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909100000
90910-00-00
Nuclear med study of other region/organ
Nuclear medicine study of other region or organ
20
Imaging services
2,014
Other nuclear medicine imaging study
Nuclear medicine study of other region or organ.
null
null
null
909010010
90901-00-10
MRI of brain w/o con medium
Magnetic resonance imaging of brain, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of brain, without contrast medium, excluding functional magnetic resonance imaging of brain.
null
Functional Magnetic Resonance Imaging of Brain (90901-09-10, 90901-09-20 [2015])
null
909010020
90901-00-20
MRI brain w/ con medium
Magnetic resonance imaging of brain, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of brain, with contrast medium, excluding functional magnetic resonance imaging of brain.
null
Functional Magnetic Resonance Imaging of Brain (90901-09-10, 90901-09-20 [2015])
null
909010110
90901-01-10
MRI head w/o con medium
Magnetic resonance imaging of head, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Face orbit Sinuses (Ethmoid) (Frontal) (Maxillary) (Sphenoid) Skull Bone
That of Brain: • Functional (90901-09-10, 90901-09-20 [2015]) • Nos (90901-09-10, 90901-09-20  [2015])
null
909010120
90901-01-20
MRI head w/ con medium
Magnetic resonance imaging of head, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Face orbit Sinuses (Ethmoid) (Frontal) (Maxillary) (Sphenoid) Skull Bone
That of Brain: • Functional (90901-09-10, 90901-09-20 [2015]) • Nos (90901-09-10, 90901-09-20  [2015])
null
909010130
90901-01-30
MRI head w/ or w/o con medium
Magnetic resonance imaging of head, without followed by with contrast
20
Imaging services
2,015
Magnetic resonance imaging
null
Face, orbit, sinuses (ethmoid) (frontal) (maxillary) (sphenoid), skull bone
Do not bill with 90901-01-20 and 90901-01-30 as they are inclusive
null
909010210
90901-02-10
MRI neck w/o con medium
Magnetic resonance imaging of neck, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of neck, without contrast medium, excluding that of cervical spine.
null
That of Cervical Spine (90901-03-10, 90901-03-20 [2015])
null
909010220
90901-02-20
MRI neck w/ con medium
Magnetic resonance imaging of neck, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of neck, with contrast medium, excluding that of cervical spine.
null
That of Cervical Spine (90901-03-10, 90901-03-20 [2015])
null
909010310
90901-03-10
MRI cervical spine w/o con medium
Magnetic resonance imaging of cervical spine, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Spinal Cord
null
null
909010320
90901-03-20
MRI cervical spine w/ con medium
Magnetic resonance imaging of cervical spine, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Spinal Cord
null
null
909010330
90901-03-30
MRI thoracic spine w/o con medium
Magnetic resonance imaging of thoracic spine, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Spinal Cord
null
null
909010340
90901-03-40
MRI thoracic spine w/ con medium
Magnetic resonance imaging of thoracic spine, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Spinal Cord
null
null
909010360
90901-03-60
MRI lumbar spine w/ con medium
Magnetic resonance imaging of lumbar spine, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Spinal Cord
null
null
909010370
90901-03-70
MRI lumbar spine w/o con medium
Magnetic resonance imaging of lumbar spine, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Spinal Cord
null
null
909010410
90901-04-10
MRI chest w/o con medium
Magnetic resonance imaging of chest, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Heart
null
null
909010420
90901-04-20
MRI chest w/ con medium
Magnetic resonance imaging of chest, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Heart
null
null
909010440
90901-04-40
Stress cardiac magnetic resonance imaging, w/ con
Stress cardiac magnetic resonance imaging, with contrast
20
Imaging services
2,015
Magnetic resonance imaging
Stress cardiac magnetic resonance imaging, with contrast.
null
null
null
909010510
90901-05-10
MRI abd w/o con medium
Magnetic resonance imaging of abdomen, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of abdomen, without contrast medium.
null
null
null
909010520
90901-05-20
MRI pelv w/ con medium
Magnetic resonance imaging of abdomen, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of abdomen, with contrast medium.
null
null
null
909010610
90901-06-10
MRI pelv w/o con medium
Magnetic resonance imaging of pelvis, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Bladder Prostate Rectum
null
null
909010620
90901-06-20
MRI pelv w/ con mediium
Magnetic resonance imaging of pelvis, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Bladder Prostate Rectum
null
null
909010711
90901-07-11
MRI extremity w/o con medium uni
Magnetic resonance imaging of extremity, without contrast medium, unilateral
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of extremity, without contrast medium (one side).
