissue of origin 220, 31081506 Endo assay seven anal 220, 310, 33081507 Fetal aneuploidy trisom risk 220, 90081508 Ftl cgen abnor two proteins 310, 33081509 Ftl cgen abnor 3 proteins 310, 33081510 Ftl cgen abnor three anal 220, 310, 33081511 Ftl cgen abnor four anal 220, 310, 33081512 Ftl cgen abnor five anal 220, 310, 33081518 Onc brst mrna 11 genes - Effective 1/1/2019 220, 31081519 Oncology breast mrna 220, 31081520 Onc breast mrna 58 genes 220, 31081521 Onc breast mrna 70 genes 220, 31081525 Oncology colon mrna 220, 310, 90081528 Oncology colorectal scr 220, 310, 90081535 Oncology gynecologic 220, 31081536 Oncology gynecologic 220, 31081538 Oncology lung 220, 31081539 Oncology prostate prob scorev 31081540 Oncology tum unknown origin 220, 31081541 Onc prostate mrna 46 genes 220, 31081545 Oncology thyroid 220, 31081551 Onc prostate 3 genes 220, 31081595 Cardiology hrt trnspl mrna 220, 31081596 Nfct ds chrnc hcv 6 assays - Effective 1/1/2019 31081599 Unlisted maaa 220, 310, 330

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

82009 Test for acetone/ketones 31082010 Acetone assay 31082013 Acetylcholinesterase assay 31082016 Acylcarnitines, qual 31082017 Acylcarnitines, quant 31082024 Assay of acth 33082030 Assay of adp & amp 310, 33082040 Assay of serum albumin 31082042 Other source albumin quan ea 31082043 Ur albumin quantitative 31082044 Ur albumin semiquantitative 31082045 Albumin ischemia modified 31082085 Assay of aldolase 31082088 Assay of aldosterone 33082103 Alpha-1-antitrypsin, total 22082104 Alpha-1-antitrypsin, pheno 22082105 Alpha-fetoprotein serum 220, 31082106 Alpha-fetoprotein amniotic 220, 31082107 Alpha-fetoprotein l3 220, 31082108 Assay of aluminum 34082120 Amines, vaginal fluid qual 31082127 Amino acid, single qual 31082128 Amino acids, mult qual 31082131 Amino acids, single quant 31082135 Assay, aminolevulinic acid 330, 34082136 Amino acids, quant, 2-5 31082139 Amino acids, quan, 6 or more 31082140 Assay of ammonia 31082143 Amniotic fluid scan 31082150 Assay of amylase 31082154 Androstanediol glucuronide 33082157 Assay of androstenedione 33082160 Assay of androsterone 33082163 Assay of angiotensin II 33082164 Angiotensin I enzyme test 31082172 Assay of apolipoprotein 31082175 Assay of arsenic 34082180 Assay of ascorbic acid 31082190 Atomic absorption 310, 34082232 Assay of beta-2 protein 22082239 Bile acids, total 31082240 Bile acids, cholylglycine 31082247 Bilirubin total 31082248 Bilirubin direct 31082252 Fecal bilirubin test 31082261 Assay of biotinidase 31082271 Occult blood other sources 31082274 Assay test for blood fecal 310, 40082286 Assay of bradykinin 31082300 Assay of cadmium 340

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

82306 Vitamin D 25 hydroxy 31082308 Assay of calcitonin 33082310 Assay of calcium 31082330 Assay of calcium 31082331 Calcium infusion test 31082340 Assay of calcium in urine 31082355 Calculus analysis, qual 31082360 Calculus assay, quant 31082365 Calculus spectroscopy 31082370 X-ray assay, calculus 31082373 Assay, c-d transfer measure 31082374 Assay, blood carbon dioxide 31082375 Assay blood carboxyhb quant 34082376 Assay blood carboxyhb qual 34082378 Carcinoembryonic antigen 31082379 Assay of carnitine 31082380 Assay of carotene 31082382 Assay urine catecholamines 33082383 Assay blood catecholamines 33082384 Assay three catecholamines 33082387 Assay of cathepsin-d 33082390 Assay of ceruloplasmin 31082397 Chemiluminescent assay 310, 330, 34082415 Assay of chloramphenicol 34082435 Assay of blood chloride 31082436 Assay of urine chloride 31082438 Assay other fluid chlorides 31082441 Test for chlorohydrocarbons 34082465 Assay bld/serum cholesterol 31082480 Assay serum cholinesterase 31082482 Assay rbc cholinesterase 31082485 Assay chondroitin sulfate 31082495 Assay of chromium 34082507 Assay of citrate 31082523 Collagen crosslinks 310, 33082525 Assay of copper 34082528 Assay of corticosterone 33082530 Cortisol free 33082533 Total cortisol 33082540 Assay of creatine 31082542 Col chromotography qual/quant 310, 330, 34082550 Assay of ck (cpk) 31082552 Assay of cpk in blood 31082553 Creatine mb fraction 31082554 Creatine isoforms 31082565 Assay of creatinine 31082570 Assay of urine creatinine 31082575 Creatinine clearance test 31082585 Assay of cryofibrinogen 40082595 Assay of cryoglobulin 310

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

82600 Assay of cyanide 34082607 Vitamin B-12 31082608 B-12 binding capacity 31082610 Cystatin C 31082615 Test for urine cystines 31082626 Dehydroepiandrosterone 33082627 Dehydroepiandrosterone 33082633 Desoxycorticosterone 33082634 Deoxycortisol 33082638 Assay of dibucaine number 31082642 Dihydrotestosterone - Effective 1/1/2019 33082652 Vit d 1 25-dihydroxy 31082656 Pancreatic elastase, fecal 31082657 Enzyme cell activity 31082658 Enzyme cell activity ra 31082664 Electrophoretic test 330, 34082668 Assay of erythropoietin 33082670 Assay of estradiol 33082671 Assay of estrogens 33082672 Assay of estrogen 33082677 Assay of estriol 33082679 Assay of estrone 33082693 Assay of ethylene glycol 34082696 Assay of etiocholanolone 33082705 Fats/lipids feces qual 31082710 Fats/lipids feces quant 31082715 Assay of fecal fat 31082725 Assay of blood fatty acids 31082726 Long chain fatty acids 31082728 Assay of ferritin 31082731 Assay of fetal fibronectin 31082735 Assay of fluoride 34082746 Assay of folic acid serum 31082747 Assay of folic acid rbc 31082757 Assay of semen fructose 31082759 Assay of rbc galactokinase 31082760 Assay of galactose 31082775 Assay galactose transferase 31082776 Galactose transferase test 31082777 Galectin-3 31082784 Assay iga/igd/igg/igm each 22082785 Assay of ige 22082787 Igg 1 2 3 or 4 each 22082800 Blood pH 31082803 Blood gases any combination 31082805 Blood gases w/O2 saturation 31082810 Blood gases, O2 sat only 31082820 Hemoglobin-oxygen affinity 31082930 Gastric analy w/ph ea spec 31082938 Gastrin test 330

