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CPT
Codes
|
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A
Cost-Benefit Analysis lists the following tests as those that are most
likely performed at the point of care. This information is intended to
enable payors to reimburse for APOCT by simply programming their systems
to accept these CPT codes and reimbursement amounts.
Updated
Laboratory CPT Codes
Laboratory
Chemistry Tests |Top
Test |
CPT |
Fee |
Hepatic
Function Panel (6 tests) |
80058 |
$10.81 |
Basic
Metabolic Panel (7 tests) |
80049 |
11.29 |
Electrolyte
Panel (4 tests) |
80051 |
9.69 |
Comprehensive
Metabolic Panel (12 tests) |
80054 |
12.48 |
Lipid
Panel (Chol, HDL, Triglycerides) |
80061 |
18.51 |
|
|
|
Cardiac/Liver/Biliary
Tests: |
|
|
CK/CPK |
82550 |
$9.01 |
CK,MB |
82553 |
15.95 |
LD |
83615 |
8.35 |
AST |
84450 |
7.14 |
ALT |
84460
|
7.32
|
ALP |
84075
|
7.15
|
GGT |
82977
|
9.95
|
Bilirubin,
total |
82247
|
6.94
|
Bilirubin,
direct |
82248
|
6.94
|
Total
Protein |
84155
|
5.06
|
Albumin |
82040
|
6.85
|
Lipid
Metabolism Tests |
|
|
Total
Cholesterol |
82465
|
$6.02
|
HDL |
83718
|
11.31
|
LDL |
83721
|
13.18
|
Triglycerides |
84478
|
7.95
|
Lp(a)
Apolipoprotein |
82172
|
21.41
|
Diabetes
Tests |
|
|
Glucose,
quantitative blood type |
82947
|
$5.42
|
Glucose
on home use meter-type device |
82962/82962
|
3.23
|
Hemoglobin
A1c |
83036
|
13.42
|
Glucose
Tolerance Test, initial 3 specimens |
82951
|
17.80
|
Glucose
Tolerance Test, each additional specimen > 3 |
82952
|
5.42
|
Fructosamine |
82985
|
20.83
|
Renal
Function Tests |
|
|
BUN |
84520
|
5.45
|
Creatinine |
82565
|
7.07
|
Individual
Chemistry Tests |
|
|
Phosphorous |
84100
|
6.56
|
Calcium |
82310
|
7.12
|
Uric
Acid |
84550
|
6.25
|
Amylase |
82150
|
8.96
|
Magnesium |
83735
|
9.26
|
Iron |
83540
|
8.95
|
TIBC |
83550
|
12.08
|
Ferritin |
82728
|
18.83
|
Prostate
Specific Antigen (PSA) |
84153
|
25.42
|
Troponin
T |
84512
|
0.00
|
Therapeutic
Drug Monitoring: |
|
|
Theophylline |
80198
|
19.56
|
Digoxin |
80162
|
18.35
|
Drug
Screening (THC, Cocaine, etc.) multiple drug classes |
80100
|
20.10
|
Thyroid
Tests: |
|
|
TSH |
84443
|
23.21
|
Thyroxine,
total |
84436
|
9.50
|
T3
Uptake |
84479
|
8.95
|
|
|
|
Pregnancy
Tests: HCG quantitative serum |
84702
|
20.80
|
|Top
LABORATORY
MICROBIOLOGY/
IMMUNOLOGY TESTS |Top
Test |
CPT |
Fee |
Strep
Thoat Tests: |
|
|
Strep
A Kits |
87880 |
$16.58 |
Ulcer
Tests: |
|
|
H.