null
null
null
909010712
90901-07-12
MRI extremity w/o con medium bil
Magnetic resonance imaging of extremity, without contrast medium, bilateral
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of extremity, without contrast medium (both sides).
null
null
null
909010721
90901-07-21
MRI extremity w/ con medium uni
Magnetic resonance imaging of extremity, with contrast medium, unilateral
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of extremity, with contrast medium (one side).
null
null
null
909010722
90901-07-22
MRI extremity w/ con medium bil
Magnetic resonance imaging of extremity, with contrast medium, bilateral
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of extremity, with contrast medium (both sides).
null
null
null
909010810
90901-08-10
MRI othr site w/o contrast
Magnetic resonance imaging of other site, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Bone Marrow Blood Supply
null
null
909010820
90901-08-20
MRI othr site w/ contrast
Magnetic resonance imaging of other site, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
null
Bone Marrow Blood Supply
null
null
909010910
90901-09-10
Functional MRI brain w/o contrast
Functional magnetic resonance imaging of brain, without contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
Functional magnetic resonance imaging of brain, without contrast medium.
null
null
null
909010920
90901-09-20
Functional MRI brain w/ contrast
Functional magnetic resonance imaging of brain, with contrast medium
20
Imaging services
2,015
Magnetic resonance imaging
Functional magnetic resonance imaging of brain, with contrast medium.
null
null
null
909011011
90901-10-11
MRI of breast w/o con medium uni
Magnetic resonance imaging of breast, without contrast medium, unilateral
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of breast, without contrast medium (one side).
null
null
null
909011012
90901-10-12
MRI of breast w/o con medium bil
Magnetic resonance imaging of breast, without contrast medium, bilateral
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of breast, without contrast medium (both sides).
null
null
null
909011021
90901-10-21
MRI of breast w/ con medium uni
Magnetic resonance imaging of breast, with contrast medium, unilateral
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of breast, with contrast medium (one side).
null
null
null
909011022
90901-10-22
MRI of breast w/ con medium bil
Magnetic resonance imaging of breast, with contrast medium, bilateral
20
Imaging services
2,015
Magnetic resonance imaging
Magnetic resonance imaging of breast, with contrast medium (both sides).
null
null
null
909040000
90904-00-00
Thermography nec
Thermography, not elsewhere classified
20
Imaging services
2,016
Other imaging services
Thermography, not elsewhere classified.
null
thermography of Breast with Radiography (59300-01-00, 59303-01-00 [1973])
null
909040010
90904-00-10
Fusion 2 or more 3d imge volumesone or more modalities
Fusion of two or more 3-dimensional image volumes of one or more modalities
20
Imaging services
2,016
Other imaging services
Fusion of two or more 3-dimensional image volumes of one or more modalities.
null
null
null
112190011
11219-00-11
Optical coherence tomography uni
Optical coherence tomography, unilateral
20
Imaging services
2,016
Other imaging services
Optical coherence tomography (one side).
null
null
null
112190012
11219-00-12
Optical coherence tomography bil
Optical coherence tomography, bilateral
20
Imaging services
2,016
Other imaging services
Optical coherence tomography (both sides).
null
null
null
999999992
99999-99-92
Unlist img code
Unlisted imaging code
20
Imaging services
2,016
Imaging services
Specified imaging code.
null
null
null
850000000
85000-00-00
BLS ambul response & treatment w/o transport
Basic life support ambulance response and the team has physically attended and treated the patient without transport.
24
EMS
2,050
EMS
Basic life support ambulance response and the team has physically attended and treated the patient without transport.
null
null
on-site medical service without transportation - Basic Life Support
850000100
85000-01-00
BLS transport up to 50 km
Patient transport that was carried out by a bls team up to 50 km distance excluding medications.
24
EMS
2,050
EMS
Patient transport that was carried out by a basic life support team up to 50 km distance excluding medications.
null
null
Code includes ambulance transport for 50 km , team fees, routine service and disposable supplies but excludes any medications given, BLS used for low priority cases.