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

82941 Assay of gastrin 33082943 Assay of glucagon 310, 33082945 Glucose other fluid 31082946 Glucagon tolerance test 310, 33082947 Assay glucose blood quant 31082948 Reagent strip/blood glucose 31082950 Glucose test 31082951 Glucose tolerance test (GTT) 31082952 GTT-added samples 31082955 Assay of g6pd enzyme 31082960 Test for G6PD enzyme 31082963 Assay of glucosidase 31082965 Assay of gdh enzyme 31082977 Assay of GGT 31082978 Assay of glutathione 31082979 Assay, rbc glutathione 31082985 Assay of glycated protein 31083001 Assay of gonadotropin (FSH) 33083002 Assay of gonadotropin (LH) 33083003 Assay, growth hormone (hgh) 33083006 Growth stimulation gene 2 220, 31083009 H pylori (c-13), blood 11083010 Assay of haptoglobin quant 31083012 Assay of haptoglobins 31083015 Heavy metal screen 34083018 Heavy metal quant each nes 34083020 Hemoglobin electrophoresis 310, 40083020 26 Hemoglobin electrophoresis 310, 40083021 Hemoglobin chromotography 310, 40083030 Fetal hemoglobin chemical 310, 40083033 Fetal hemoglobin assay qual 310, 40083036 Glycosylated hemoglobin test 310, 40083045 Blood methemoglobin test 310, 40083050 Blood methemoglobin assay 310, 40083051 Assay of plasma hemoglobin 310, 40083060 Blood sulfhemoglobin assay 310, 40083065 Assay of hemoglobin heat 310, 40083068 Hemoglobin stability screen 310, 40083069 Assay of urine hemoglobin 32083070 Assay of hemosiderin, qual 320, 40083080 Assay of b hexosaminidase 31083088 Assay of histamine 34083090 Assay of homocystine 31083150 Assay of homovanillic acid 33083491 Assay of corticosteroids 17 33083497 Assay of 5-hiaa 33083498 Assay of progesterone 17-d 33083500 Assay, free hydroxyproline 310, 33083505 Assay, total hydroxyproline 310, 33083516 Immunoassay nonantibody 310, 330, 340

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

83518 Immunoassay dipstick 310, 330, 34083519 Ria nonantibody 220, 310, 330, 34083520 Immunoassay quant nos nonab 220, 310, 330, 34083525 Assay of insulin 33083527 Assay of insulin 33083528 Assay of intrinsic factor 31083540 Assay of iron 31083550 Iron binding test 31083570 Assay of idh enzyme 31083582 Assay of ketogenic steroids 33083586 Assay 17- ketosteroids 33083593 Fractionation ketosteroids 33083605 Assay of lactic acid 31083615 Lactate (LD) (LDH) enzyme 31083625 Assay of ldh enzymes 31083630 Lactoferrin fecal (qual) 31083631 Lactoferrin fecal (quant) 31083632 Placental lactogen 33083633 Test urine for lactose 31083655 Assay of lead 34083661 L/s ratio, fetal lung 31083662 Foam stability fetal lung 31083663 Fluoro polarize fetal lung 31083664 Lamellar bdy fetal lung 31083670 Assay of lap enzyme 31083690 Assay of lipase 31083695 Lipoprotein (a) 31083698 Assay lipoprotein pla2 31083700 Lipopro bld, electrphoretic 31083701 Lipoprotein bld hr fraction 31083704 Lipoprotein bld quan part 31083718 Assay of lipoprotein 31083719 Assay of blood lipoprotein 31083721 Assay of blood lipoprotein 31083722 Lipoprtn dir meas sd ldl chl - Effective 1/1/2019 31083727 Assay of lrh hormone 33083735 Assay of magnesium 31083775 Assay malate dehydrogenase 31083785 Assay of manganese 31083789 Mass spectrometry qual/quant 310, 330, 34083825 Assay of mercury 34083835 Assay of metanephrines 33083857 Assay of methemalbumin 31083861 Microfluid analy tears 31083864 Mucopolysaccharides 31083872 Assay synovial fluid mucin 31083873 Assay of csf protein 31083874 Assay of myoglobin 31083876 Assay myeloperoxidase 31083880 Assay of natriuretic peptide 310

CPT only copyright 2018 American Medical Association. All rights reserved. 18

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

83883 Assay nephelometry not spec 220, 31083885 Assay of nickel 34083915 Assay of nucleotidase 31083916 Oligoclonal bands 220, 31083918 Organic acids total quant 310, 34083919 Organic acids qual each 310, 34083921 Organic acid single quant 310, 34083930 Assay of blood osmolality 31083935 Assay of urine osmolality 31083937 Assay of osteocalcin 31083945 Assay of oxalate 31083950 Oncoprotein her-2/neu 31083951 Oncoprotein dcp 31083970 Assay of parathormone 33083986 Assay of ph body fluid nos 31083992 Assay for phencyclidine 34083993 Assay for calprotectin fecal 31084030 Assay of blood pku 31084035 Assay of phenylketones 31084060 Assay acid phosphatase 31084066 Assay prostate phosphatase 31084075 Assay alkaline phosphatase 31084078 Assay alkaline phosphatase 31084080 Assay alkaline phosphatases 31084081 Assay phosphatidylglycerol 31084085 Assay of rbc pg6d enzyme 31084087 Assay phosphohexose enzymes 31084100 Assay of phosphorus 31084105 Assay of urine phosphorus 31084106 Test for porphobilinogen 31084110 Assay of porphobilinogen 31084112 Eval amniotic fluid protein 31084119 Test urine for porphyrins 31084120 Assay of urine porphyrins 31084126 Assay of feces porphyrins 31084132 Assay of serum potassium 31084133 Assay of urine potassium 31084134 Assay of prealbumin 31084135 Assay of pregnanediol 33084138 Assay of pregnanetriol 33084140 Assay of pregnenolone 33084143 Assay of 17-hydroxypregneno 33084144 Assay of progesterone 33084145 Procalcitonin (pct) 33084146 Assay of prolactin 33084150 Assay of prostaglandin 31084152 Assay of psa complexed 31084153 Assay of psa total 31084154 Assay of psa free 31084155 Assay of protein serum 310