pylori Kits |
86677 |
$20.05 |
Chlamydia
Kit Tests: |
|
|
Chlamydia
Ab Test |
86631 |
$16.35 |
Chlamydia
Antigen Test, EIA |
86631 |
$16.35 |
Mononucleosis
Kit Tests |
86308 |
7.15 |
Rheumatoid
Factor Tests |
86430 |
7.85 |
Syphilis
Kit Tests |
86592 |
5.90 |
Herpes
Kit Tests |
86694 |
19.89 |
Sexually
Transmitted Disease Tests |
|
|
candida,
DNA Direct Probe Tests |
87480
|
27.71
|
trichomonas,
DNA Direct Probe Tests |
87797
|
27.71
|
gardnerella,
DNA Direct Probe Tests |
87510
|
27.71
|
Influenza
Kit Tests |
87449
|
16.58
|
Tests
For Infections |
|
$3.55
|
Urine
Screen, non-culture kit |
81007
|
3.55 |
Urine,
culture |
87087
|
|
Urine,
colony count |
87086
|
11.16 |
Urine,
presumptive identification of bacteria |
87088
|
11.18 |
Urine,
antibiotic susceptibility test |
87184
|
9.53 |
Throat,
culture for Strep A |
87082
|
9.16 |
Cervical/Urethral,
culture for N. gonorrhoeae |
87081
|
9.16 |
Allergy
Kit Tests: |
86005
|
$11.02
|
|Top
LABORATORY
URINALYSIS/MICROSCOPIC EXAMINATIONS/MISCELLANEOUS TESTS |Top
Test |
CPT |
Fee |
Semen
Analysis: |
89300 |
12.32 |
Urinalysis
Tests: |
|
|
Strip
Urine Tests, manual w/out microscopy |
81002 |
3.54 |
Strip
Urine Tests, manual w/ microscopy |
81000 |
4.37 |
Strip
Urine Tests, automated w/out microscopy |
81003 |
3.10 |
Strip
Urine Tests, automated w/ microscopy |
81001 |
4.37 |
Tests
for Vaginal/Skin Infections: |
|
|
Wet/KOH
Prep (for yeast, bacteria, cells, etc.) |
87210 |
5.90 |
Tests
for Allergies: |
|
|
Nasal
Smear for Eosinophils |
89190 |
6.56 |
Tests
for Colon Cancer: |
|
|
Fecal
Occult Blood Screening Test |
G0107
|
4.49
|
Fecal
Occult Blood Test |
82270
|
4.49
|
Tests
for Allergies: |
|
|
HCG
qualitative Urine/Serum Kit Test |
81025
|
8.74
|
Bladder
Cancer Tests: |
|
|
BTA
Stat Test |
83516
|
16.38
|
ACCU Dx
Test |
86316
|
28.76
|
|Top
LABORATORY
BLOOD TESTS FOR ANEMIA, LEUKEMIA,
INFECTION,
BLEEDING DISORDERS: HEMOTOLOGY TESTS |Top
Test |
CPT |
Fee |
Complete
Blood Count (including WBC
differential & platelet count) |
85024-
85025 |
11.70
10.74 |
Hemoglobin/Hematocrit
Test |
85018
85013 |
3.27
3.27 |
Prothrombin
Time Test (PT) |
85610 |
5.43 |
Activated
Partial Thromboplastin Test (APTT) |
85730 |
8.30 |
Platelet
Count, manual |
85590 |
5.94 |
Platelet
Count, automated |
85595 |
6.18 |
Reticulocyte
Count, manual |
85044 |
5.94 |
Sedimentation
Rate Test, manual |
85651 |
4.91 |
Sedimentation
Rate Test, automated |
85652 |
3.73 |
|Top
Laboratory
Immunohematology Tests
Test |
CPT |
Fee |
Blood
Grouping & Typing |
86900/
86901 |
4.12
4.12 |
|Top
Updated
Physiologic CPT Codes
Holter
Monitoring |Top
Test |
CPT |
Fee |
ECG
monitoring for 24 hours with super-imposition scanning; includes
recording, scanning analysis with report, physician review, and
interpretation. |
93224 |
152.62 |
Recording |
93225 |
45.48 |
Scanning
analysis with report |
93226 |
80.05 |
Physician
review and interpretation |
93227 |
27.09 |
ECG
monitoring for 24 hours without super-imposition scanning;
includes recording, microprocessor-based analysis with report,
physician review, and interpretation. |
93230 |
162.09 |
Recording |
93231 |
55.56 |
Microprocessor-based