851000000
85100-00-00
BLS ambl chrge per ea 10 km exceed 1st 50 km (add-on)
Basic life support ambulance extra distance charge per 10 km exceeding first 50 km. (add-on code)
24
EMS
2,050
EMS
Basic life support ambulance extra distance charge per 10 km exceeding first 50 km.
null
null
This is an add-on code for 85000-01-00 for each additional 10 km distance more than the first 50 km
851100000
85110-00-00
BLS team deploy to dynamic post, standby; calcultd by hour
Basic life support team deployed to a dynamic post, on standby; calculated by hour
24
EMS
2,050
EMS
Basic life support team deployed to a dynamic post, on standby; per hour.
null
null
attendance of the BLS ambulance for any event, in a state of readiness; calculation for code per each hour Direct contracting with non insurance
851200000
85120-00-00
BLS transport declination
A patient transport request that was declined by the patient after srca dispatch has deployed a bls team and the team has physically attended to the patient
24
EMS
2,050
EMS
A patient transport request that was declined by the patient after srca dispatch has deployed a basic life support team and the team has physically attended to the patient.
null
null
Not for insurance reimbursement
851300000
85130-00-00
BLS cancelation
A patient transport request that was canceled after srca dispatch has deployed a bls team and before the team has physically attended to the patient
24
EMS
2,050
EMS
A patient transport request that was canceled after srca dispatch has deployed a basic life support team and before the team has physically attended to the patient.
null
null
Not for insurance reimbursement
852000000
85200-00-00
ALS ambul response & treatment w/o transport
Advanced life support ambulance response and the team has physically attended and treated the patient without transport.
24
EMS
2,050
EMS
Advanced life support ambulance response and the team has physically attended and treated the patient without transport.
null
null
on-site medical service without transportation - Advanced Life Support
852000100
85200-01-00
ALS support transport up to 50 km
Patient transport that was carried out by a als team, up to 50 km distance, in cases of mid to high priority and possibly life threatening situations, excluding medications.
24
EMS
2,050
EMS
Patient transport that was carried out by ALS team, up to 50 km distance, in cases of mid to high priority and possibly life threatening situations, excluding medications.
null
null
Code includes ambulance transport up to 50 km, team fees, routine services and disposable supplies but excludes any medications given, ALS used for high-priority cases
853000000
85300-00-00
ALS ambl charge per ea 10km exceed 50 km up to 300 km (add-on)
Advance life support ambulance extra distance charge per 10 km exceeding first 50 km up to 300 km (add-on code)
24
EMS
2,050
EMS
Advanced life support ambulance extra distance charge per 10 km exceeding first 50 km up to 300 km.
null
null
This code is an add-on code for 85200-01-00 for each additional 10 km distance more than the first 50 km
853100000
85310-00-00
ALS - standby per hour
Als team deployed to a dynamic post, on standby; calculated by hour.
24
EMS
2,050
EMS
Advanced life support team deployed to a dynamic post, on standby; per hour.
null
null
attendance of the ALS ambulance for any event, in a state of readiness, calculation for code per each hour Direct contracting with non insurance
853200000
85320-00-00
ALS transport declination
A patient transport request that was declined by the patient afteremsdispatch has deployed an als team and the team has physically attended to the patient
24
EMS
2,050
EMS
A patient transport request that was declined by the patient after emergency medical services dispatch has deployed an als team and the team has physically attended to the patient.
null
null
Not for insurance reimbursement
853300000
85330-00-00
ALS cancelation
ALS team transport request that was canceled after EMS dispatch has deployed the team and before the team has physically attended to the patient
24
EMS
2,050
EMS
Advanced life support team transport request that was canceled after emergency medical services dispatch has deployed the team and before the team has physically attended to the patient.
null
null
Not for insurance reimbursement
854000000
85400-00-00
ALS service by specialized team (add-on code)
The deployment of a specialized team for highly specialized patient care service that may or may not include transport (add-on code)
24
EMS
2,050
EMS
The deployment of a specialized team for highly specialized patient care service that may or may not include transport.
null
null
This code is used to report the attendance of a specialized team in addition to the ALS ambulance. Must be reported with ALS codes.(** list codes here**) Examples of this service include hazardous material response, tactical event response, urban search and rescue response, wilderness response and others.