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

84156 Assay of protein urine 31084157 Assay of protein other 31084160 Assay of protein any source 31084163 Pappa serum 31084165 Protein electrophoresis serum 31084165 26 Protein electrophoresis serum 31084166 Protein electrophoresis/urine/csf 31084166 26 Protein electrophoresis/urine/csf 31084181 Western blot test 22084181 26 Western blot test 22084182 Protein western blot test 22084182 26 Protein western blot test 22084202 Assay RBC protoporphyrin 31084203 Test RBC protoporphyrin 31084206 Assay of proinsulin 33084207 Assay of vitamin b-6 31084210 Assay of pyruvate 31084220 Assay of pyruvate kinase 31084228 Assay of quinine 34084233 Assay of estrogen 33084234 Assay of progesterone 33084235 Assay of endocrine hormone 33084238 Assay nonendocrine receptor 220, 33084244 Assay of renin 33084252 Assay of vitamin b-2 31084255 Assay of selenium 34084260 Assay of serotonin 310, 33084270 Assay of sex hormone globul 33084275 Assay of sialic acid 31084285 Assay of silica 34084295 Assay of serum sodium 31084300 Assay of urine sodium 31084302 Assay of sweat sodium 31084305 Assay of somatomedin 33084307 Assay of somatostatin 33084311 Spectrophotometry 140, 220, 310, 40084315 Body fluid specific gravity 31084375 Chromatogram assay, sugars 31084376 Sugars single qual 31084377 Sugars multiple qual 31084378 Sugars single quant 31084379 Sugars multiple quant 31084392 Assay of urine sulfate 31084402 Assay of testosterone 33084403 Assay of total testosterone 33084410 Testosterone bioavailable 33084425 Assay of vitamin b-1 31084430 Assay of thiocyanate 34084431 Thromboxane urine 31084432 Assay of thyroglobulin 310

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

84436 Assay of total thyroxine 33084437 Assay of neonatal thyroxine 33084439 Assay of free thyroxine 33084442 Assay of thyroid activity 33084443 Assay thyroid stim hormone 33084445 Assay of tsi globulin 33084446 Assay of vitamin e 31084449 Assay of transcortin 31084450 Transferase (AST) (SGOT) 31084460 Alanine amino (ALT) (SGPT) 31084466 Assay of transferrin 31084478 Assay of triglycerides 31084479 Assay of thyroid (t3 or t4) 33084480 Assay, triiodothyronine (t3) 33084481 Free assay (FT-3) 33084482 T3 reverse 33084484 Assay of troponin quant 31084485 Assay duodenal fluid trypsin 31084488 Test feces for trypsin 31084490 Assay of feces for trypsin 31084510 Assay of tyrosine 31084512 Assay of troponin qual 31084520 Assay of urea nitrogen 31084525 Urea nitrogen semi-quant 31084540 Assay of urine/urea-n 31084545 Urea-N clearance test 31084550 Assay of blood/uric acid 31084560 Assay of urine/uric acid 31084577 Assay of feces/urobilinogen 31084578 Test urine urobilinogen 32084580 Assay of urine urobilinogen 31084583 Assay of urine urobilinogen 32084585 Assay of urine vma 33084586 Assay of vip 33084588 Assay of vasopressin 33084590 Assay of vitamin a 31084591 Assay of nos vitamin 31084597 Assay of vitamin k 31084600 Assay of volatiles 34084620 Xylose tolerance test 31084630 Assay of zinc 31084681 Assay of c-peptide 31084702 Chorionic gonadotropin test 33084703 Chorionic gonadotropin assay 33084704 hCG free beta chain test 33084999 Clinical chemistry test 310, 330, 34085002 Bleeding time test 40085004 Automated diff WBC count 40085007 BI smear w/diff WBC count 40085008 BI smear w/o diff WBC count 400

CPT only copyright 2018 American Medical Association. All rights reserved. 21

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

85009 Manual diff WBC count b-coat 40085014 Hematocrit 40085018 Hemoglobin 40085025 Complete CBC w/auto diff WBC 40085027 Complete CBC automated 40085032 Manual cell count each 40085041 Automated RBC count 40085044 Manual reticulocyte count 40085045 Automated reticulocyte count 40085046 Reticyte/hgb concentrate 40085048 Automated leukocyte count 40085049 Automated platelet count 40085055 Reticulated platelet assay 40085060 Blood smear interpretation 400, 61085097 Bone marrow interpretation 400, 61085130 Chromogenic substrate assay 40085170 Blood clot retraction 40085175 Blood clot lysis time 40085210 Clot factor II prothrom spec 40085220 Blood clot factor V test 40085230 Clot factor VII proconvertin 40085240 Clot factor VIII ahg 1 stage 40085244 Clot factor VIII reltd antgn 40085245 Clot factor VIII vw ristoctn 40085246 Clot factor VIII vw antigen 40085247 Clot factor VIII multimetric 40085250 Clot factor IX ptc/chrstmas 40085260 Clot factor X stuart-power 40085270 clot factor XI pta 40085280 Clot factor XII hagerman 40085290 Clot factor XIII fibrin stab 40085291 Clot factor XIII fibrin scrn 40085292 Clot factor fletcher fact 40085293 Clot factor wght kininogen 40085300 Antithrombin III activity 40085301 Antithrombin III antigen 40085302 Clot inhib prot c antigen 40085303 Clot inhib prot c activity 40085305 Clot inhib prot s total 40085306 Clot inhib prot s free 40085307 Assay activated protein c 40085335 Factor inhibitor test 40085337 Thrombomodulin 40085345 Coagulation time lee & white 40085347 Coagulation time activated 40085348 Coagulation time otr method 40085360 Euglobulin lysis 40085362 Fibrin degradation products 40085366 Fibrinogen test 40085370 Fibrinogen test 400

