CPT Codes

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  CPT Codes  

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.

Laboratory Chemistry Tests
Laboratory Microbiology/Immunology Tests
Laboratory Urinalysis/Microscopic Examinations/Misc. Tests
Laboratory Blood Tests for Anemia, Leukemia, Infection, Bleeding Disorders: Hematology Tests
Laboratory Immunohematology Tests
Holter Monitoring
Spirometry Tests
Bone Mineral Density Tests
Pulse Oximetry
Exercise Testing
Resting ECG
Ambulatory Blood Pressure (ABP)
Colposcopy
Rhinolaryngoscopy
Sigmoidoscopy

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

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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

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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

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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

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Laboratory Immunohematology Tests

Test CPT  Fee
Blood Grouping & Typing 86900/
86901
 
4.12
4.12

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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

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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 

 

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Bone Mineral Density Tests

Test CPT  Fee
Ultrasound tests, each 15 minutes 97035  10.24 

 

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Pulse Oximetry

Test CPT  Fee
Pulse Oximetry, single determination 94760  4.34 
Pulse Oximetry, multiple determinations  94761  6.83

 

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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

 

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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

 

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Ambulatory Blood Pressure (ABP)

Test CPT  Fee
ABP monitoring, 24 hours, including recording, scanning analysis, interpretation and report 93784  39.92 

 

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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

 

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Rhinolaryngoscopy

Test CPT  Fee
Diagnostic Nasopharyngoscopy with Endoscope 92511  $80.95

 

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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

 

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