855000000
85500-00-00
Aeromedical transport (medivac)
Patient transport that was carried out by an aeromedical services team
24
EMS
2,050
EMS
Transports patient by an aeromedical services team.
null
null
for All Medivac transport - Extra insurance benefit
730000000
73000-00-00
BMP (Ca ionized)
Basic metabolic panel [ionized calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, potassium, sodium, blood urea nitrogen (BUN)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Basic metabolic panel (BMP) measures the blood level of ionized calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood urea nitrogen (BUN), and creatinine.
null
null
If two or more test panels of same substances are reported, assign only one code for the panel with the greater number of substances measured (e.g. do not code 73000-00-00 with 73000-00-40)
730000010
73000-00-10
BMP (Ca total)
Basic metabolic panel [total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, potassium, sodium, blood urea nitrogen (BUN)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Basic metabolic panel (BMP) measures the blood level of total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood urea nitrogen (BUN), and creatinine.
null
null
null
730000020
73000-00-20
General health panel
General health panel [comprehensive metabolic panel (CMP) and (automated complete blood count (CBC) and automated differential white blood cells (WBC) or automated complete blood count (CBC) and manual differential white blood cells (WBC)) or thyroid stimulating hormone (TSH)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Three components are required; comprehensive metabolic panel, thyroid stimulating hormone (TSH), and a blood count with manual or automated differential (e.g. patient’s metabolic processes as blood/thyroid state
null
null
null
730000030
73000-00-30
Serum electrolyte panel
Serum electrolyte panel [Carbon dioxide (bicarbonate)(CO2), Chloride (Cl), Potassium (K), Sodium (Na)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Electrolyte panel measures carbon dioxide, chloride, potassium, and sodium in a specimen.
null
null
null
730000040
73000-00-40
CMP
Comprehensive metabolic panel [albumin, total bilirubin, total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, phosphatase, alkaline, potassium, total protein, sodium, alanine amino-transferase (ALT), serum glutamic-pyruvic transaminase (SGPT), aspartate amino-transferase (AST), serum glutamic-oxaloacetic transaminase (SGOT), blood urea nitrogen (BUN)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Comprehensive metabolic panel measures the blood level of 14 chemicals
null
null
If two or more test panels of same substances are reported, assign only one code for the panel with the greater number of substances measured (e.g. do not code 73000-00-00 with 73000-00-40)
730000050
73000-00-50
Obstetric panel
Obstetric panel [automated complete blood count (CBC) and automated differential white blood cell (WBC) count or automated complete blood count (CBC), and manual differential white blood cell (WBC) count, Hepatitis B surface antigen (HBsAg), rubella antibody , syphilis test (non-treponemal antibody) qualitative (e.g. VDRL, RPR, ART), RBC antibody (each serum technique), blood typing, ABO and Rh (D)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Obstetric panel includes tests for a complete blood count with differential, a hepatitis B surface antigen, a rubella antibody, a qualitative non treponemal syphilis test, a red blood cell antibody screen, ABO blood typing, and Rh typing.
null
null
null
730000060
73000-00-60
Lipid profile
Lipid profile [total serum Cholesterol, Triglycerides, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Lipid panel measures the blood level of cholesterol and triglycerides in the blood
null
null
null
730000070
73000-00-70
Renal function profile
Renal function profile [albumin, calcium (Ca), carbon dioxide (bicarbonate)(Co2), chloride (Cl), creatinine (Cr), glucose (Glu), phosphorus inorganic (phosphate), potassium (K), sodium (Na), blood urea nitrogen (BUN)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Renal function panel measures the blood level of chemicals for kidney function evaluation.
null
null
null
730000080
73000-00-80
Acute hepatitis panel
Acute hepatitis panel [Hepatitis A antibody (HAAb), Immunoglobulin M (IgM) antibody, Hepatitis B core antibody (HBcAb), IgM antibody, Hepatitis B surface antigen (HBsAg), Hepatitis C antibody]
21
Laboratory and Pathology
3,000
Essential Test Panels
Acute hepatitis panel includes tests for hepatitis A IgM antibody, hepatitis B core IgM antibody, hepatitis B surface antigen, and hepatitis C antibody.
null
null
null
730000090
73000-00-90
Liver function panel
Liver function panel [Albumin, Bilirubin, Alanine Amino-Transferase (ALT), Serum Glutamic-Pyruvic Transaminase (SGPT), Aspartate Amino-Transferase (AST), Serum Glutamic-Oxaloacetic Transaminase (SGOT), Phosphatase)
21
Laboratory and Pathology
3,000
Essential Test Panels
Liver function panel measures the levels of total protein, albumin, alkaline phosphatase, bilirubin, both total and direct, and liver enzymes.