CPT only copyright 2018 American Medical Association. All rights reserved. 22

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

85378 Fibrin degrade semiquant 40085379 Fibrin degradation, quant 40085380 Fibrin degradj d-dimer 40085384 Fibrinogen activity 40085385 Fibrinogen antigen 40085390 Fibrinolysins screen i&r 40085390 26 Fibrinolysins screen i&r 40085396 Clotting assay, whole blood 40085397 Clotting funct activity 40085400 Fibrinolytic plasmin 40085410 Fibrinolytic antiplasmin 40085415 Fibrinolytic plasminogen 40085420 Fibrinolytic plasminogen 40085421 Fibrinolytic plasminogen 40085441 Heinz bodies direct 40085445 Heinz bodies induced 40085460 Hemoglobin fetal 40085461 Hemoglobin fetal 400, 51085475 Hemolysin acid 22085520 Heparin assay 40085525 Heparin neutralization 40085530 Heparin-protamine tolerance 40085536 Iron stain peripheral blood 40085540 Wbc alkaline phosphatase 40085547 RBC mechanical fragility 40085549 Muramidase 31085555 RBC osmotic fragility 40085557 RBC osmotic fragility 40085576 Blood platelet aggregation 40085576 26 Blood platelet aggregation 40085597 Phospholipid pltlt neutraliz 40085598 Hexagnal phosph pltlt neutrl 220, 40085610 Prothrombin time 40085611 Prothrombin test 40085612 Viper venom prothrombin time 40085613 Russell viper venom diluted 40085635 Reptilase test 40085652 Rbc sed rate, automated 40085660 RBC sickle cell test 40085670 Thrombin time plasma 40085675 Thrombin time titer 40085705 Thromboplastin inhibition 40085730 Thromboplastin time, partial 40085732 Thromboplastin time, partial 40085810 Blood viscosity examination 310, 400 85999 Hematology procedure 40086000 Agglutinins febrile antigen 22086001 Allergen specific IgG 22086003 Allg spec ige crude xtrc ea 22086005 Allg spec ige multiallg scr 220

CPT only copyright 2018 American Medical Association. All rights reserved. 23

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

86008 Allg spec ige recomb ea 22086021 WBC antibody identification 01086022 Platelet antibodies 22086023 Immunoglobulin assay 220, 520, 53086038 Antinuclear antibodies 22086039 Antinuclear antibodies (ANA) 22086060 Antistreptolysin o titer 22086063 Antistreptolysin o screen 22086140 C-reactive protein 22086141 C-reactive protein hs 22086146 Beta-2 glycoprotein antibody 22086147 Cardiolipin antibody ea ig 210, 22086148 Anti-phospholipid antibody 22086152 Cell enumeration & id 220, 400, 61086153 Cell enumeration phys interp 220, 400, 61086153 26 Cell enumeration phys interp 220, 400, 61086155 Chemotaxis assay 22086156 Cold agglutinin screen 22086157 Cold agglutinin titer 22086160 Complement antigen 22086161 Complement/function activity 22086162 Complement total (CH50) 22086171 Complement fixation each 22086200 CCP antibody 22086215 Deoxyribonuclease antibody 22086225 DNA antibody native 22086226 DNA antibody, single strand 22086235 Nuclear antigen antibody 22086255 Fluorescent antibody screen 22086255 26 Fluorescent antibody screen 22086256 Fluorescent antibody titer 22086256 26 Fluorescent antibody titer 22086277 Growth hormone antibody 22086280 Hemagglutination inhibition 22086294 Immunoassay tumor qual 220, 31086300 Immunoassay tumor ca 15-3 220, 31086301 Immunoassay tumor ca 19-9 220, 31086304 Immunoassay tumor ca 125 220, 31086305 Human epididymis protein 4 210, 31086308 Heterophile antibodies screen 22086309 Heterophile antibodies titer 22086310 Heterophile antibodies absrbj 22086316 Immunoassay tumor other 220, 31086317 Immunoassay infectious agent 22086318 Immunoassay infectious agent 22086320 Serum immunoelectrophoresis 22086320 26 Serum immunoelectrophoresis 22086325 Other immunoelectrophoresis 22086325 26 Other immunoelectrophoresis 22086327 Immunoelectrophoresis assay 220

CPT only copyright 2018 American Medical Association. All rights reserved. 24

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

86327 26 Immunoelectrophoresis assay 22086329 Immunodiffusion nes 22086331 Immunodiffusion ouchterlony 22086332 Immune complex assay 22086334 Immunofixation e-phoresis, serum 22086334 26 Immunofixation e-phoresis, serum 22086335 Immunofixation e-phoresis/urine/csf 22086335 26 Immunofixation e-phoresis/urine/csf 22086336 Inhibin A 220, 33086337 Insulin antibodies 22086340 Intrinsic factor antibody 22086341 Islet cell antibody 22086343 Leukocyte histamine release 22086344 Leukocyte phagocytosis 22086352 Cell function assay w/stim 22086353 Lymphocyte transformation 010, 22086355 B cells total count 22086356 Mononuclear cell antigen 22086357 Nk cells total count 22086359 T cells total count 22086360 T cell absolute count/ratio 22086361 T cell absolute count 22086367 Stem cells total count 22086376 Microsomal antibody 22086382 Neutralization test viral 22086384 Nitroblue tetrazolium dye 22086386 Nuclear matrix protein 22 220, 31086403 Particle agglut antbdy scrn 22086406 Particle agglut antbdy titr 22086430 Rheumatoid factor test qual 22086431 Rheumatoid factor quant 22086480 Tb test cell immun measure 22086481 Tb ag response t-cell susp 22086590 Streptokinase antibody 22086592 Syphilis test non-trep qual 21086593 Syphilis test non-trep quant 21086602 Antinomyces antibody 22086603 Adenovirus antibody 22086606 Aspergillus antibody 22086609 Bacterium antibody 22086611 Bartonella antibody 22086612 Blastomyces antibody 22086615 Bordetella antibody 22086617 Lyme disease antibody 22086618 Lyme disease antibody 22086619 Borrelia antibody 22086622 Brucella antibody 22086625 Campylobacter antibody 22086628 Candida antibody 22086631 Chlamydia antibody 220