analysis with report |
93232 |
79.34 |
Physician
review and interpretation |
93233 |
27.09 |
|Top
Spirometry
Tests |Top
Test |
CPT |
Fee |
Spirometry,
including graphic record, total and timed vital capacity,
expiratory flow rate, and/or maximal voluntary ventilation. |
94010 |
37.091 |
Bronchospasm
evaluation: spirometry as in 94010, before and after
bronchodilator or exercise |
94060 |
62.88 |
Multiple
spirometric determinations after bronchodilator with spirometry as
in 94010 |
94070 |
85.25 |
Spirometry,
slow vital capacity |
94150 |
- |
Maximum
breathing capacity, max. vol. vent |
94200 |
17.04 |
Respiratory
flow volume loop |
94375 |
28.99 |
Aerosol or
vapor inhalations; intitial |
94664 |
20.38 |
Subsequent |
94665 |
17.87 |
|Top
Bone Mineral
Density Tests
Test |
CPT |
Fee |
Ultrasound
tests, each 15 minutes |
97035 |
10.24 |
|Top
Pulse Oximetry
Test |
CPT |
Fee |
Pulse
Oximetry, single determination |
94760 |
4.34 |
Pulse
Oximetry, multiple determinations |
94761 |
6.83 |
|Top
Exercise
Testing
Test |
CPT |
Fee |
Cardiovascular
stress test, treadmill or bicycle exercise, continuous ECG
monitoring and/or pharmacological stress; with physician
supervision, with interpretation and report |
93015 |
100.16 |
Physician
supervision only, without interpretation and report |
93016 |
23.13 |
Tracing
only, without interpretation and report |
93017 |
61.05 |
Interpretation
and report only |
93018 |
15.53 |
|Top
Resting ECG
Test |
CPT |
Fee |
Routine
ECG with at least 12 leads; with interpretation and report |
93000 |
25.41 |
Tracing
only, without interpretation and report |
93005 |
16.38 |
Interpretation
and report only |
93010 |
9.02 |
Rhythm ECG, one to three leads; with interpretation and report |
93040 |
13.39 |
Tracing
only without interpretation and report |
93041 |
5.45 |
Interpretation
and report only |
93042 |
7.93 |
Electronic
analysis of dual-chamber pacemaker system; without reprogramming |
93731 |
42.02 |
With
reprogramming |
93732 |
66.97 |
Electronic
analysis of single chamber pacemaker system; without reprogramming |
93734 |
32.61 |
With
reprogramming |
93735 |
55.01 |
|Top
Ambulatory
Blood Pressure (ABP)
Test |
CPT |
Fee |
ABP
monitoring, 24 hours, including recording, scanning analysis,
interpretation and report |
93784 |
39.92 |
|Top
Coloscopy
Test |
CPT |
Fee |
Colposcopy |
57452 |
$100.80 |
Colposcopy
with Biopsy |
57454 |
118.85 |
Colposcopy
with Electrosurgical Loop Excision of the Cervix |
57460 |
190.79 |
Cervical
Biopsy |
57500 |
131.98 |
Cryotherapy
of Cervix |
57511 |
167.36 |
Laser
Ablation of Cervix |
57513 |
174.28 |
Conization
of Cervix |
57520 |
321.36 |
Endometrial
Biopsy |
58100 |
114.48 |
Vulvar
Biopsy |
56605 |
112.77 |
Destruction
of Vulvar Lesion |
56501 |
148.62 |
Biopsy
of Vagina Lesion |
57100 |
106.54 |
|Top
Rhinolaryngoscopy
Test |
CPT |
Fee |
Diagnostic
Nasopharyngoscopy with Endoscope |
92511 |
$80.95 |
|Top
Sigmoidoscopy
Test |
CPT |
Fee |
Sigmoidoscopy,
Flexible Fiberoptic; Diagnostic |
45330 |
106.40 |
Sigmoicoscopy
for biopsy and/or Collection of Specimen by Brushing or Washing |
45331 |
130.73 |
|Top
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