null
null
null
730000100
73000-01-00
Obstetric panel w/ HIV testing
Obstetric panel [complete blood count (CBC) and automated differential white blood cell (WBC) count or automated complete blood count (CBC) and manual differential WBC count, hepatitis B surface antigen (HBsAg), HIV-1 antigen(s) with HIV-1 and HIV-2 antibodies (single result), rubella antibody, syphilis test (non-treponemal antibody) qualitative (e.g., VDRL, RPR, ART), RBC antibody screen (each serum technique), blood typing, ABO and Rh (D)]
21
Laboratory and Pathology
3,000
Essential Test Panels
Obstetric panel includes tests for a complete blood and differential count, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens and antibodies for HIV–1 and HIV–2, a rubella antibody test, a qualitative nontreponemal syphilis test, a red blood cell antibody screen, ABO blood typing, and Rh typing.
null
null
null
730000105
73000-01-05
New born profile
New born profile (17 tests)
21
Laboratory and Pathology
3,000
Essential Test Panels
New born profile
null
null
Code when performed to a newborn and only when all 17 tests are done
730000110
73000-01-10
ACTH stimulation panel
Adrenocorticotropic hormone (ACTH) stimulation panel; (Cortisol x2)
21
Laboratory and Pathology
3,000
Essential Test Panels
(ACTH) Stimulation panel measures cortisol and 11 deoxycortisol levels, before and after the administration of the drug metyrapone.
null
null
null
730000120
73000-01-20
ACTH (21 Hydroxylase) panel
Adrenocorticotropic hormone (ACTH) stimulation panel for 21 hydroxylase deficiency; (Cortisol x2, 17 Hydroxyprogesterone x2)
21
Laboratory and Pathology
3,000
Essential Test Panels
This test measures levels of cortisol and 17 hydroxyprogesterone in response to the inection of synthetic adrenocorticotropic hormone (ACTH).
null
null
Assign this code only if all panel tests are performed, otherwise assign the individual test code
730000130
73000-01-30
ACTH (3 Beta-Hydroxydehydrogenase) panel
Adrenocorticotropic hormone (ACTH) stimulation panel for 3-Beta-Hydroxydehydrogenase deficiency; (Cortisol x2, 17 Hydroxypregnenolone x2)
21
Laboratory and Pathology
3,000
Essential Test Panels
This test measures levels of cortisol and 17 hydroxypregnenolone in response to the inection of synthetic adrenocorticotropic hormone (ACTH).
null
null
Assign this code only if all panel tests are performed, otherwise assign the individual test code
730000140
73000-01-40
Aldosterone suppression panel
Aldosterone suppression evaluation panel; (Aldosterone x2, Renin x2)
21
Laboratory and Pathology
3,000
Essential Test Panels
This panel includes four separate tests: two aldosterone assays and two renin assays.
null
null
Assign this code only if all panel tests are performed, otherwise assign the individual test codes. If this panel test performed in addition to different individual tests, assign codes for each (test panel code and individual test codes)
730000150
73000-01-50
Calcitonin profile
Calcitonins stimulation profile; (Calcitonin x3)
21
Laboratory and Pathology
3,000
Essential Test Panels
This panel includes three separate tests for calcitonin.
null
null
Assign this code only if all panel tests are performed, otherwise assign the individual test codes. If this panel test performed in addition to different individual tests, assign codes for each (test panel code and individual test codes)
730000160
73000-01-60
CRH stimulation profile
Corticotropic releasing hormone (CRH) stimulation profile; (Cortisol x6, Adrenocorticotropic Hormone x6)
21
Laboratory and Pathology
3,000
Essential Test Panels
This panel includes six cortisol assays and six ACTH assays.
null
null
Assign this code only if all panel tests are performed, otherwise assign the individual test codes. If this panel test performed in addition to different individual tests, assign codes for each (test panel code and individual test codes)
730000170
73000-01-70
HCG testosterone profile
Human chorionic gonadotropin (HCG) stimulation profile; (Testosterone x2) on 3 pooled blood samples
21
Laboratory and Pathology
3,000
Essential Test Panels
This panel includes two testosterone assays on three pooled blood samples to measure testosterone response.