CPT only copyright 2018 American Medical Association. All rights reserved. 25

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

86632 Chlamydia igm antibody 22086635 Coccidioides antibody 22086638 Q fever antibody 22086641 Cryptococcus antibody 22086644 CMV antibody 22086645 CMV antibody IgM 22086648 Diphtheria antibody 22086651 Encephalitis californ antbdy 22086652 Encephalitis east eqne antbdy 22086653 Encephalitis st louis antbdy 22086654 Encephalitis west eqne antbdy 22086658 Enterovirus antibody 22086663 Epstein-barr antibody 22086664 Epstein-barr nuclear antigen 22086665 Epstein-barr capsid vca 22086666 Ehrlichia antibody 22086668 Francisella tularensis 22086671 Fungus antibody 22086674 Giardia lamblia antibody 22086677 Helicobacter pylori 22086682 Helminth antibody 22086684 Hemophilus influenza 22086687 Htlv-i antibody 22086688 Htlv-ii antibody 22086689 HTLV/HIV confirmatory test 22086692 Hepatitis delta agent antbdy 22086694 Herpes simplex nes antbdy 22086695 Herpes simplex type 1 test 22086696 Herpes simplex type 2 test 22086698 Histoplasma antibody 22086701 HIV-1 antibody 22086702 HIV-2 antibody 22086703 Hiv-1/hiv-2 1 result antbdy 22086704 Hep b core antibody, total 22086705 Hep b core antibody, igm 22086706 Hep b surface antibody 22086707 Hep be antibody 22086708 Hepatitis a antibody 22086709 Hepatitis a igm antibody 22086710 Influenza virus antibody 22086711 John cunningham antibody 22086713 Legionella antibody 22086717 Leishmania antibody 22086720 Leptospira antibody 22086723 Listeria monocytogenes 22086727 Lymph choriomeningitis ab 22086732 Mucormycosis antibody 22086735 Mumps antibody 22086738 Mycoplasma antibody 22086741 Neisseria meningitidis 220

CPT only copyright 2018 American Medical Association. All rights reserved. 26

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

86744 Nocardia antibody 22086747 Parvovirus antibody 22086750 Malaria antibody 22086753 Protozoa antibody nos 22086756 Respiratory virus antibody 22086757 Rickettsia antibody 22086759 Rotavirus antibody 22086762 Rubella antibody 22086765 Rubeola antibody 22086768 Salmonella antibody 22086771 Shigella antibody 22086774 Tetanus antibody 22086777 Toxoplasma antibody 22086778 Toxoplasma antibody igm 22086780 Treponema pallidum 21086784 Trichinella antibody 22086787 Varicella-zoster antibody 22086788 West nile virus ab igm 22086789 West nile virus antibody 22086790 Virus antibody nos 22086793 Yersinia antibody 22086794 Zika virus igm antibody 22086800 Thyroglobulin antibody 22086803 Hepatitis c ab test 22086804 Hep c ab test confirm 22086805 Lymphocytotoxicity assay 01086806 Lymphocytotoxicity assay 01086807 Cytotoxic antibody screening 01086808 Cytotoxic antibody screening 01086812 HLA typing A B or C 01086813 HLA typing A B or C 01086816 HLA typing DR/DQ 01086817 HLA typing DR/DQ 01086821 Lymphocyte culture mixed 01086825 Hla x-match non-cytotoxic 01086826 Hla x-match noncytotoxc addl 01086828 Hla class i&ii antibody qual 01086829 Hla class i/ii antibody qual 01086830 Hla class i phenotype qual 01086831 Hla class ii phenotype qual 01086832 Hla class i high defin qual 01086833 Hla class ii high defin qual 01086834 Hla class i semiquant panel 01086835 Hla class ii semiquant panel 01086849 Immunology procedure 22086850 RBC antibody screen 520, 53086860 RBC antibody elution 54086870 RBC antibody identification 54086880 Coombs test direct 520, 53086885 Coombs test indirect, qual 520, 530

CPT only copyright 2018 American Medical Association. All rights reserved. 27

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

86886 Coombs test, indirect, titer 520, 53086890 Autologous blood process 510, 53086900 Blood typing serologic ABO 51086901 Blood typing serologic Rh (D) 51086902 Blood type antigen donor ea 55086904 Blood typing patient serum 55086905 Blood typing RBC antigens 55086906 Blood typing Rh phenotype 51086920 Compatibility test spin 55086921 Compatibility test incubate 55086922 Compatibility test antiglob 55086940 Hemolysins/agglutinins auto 54086941 Hemolysins/agglutinins 54086970 RBC pretx incubatj w/chemicl 520, 530, 540, 55086971 RBC pretx incubatj w/enzymes 520, 530, 540, 55086972 RBC pretx incubatj w/density 520, 530, 540, 55086975 RBC serum pretx incubj drugs 54086976 RBC serum pretx id dilution 54086977 RBC serum pretx incubj/inhib 54086978 RBC pretreatment serum 54087003 Small animal inoculation 110, 140, 15087015 Specimen infect agnt conctj 115, 13087040 Blood culture for bacteria 11087045 Feces culture aerobic bact 11087046 Stool cultr aerobic bact ea 11087070 Culture othr specimn aerobic 11087071 Culture aerobic quant other 11087073 Culture bacteria anaerobic 11087075 Cultr bacteria except blood 11087076 Culture anaerobe ident each 11087077 Culture aerobic identify 11087081 Culture screen only 11087084 Culture of specimen by kit 11087086 Urine culture/colony count 11087088 Urine bacteria culture 11087101 Skin fungi culture 12087102 Fungus isolation culture 12087103 Blood fungus culture 12087106 Fungi identification yeast 12087107 Fungi identification mold 12087109 Mycoplasma 11087110 Chlamydia culture 11087116 Mycobacteria culture 11587118 Mycobacteric identification 11587140 Culture type immunofluoresc 110, 120, 14087143 Culture typing glc/hplc 110, 115, 12087147 Culture type immunologic 110, 120, 14087149 Dna/rna direct probe 110, 11587150 Dna/rna amplified probe 110, 115, 120, 14087152 Culture type pulse field gel 110, 115