null
null
Assign this code only if all panel tests are performed, otherwise assign the individual test codes. If this panel test performed in addition to different individual tests, assign codes for each (test panel code and individual test codes)
730000180
73000-01-80
HCG estradiol profile
Human chorionic gonadotropin (HCG) stimulation profile; (Estradiol x2) on 3 pooled blood samples
21
Laboratory and Pathology
3,000
Essential Test Panels
This panel includes two testosterone assays on three pooled blood samples to measure estradiol response.
null
null
Assign this code only if all panel tests are performed, otherwise assign the individual test codes. If this panel test performed in addition to different individual tests, assign codes for each (test panel code and individual test codes)
730000190
73000-01-90
Renal vein stimulation panel
Renal vein stimulation panel; (Renin x6)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures renal vein renin samples before and after the injection of a stimulant
null
null
null
730000200
73000-02-00
Peripheral vein stimulation panel
Peripheral vein stimulation panel; (Renin x2)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures peripheral vein renin samples before and after the injection of a stimulant
null
null
null
730000210
73000-02-10
Pituitary evaluation panel
Combined-rapid anterior pituitary evaluation panel; [Adrenocorticotropic hormone (ACTH) x4, Luteinizing hormone (LH) x4, Follicle stimulating hormone (FSH) x4, Prolactin x4, Human growth hormone x4, Cortisol x4, and Thyroid stimulating hormone (TSH) x4]
21
Laboratory and Pathology
3,000
Essential Test Panels
Seven hormones are measured with four units for each (e.g. suspected pituitary tumor)
null
null
null
730000220
73000-02-20
Dexamethasone suppression panel
Dexamethasone suppression panel [free cortisol x2 (urine), cortisol x2, volume measurement for timed collection x2]
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures serum cortisol and 24 hour urine free cortisol then measures a second sampling for the serum cortisol and 24 hour urine free cortisol after administration of a suppressant
null
null
null
730000230
73000-02-30
Glucagon tolerance insulinoma panel
Glucagon tolerance panel for insulinoma; (Glucose x3, Insulin x3)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures three samples of glucose and insulin before and after receiving a stimulant at three different times, to diagnose insulinoma condition
null
null
null
730000240
73000-02-40
Glucagon tolerance pheochromocytoma panel
Glucagon tolerance panel for pheochromocytoma; (Catecholamines fractionated x2)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures fractionated catecholamines before and after receiving a stimulant
HorMonE INFERTILITY LAB-PKG (M)
null
null
730000250
73000-02-50
Reproductive hormone profile
Reproductive hormone profile [follicle stimulating hormone (FSH), luteinizing hormone (LH)]
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures four serum samples of follicle stimulating hormone and luteinizing hormone at four different times
null
null
null
730000260
73000-02-60
GH stimulation panel
Growth hormone stimulation panel; (Human Growth Hormone x4)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures one sample of growth hormone before and three samples after receiving a stimulant
null
null
null
730000270
73000-02-70
GH suppression panel
Growth hormone suppression panel; (Glucose x3, Human Growth Hormone x4)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures one sample of glucose before and two samples after receiving a glucose, it also measures one sample of growth hormone before and three samples after receiving a glucose
null
null
null
730000280
73000-02-80
Insulin C peptide Suppression panel
Insulin Induced C-Peptide Suppression Panel; (Insulin C-peptide x5, Glucose x5)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures one sample of glucose and the C peptide before and four samples after receiving insulin, it also measures one sample of insulin
null
null
null
730000290
73000-02-90
Insulin tolerance panel; ACTH insufficiency
Adrenocorticotropic hormone (ACTH) insufficiency insulin tolerance panel; (Cortisol x5, Glucose x5)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures one sample of glucose and cortisol before and four samples after receiving insulin
null
null
null
730000300
73000-03-00
Insulin tolerance panel; GH deficiency
Growth hormone deficiency insulin tolerance panel; (Glucose x5, Human Growth Hormone x5)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures one sample of glucose and human growth hormone before and four samples after receiving insulin
null
null
null
730000310
73000-03-10
Metyrapone panel
Metyrapone panel; (Cortisol x2, 11 Deoxycortisol x2)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures one sample cortisol and 11 deoxycortisol before and one sample after metyrapone injection