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

87153 Dna/rna sequencing 110, 115, 120, 14087158 Culture typing added method 110, 11587164 Dark field examination 110, 21087164 26 Dark field examination 110, 21087166 Dark field examination 110, 21087168 Macroscopic exam arthropod 13087169 Macacroscopic exam parasite 13087172 Pinworm exam 13087176 Tissue homogenization cultr 15087177 Ova and parasites smears 13087181 Microbe susceptible diffuse 110, 115, 12087184 Microbe susceptible disk 110, 115, 12087185 Microbe susceptible enzyme 11087186 Microbe susceptible mic 110, 115, 12087187 Microbe susceptible mlc 110, 12087188 Microbe suscept macrobroth 110, 115, 12087190 Microbe suscept mycobacteri 11587197 Bactericidal level serum 11087205 Smear gram stain 110, 12087206 Smear fluorescent/acid stai 110, 115, 120, 130,14087207 Smear special stain 130, 14087207 26 Smear special stain 130, 14087209 Smear complex stain 13087210 Smear wet mount saline/ink 110, 120, 13087220 Tissue exam for fungi 120, 13087230 Assay toxin or antitoxin 11087250 Virus inoculate eggs/animal 14087252 Virus inoculation tissue 14087253 Virus inoculate tissue addl 14087254 Virus inoculation shell via 14087255 Genet virus isolate HSV 14087260 Adenovirus ag if 14087265 Pertussis ag if 11087267 Enterovirus antibody DFA 22087269 Giardia ag if 13087270 Chlamydia trachomatis ag if 11087271 Cytomegalovirus dfa 22087272 Cryptosporidum ag if 13087273 Herpes simplex 2 ag if 14087274 Herpes simplex 1 ag if 14087275 Influenza b ag if 14087276 Influenza a ag if 14087278 Legion pneumophilia ag if 11087279 Parainfluenza ag if 14087280 Respiratory syncytial ag if 14087281 Pneumocystis carinii ag if 13087283 Rubeola ag if 14087285 Treponema pallidum ag if 11087290 Varicella zoster ag if 14087299 Antibody detection nos if 110, 115, 120, 130, 140

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

87300 Ag detection polyval if 11087301 Adenovirus ag ia 14087305 Aspergillus ag ia 12087320 Chylmd trach ag ia 11087324 Clostridium ag ia 11087327 Cryptococcus neoform ag ia 12087328 Cryptosporidium ag ia 13087329 Giardia ag ia 13087332 Cytomegalovirus ag ia 14087335 E coli 0157 ag ia 11087336 Entamoeb hist dispr ag ia 13087337 Entamoeb hist group ag ia 13087338 Hpylori stool ia 11087339 H pylori ag ia 11087340 Hepatitis b surface ag ia 22087341 Hepatitis b surface ag ia 22087350 Hepatitis be ag ia 22087380 Hepatitis delta ag ia 22087385 Histoplasma capsul ag ia 12087389 Hiv-1 ag w/hiv-1 & hiv-2 ab 22087390 Hiv-1 ag ia 22087391 Hiv-2 ag ia 22087400 Influenza a/b ag ia 14087420 Resp syncytial ag ia 14087425 Rotavirus ag ia 14087427 Shiga-like toxin ag ia 11087430 Strep a ag ia 11087449 Ag detect nos ia mult 110, 120, 130, 14087450 Ag detect nos ia single 110, 120, 130, 14087451 Ag detect polyval ia mult 110, 120, 13087471 Bartonella dna amp probe 11087472 Bartonella dna quant 11087475 Lyme dis dna dir probe 11087476 Lyme dis dna amp probe 11087480 Candida dna dir probe 12087481 Candida dna amp probe 12087482 Candida dna quant 12087483 Cns dna amp probe type 12-25 110, 120, 14087485 Chylmd pneum dna dir probe 11087486 Chylmd pneum dna amp probe 11087487 Chylmd pneum dna quant 11087490 Chylmd trach dna dir probe 11087491 Chylmd trach dna amp probe 11087492 Chylmd trach dna quant 11087493 C diff amplified probe 11087495 Cytomeg dna dir probe 14087496 Cytomeg dna amp probe 14087497 Cytomeg dna quant 14087498 Enterovirus probe&revrs trns 14087500 Vanomycin dna amp probe 110

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

87501 Influenza dna amp prob 1+ 14087502 Influenza dna amp probe 14087503 Influenza dna amp prob addl 14087505 Nfct agent detection gi 110, 14087506 Iadna-dna/rna probe tq 6-11 110, 14087507 Iadna-dna/rna probe tq 12-25 110, 14087510 Gardner vag dna dir probe 11087511 Gardner vag dna amp probe 11087512 Gardner vag dna quant 11087516 Hepatitis b dna amp probe 22087517 Hepatitis b dna quant 22087520 Hepatitis c rna dir probe 22087521 Hepatitis c probe&rvrs trnsc 22087522 Hepatitis c revrs trnscrpj 22087525 Hepatitis g dna dir probe 22087526 Hepatitis g dna amp probe 22087527 Hepatitis g dna quant 22087528 Hsv dna dir probe 14087529 Hsv dna amp probe 14087530 Hsv dna quant 14087531 Hhv-6 dna dir probe 14087532 Hhv-6 dna amp probe 14087533 Hhv-6 dna quant 14087534 Hiv-1 dna dir probe 140, 22087535 Hiv-1 probe&reverse trnscrpj 140, 22087536 Hiv-1 quant&revrse trnscrpj 140, 22087537 Hiv-2 dna dir probe 140, 22087538 Hiv-2 probe&revrse trnscripj 140, 22087539 Hiv-2 quant&revrse trnscripj 140, 22087540 Legion pneumo dna dir prob 11087541 Legion pneumo dna amp prob 11087542 Legion pneumo dna quant 11087550 Mycobacteria dna dir probe 11587551 Mycobacteria dna amp probe 11587552 Mycobacteria dna quant 11587555 M.tuberculo dna dir probe 11587556 M.tuberculo dna amp probe 11587557 M.tuberculo dna quant 11587560 M.avium-intra dna dir prob 11587561 M.avium-intra dna amp prob 11587562 M.avium-intra dna quant 11587580 M.pneumon dna dir probe 11087581 M.pneumon dna amp probe 11087582 M.pneumon dna quant 11087590 N.gonorrhoeae dna dir prob 11087591 N.gonorrhoeae dna amp prob 11087592 N.gonorrhoeae dna quant 11087623 Hpv low-risk types 14087624 Hpv high-risk types 14087625 Hpv types 16 & 18 only 140

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

87631 Resp virus 3-5 targets 14087632 Resp virus 6-11 targets 14087633 Resp virus 12-25 targets 14087634 Rsv dna/rna amp probe 14087640 Staph a dna amp probe 11087641 Mr-staph dna amp probe 11087650 Strep a dna dir probe 11087651 Strep a dna amp probe 11087652 Strep a dna quant 11087653 Strep b dna amp probe 11087660 Trichomonas vagin dir probe 13087661 Trichomonas vaginalis amplif 13087662 Zika virus dna/rna amp probe 14087797 Detect agent nos dna dir 110, 115, 120, 130, 14087798 Detect agent nos dna amp 110, 115, 120, 130, 14087799 Detect agent nos dna quant 110, 115, 120, 130, 14087800 Detect agnt mult dna direc 110, 115, 120, 130, 14087801 Detect agnt mult dna ampli 110, 115, 120, 130, 14087802 Strep b assay w/optic 11087803 Clostridium toxin a w/optic 11087804 Influenza assay w/optic 14087806 Hiv antigen w/hiv antibodies 140, 22087807 RSV assay w/optic 14087808 Trichomonas assay w/optic 13087809 Adenovirus assay w/optic 14087810 Chylmd trach assay w/optic 11087850 N. gonorrhoeae assay w/optic 11087880 Strep a assay w/optic 11087899 Agent nos assay w/optic 11087901 Genotype dna hiv reverse t 140, 22087902 Genotype dna hepatitis C 140, 22087903 Phenotype dna hiv w/culture 140, 22087904 Phenotype dna hiv w/clt add 140, 22087905 Sialidase enzyme assay 110, 115, 120, 13087906 Genotype dna hiv reverse t 140, 22087910 Genotype cytomegalovirus 14087912 Genotype dna hepatitis b 22087999 Microbiology procedure 110, 115, 120, 130, 14088104 Cytopath fl nongyn smears 63088104 TC Cytopath fl nongyn smears 63088104 26 Cytopath fl nongyn smears 63088106 Cytopath fl nongyn filter 63088106 TC Cytopath fl nongyn filter 63088106 26 Cytopath fl nongyn filter 63088108 Cytopath concentrate tech 63088108 TC Cytopath concentrate tech 63088108 26 Cytopath concentrate tech 63088112 Cytopath cell enhance tech 63088112 TC Cytopath cell enhance tech 63088112 26 Cytopath cell enhance tech 630

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

88120 Cytp urne 3-5 probes ea spec 610, 90088120 TC Cytp urne 3-5 probes ea spec 610, 90088120 26 Cytp urne 3-5 probes ea spec 610, 90088121 Cytp urine 3-5 probes cmptr 610, 90088121 TC Cytp urine 3-5 probes cmptr 610, 90088121 26 Cytp urine 3-5 probes cmptr 610, 90088130 Sex chromatin identification 90088140 Sex chromatin identification 90088141 Cytopath, c/v, interpret 63088142 Cytopath c/v thin layer 63088143 Cytopath c/v thin layer redo 63088147 Cytopath c/v automated 63088148 Cytopath c/v auto rescreen 63088150 Cytopath c/v manual 63088152 Cytopath c/v auto redo 63088153 Cytopath c/v redo 63088155 Cytopath c/v index add-on 63088160 Cytopath smear other source 63088160 TC Cytopath smear other source 63088160 26 Cytopath smear other source 63088161 Cytopath smear other source 63088161 TC Cytopath smear other source 63088161 26 Cytopath smear other source 63088162 Cytopath smear other source 63088162 TC Cytopath smear other source 63088162 26 Cytopath smear other source 63088164 Cytopath tbs c/v manual 63088165 Cytopath tbs c/v redo 63088166 Cytopath tbs c/v auto redo 63088167 Cytopath tbs c/v select 63088172 Cytp dx eval fna 1st ea site 610, 63088172 TC Cytp dx eval fna 1st ea site 610, 63088172 26 Cytp dx eval fna 1st ea site 610, 63088173 Cytopath eval fna report 610, 63088173 TC Cytopath eval fna report 610, 63088173 26 Cytopath eval fna report 610, 63088174 Cytopath c/v auto in fluid 63088175 Cytopath c/v auto fluid redo 63088177 Cytp fna eval ea addl 610, 63088177 TC Cytp fna eval ea addl 610, 63088177 26 Cytp fna eval ea addl 610, 63088182 Cell marker study 220, 400, 61088182 TC Cell marker study 220, 400, 61088182 26 Cell marker study 220, 400, 61088184 Flowcytometry/ tc 1 marker 220, 400, 61088185 Flowcytometry/tc add-on 220, 400, 61088187 Flowcytometry/read 2-8 220, 400, 61088188 Flowcytometry/read 9-15 220, 400, 61088189 Flowcytometry/read 16 & > 220, 400, 61088199 Cytopathology procedure 630

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

88199 TC Cytopathology procedure 63088199 26 Cytopathology procedure 63088230 Tissue culture lymphocyte 90088233 Tissue culture skin/biopsy 90088235 Tissue culture placenta 90088237 Tissue culture bone marrow 90088239 Tissue culture tumor 90088245 Chromosome analysis 20-25 90088248 Chromosome analysis 50-100 90088249 Chromosome analysis 100 90088261 Chromosome analysis 5 90088262 Chromosome analysis 15-20 90088263 Chromosome analysis 45 90088264 Chromosome analysis 20-25 90088267 Chromosome analys placenta 90088269 Chromosome analys amniotic 90088271 Cytogenetics dna probe 90088272 Cytogenetics 3-5 90088273 Cytogenetics 10-30 90088274 Cytogenetics 25-99 90088275 Cytogenetics 100-300 90088280 Chromosome karyotype study 90088283 Chromosome banding study 90088285 Chromosome count additional 90088289 Chromosome study additional 90088291 Cyto/molecular report 90088299 Cytogenetic study 90088300 Surgical path gross 610, 62088300 TC Surgical path gross 610, 62088300 26 Surgical path gross 610, 62088302 Tissue exam by pathologist 610, 62088302 TC Tissue exam by pathologist 610, 62088302 26 Tissue exam by pathologist 610, 62088304 Tissue exam by pathologist 610, 62088304 26 Tissue exam by pathologist 610, 62088305 Tissue exam by pathologist 610, 620, 63088305 26 Tissue exam by pathologist 610, 620, 63088307 Tissue exam by pathologist 610, 62088307 TC Tissue exam by pathologist 610, 62088307 26 Tissue exam by pathologist 610, 62088309 Tissue exam by pathologist 610, 62088309 TC Tissue exam by pathologist 610, 62088309 26 Tissue exam by pathologist 610, 62088312 Special stains group 1 610, 620, 63088312 26 Special stains group 1 610, 620, 63088313 Special stains group 2 130, 610, 620, 63088313 26 Special stains group 2 130, 610, 620, 63088314 Histochemical stains add -on 610, 620, 63088314 26 Histochemical stains add -on 610, 620, 63088319 Enzyme histochemistry 310, 630