null
null
null
730000320
73000-03-20
TRH stimulation panel; 1 hour
Thyrotropin releasing hormone (TRH) stimulation panel; [Thyroid stimulating hormone (TSH x3)] 1 hour test
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures one sample of thyroid stimulating hormone before and two samples after thyrotropin releasing hormone drug injection
null
null
null
730000330
73000-03-30
TRH stimulation panel; 2 hour
Thyrotropin releasing hormone (TRH) stimulation panel; [Thyroid stimulating hormone (TSH x4)] 2 hour test
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures one sample of thyroid stimulating hormone before and three samples after thyrotropin releasing hormone drug injection
null
null
null
730000071
73000-00-71
Pre-op investigation for kidney; group tests
Pre-operative investigation for kidney group tests
21
Laboratory and Pathology
3,000
Essential Test Panels
Group of tests for investigation of kidney function
null
null
null
730000340
73000-03-40
Thyroid hormones PKG (TSH FT3 FT4)
Thyroid hormones package (TSH, FT3, FT4)
21
Laboratory and Pathology
3,000
Essential Test Panels
The test measures a group of thyroid hormones
null
null
null
730000350
73000-03-50
Pleural Fluid Panel
Pleural fluid panel for diagnostic analysis of pleural effusion
21
Laboratory and Pathology
3,000
Essential Test Panels
A panel of tests which may include any of the following: (pH level, Gram stain culture, Blood cell count and differential, Glucose level, protein levels, and lactic acid dehydrogenase (LDH) level,Creatinine level, or Cytology).
null
null
null
730504361
73050-43-61
Antimicrobial Susceptibility; Agar Dilution
Antimicrobes susceptibility studyies by agar dilution method
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Antimicrobes susceptibility studyies by agar dilution method
null
null
null
730504441
73050-44-41
Fluorescent Noninfectious Agent Mitochondrial Ab; Titer
Fluorescent Noninfectious Agent Mitochondrial Antibody in Titer
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Identification of mitrochondrial antibodies by fluorescence
null
null
null
730504551
73050-45-51
RotaVirus & Adenovirus Screening (Stool)
Combined Rotavirus and Adenovirus Screening in Stool
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Stool screen for rotavirus and adenovirus
null
null
null
730504581
73050-45-81
Cryptosporidium Parvum Giardia Lamblia Entamoeba Histolytica; Ag Panel
Panel for detection of Cryptosporidium Parvum, Giardia Lamblia, and Entamoeba Histolytica Antigens In Stool
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Detection panel for Cryptosporidium Parvum, Giardia Lamblia And Entamoeba Histolytica Antigens In Human Stool
null
null
null
730504975
73050-49-75
Coronavirus Ag; IFA; Qual/SemiQuant
Qualitative/semiquantitative immunofluorescent technique (IFA) detection of severe acute respiratory syndrome coronavirus Antigen (Ag)
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Immunofluorescent technique detection of severe acute respiratory syndrome coronavirus Ag qualitatively or semiquantitatively
null
null
null
730504976
73050-49-76
Coronavirus & Influenza A/B Ag; IFA; Qual/SemiQuant
Qualitative/semiquantitative immunofluorescent technique (IFA) detection of severe acute respiratory syndrome coronavirus and Influenza Virus types A and B Antigen (Ag)
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Immunofluorescent technique detection of severe acute respiratory syndrome coronavirus and influenza virus types A and B Ag qualitatively or semiquantitatively
null
null
null
730505675
73050-56-75
Mycobacteria Genitalium; Direct probe
Detection of Mycobacteria Genitalium by nucleic acid (DNA or RNA) amplified probe technique
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Detection of mycobacteria genitalium by nucleic acid (DNA or RNA) amplified probe technique
null
null
null
730505711
73050-57-11
Culture & Sensitivity; Gonorrhea
Culture and sensitivity Gonorrhea
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Culture and sensitivity test for Gonorrhea
null
null
null
730505765
73050-57-65
Orthopoxvirus; Amplified probe
Detection of Orthopoxvirus by nucleic acid (DNA or RNA) amplified probe technique
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Detection of orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus) by nucleic acid (DNA or RNA) amplified probe technique
null
null
null
730505811
73050-58-11
CoronaVirus; Multiplex Amplified probe
Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) by nucleic acid (DNA or RNA), influenza virus types A and B multiplex amplified probe technique
21
Laboratory and Pathology
3,050
Chemistry & Microbiology
Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) by nucleic acid (DNA or RNA), influenza virus types A and B multiplex amplified probe technique
null
null
null