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

88319 TC Enzyme histochemistry 310, 63088319 26 Enzyme histochemistry 310, 63088321 Microslide consultation 610, 620, 63088323 Microslide consultation 610, 620, 63088323 TC Microslide consultation 610, 620, 63088323 26 Microslide consultation 610, 620, 63088325 Comprehensive review of data 610, 620, 63088331 Path consult intraop 1 bloc 610, 62088331 TC Path consult intraop 1 bloc 610, 62088331 26 Path consult intraop 1 bloc 610, 62088332 Path consult intraop addl 610, 62088332 TC Path consult intraop addl 610, 62088332 26 Path consult intraop addl 610, 62088333 Intraop cyto path consult 1 610, 620, 63088333 TC Intraop cyto path consult 1 610, 620, 63088333 26 Intraop cyto path consult 1 610, 620, 63088334 Intraop cyto path consult 2 610, 620, 63088334 TC Intraop cyto path consult 2 610, 620, 63088334 26 Intraop cyto path consult 2 610, 620, 63088341 Immunohisto antd addl slide 220, 61088341 TC Immunohisto antd addl slide 220, 61088341 26 Immunohisto antd addl slide 220, 61088342 Immunohisto antb 1st stain 220, 61088342 TC Immunohisto antb 1st stain 220, 61088342 26 Immunohisto antb 1st stain 220, 61088344 Immunohisto antibody slide 220, 61088344 TC Immunohisto antibody slide 220, 61088344 26 Immunohisto antibody slide 220, 61088346 Immunofluor antb 1st stain 220, 61088346 TC Immunofluor antb 1st stain 220, 61088346 26 Immunofluor antb 1st stain 220, 61088348 Electron microscopy 610, 620, 63088348 TC Electron microscopy 610, 620, 63088348 26 Electron microscopy 610, 620, 63088350 Immunofluor antb addl stain 220. 61088350 TC Immunofluor antb addl stain 220. 61088350 26 Immunofluor antb addl stain 220. 61088355 Analysis skeletal muscle 61088355 TC Analysis skeletal muscle 61088355 26 Analysis skeletal muscle 61088356 Analysis nerve 61088356 TC Analysis nerve 61088356 26 Analysis nerve 61088358 Analysis tumor 61088358 TC Analysis tumor 61088358 26 Analysis tumor 61088360 Tumor immunohistochem/manual 220, 61088360 TC Tumor immunohistochem/manual 220, 61088360 26 Tumor immunohistochem/manual 220, 61088361 Tumor immunohistochem/comput 220, 610

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HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

88361 TC Tumor immunohistochem/comput 220, 61088361 26 Tumor immunohistochem/comput 220, 61088362 Nerve teasing preparations 61088362 TC Nerve teasing preparations 61088362 26 Nerve teasing preparations 61088363 Xm archive tissue molec anal 610, 63088364 Insitu hybridization (fish) 610, 630, 90088364 TC Insitu hybridization (fish) 610, 630, 90088364 26 Insitu hybridization (fish) 610, 630, 90088365 Insitu hybridization (fish) 610, 630, 90088365 TC Insitu hybridization (fish) 610, 630, 90088365 26 Insitu hybridization (fish) 610, 630, 90088366 Insitu hybridization (fish) 610, 630, 90088366 TC Insitu hybridization (fish) 610, 630, 90088366 26 Insitu hybridization (fish) 610, 630, 90088367 Insitu hybridization auto 610, 630, 90088367 TC Insitu hybridization auto 610, 630, 90088367 26 Insitu hybridization auto 610, 630, 90088368 Insitu hybridization manual 610, 630, 90088368 TC Insitu hybridization manual 610, 630, 90088368 26 Insitu hybridization manual 610, 630, 90088369 M/phmtrc alysishquant/semiq 610, 630, 90088369 TC M/phmtrc alysishquant/semiq 610, 630, 90088369 26 M/phmtrc alysishquant/semiq 610, 630, 90088371 Protein, western blot tissue 220, 61088371 26 Protein, western blot tissue 220, 61088372 Protein analysis w/probe 220, 61088372 26 Protein analysis w/probe 220, 61088373 M/phmtrc alys ishquant/semiq 610, 630, 90088373 TC M/phmtrc alys ishquant/semiq 610, 630, 90088373 26 M/phmtrc alys ishquant/semiq 610, 630, 90088374 M/phmtrc alys ishquant/semiq 610, 630, 90088374 TC M/phmtrc alys ishquant/semiq 610, 630, 90088374 26 M/phmtrc alys ishquant/semiq 610, 630, 90088375 Optical endomicroscpy interp 61088377 M/phmtrc alys ishquant/semiq 610, 630, 90088377 TC M/phmtrc alys ishquant/semiq 610, 630, 90088377 26 M/phmtrc alys ishquant/semiq 610, 630, 90088380 Microdissection laser 61088380 TC Microdissection laser 61088380 26 Microdissection laser 61088381 Microdissection manual 61088381 TC Microdissection manual 61088381 26 Microdissection manual 61088387 Tiss exam molecular study 61088387 TC Tiss exam molecular study 61088387 26 Tiss exam molecular study 61088388 Tiss ex molecul study add-on 61088388 TC Tiss ex molecul study add-on 61088388 26 Tiss ex molecul study add-on 610

CPT only copyright 2018 American Medical Association. All rights reserved. 36

HCPCS MOD DESCRIPTIONLABORATORY CERTIFICATION (LC)

CODE

88399 Surgical pathology procedure 610, 62088399 TC Surgical pathology procedure 610, 62088399 26 Surgical pathology procedure 610, 62089050 Body fluid cell count 40089051 Body fluid cell count 40089060 Exam synovial fluid crystals 31089060 26 Exam synovial fluid crystals 31089125 Specimen fat stain 31089160 Exam feces for meat fibers 31089230 Collect sweat for test 31089240 Pathology lab procedure 610, 620, 63089300 Semen analysis w/huhner 40089310 Semen analysis w/count 40089320 Semen anal vol/count/mot 40089321 Semen anal sperm detection 40089322 Semen anal strict criteria 40089325 Sperm antibody test 22089329 Sperm evaluation test 40089330 Evaluation, cervical mucus 40089331 Retrograde ejaculation anal 4000009M Fetal aneuploidy trisom risk 220, 9000011M Onc prst8 ca mrna 12 gen alg - Effective 1/1/2018 220, 3100012M Onc mrna 5 gen rsk urthl ca - Effective 4/1/2018 220, 3100013M Onc mrna 5 gen recr urthl ca - Effective 4/1/2018 220, 3100111T Rbc membranes fatty acids 310