• CPT Divided into fourteen subsections:
Organ or Disease Oriented Panels 80048* - 80076
Drug Testing 80100 - 80103
Therapeutic Drug Assays 80150 - 80299
Evocative/Suppression Testing 80400 - 80440
Consultations (Clinical Pathology) 80500 - 80502
Urinalysis 81000 - 81099
Chemistry 82000 - 84999
Hematology and Coagulation 85002 - 85999
Immunology 86000 - 86849
Transfusion Medicine 86850 - 86999
Microbiology 87001 - 87999
Anatomic Pathology 88000 - 88099
Cytopathology 88104 - 88199
Cytogenetic Studies 88230 - 88299
Surgical Pathology 88300 - 88399
Transcutaneous Procedures 88400
Other Procedures 89050 - 89399
Getting Payment from Medicare for Clinical Laboratory Services codes
Certain clinical diagnosis procedures listed in the Pathology and Laboratory sections of the Physicians' Current Procedural Terminology (CPT) (1) are not considered a part of the laboratory fee schedule. The procedures listed below are paid from the Physician Fee Schedule at 80% of the amount listed on that fee schedule. The beneficiary is responsible for the remaining 20% once the annual deductible has been met. These procedures are not subject to national limitations:
Clinical pathology consultations
Bone marrow smears and biopsy
Blood bank physician services
Skin tests
Anatomical and surgical pathology services
Duodenal and gastric intubation
Sputum and sweat collection
Medicare tests must be billed on an assigned basis. This means that the provider must accept the Medicare reimbursement as payment in full for any covered laboratory test. Medicare patients may not be billed for any additional amounts for covered tests. (See below for policies regarding tests that are not covered by Medicare). Medicare patients may be billed for non-covered services. The mandatory assignment requirement for laboratory tests applies regardless of whether the physician is participating (accepts assignment for all Medicare services) or non-participating (does not accept assignment for all Medicare services).
Direct billing is also required for all Medicare-reimbursed laboratory tests. Tests must be billed directly to Medicare by the laboratory or physician performing the tests. If an outside laboratory performs a test on a referral from a physician, only the reference laboratory may legally bill Medicare for the procedure.
However, hospitals and reference laboratories that send specimens to other laboratories may bill Medicare for tests performed by the other laboratories if the referring laboratory meets any one of the following three exceptions:
(a) The referring laboratory is located in or is part of a rural hospital;
(b) The referring laboratory is wholly owned by the reference laboratory, or the referring laboratory wholly owns the reference laboratory, or both referring laboratory and reference laboratory are wholly owned by a third entity; or
(c) No more than 30% of the clinical diagnostic tests for which a laboratory receives requests annually are performed by another laboratory other than an ownership-related laboratory.
For the purpose of the 30% exception, each CPT code billed counts as one test.
For example, when CPT code 80054 is billed, it is counted as one test although 12 tests are performed.
Lab CPT codes list which can be performed by CLIA certified providers . Providers with a CLIA certificate may conduct the following laboratory tests in their offices:
Description Codes Description Codes
Urinalysis 81000- 81003
Crystal Identification 89060
Glucose 82947- 82948
ESR 85651, 85652
Prothrombin time 85610
BM Aspiration 85097
Tuberculosis Intra-Dermal Skin Test 86580
Platelet 85007
Urine Pregnancy Test 81025
Bilirubin Direct 82248
Tissue Exam (KOH) Prep 87220
Bilirubin Total 82247
Wet Mounts 87177, 87210
Hemoglobin Glycated 83036
FOBT (Hemocult) 82270
Blood Smear 85060
Strep Test Group A 87070, 87880
Molecular Cytogenetics Chromosomal 88273
CBC 85025- 85048
Molecular Cytogenetics Interphase 88274
BUN, Creatinine 82565
Special Stains Group I 88312
Potassium 84132
Special Stains Group II 88313
Hemoglobin 85018
Clinical Pathology Consultation Limited 80500
Semen Analysis 89300 - 89320
Clinical Pathology Consultation Comprehensive 80502
Sperm Evaluation 89329
Lead Testing 83655
Cervical Mucus Penetration Test 89330
Rapid Flu Test 87804
Organ or Disease Oriented Panels 80048* - 80076
Drug Testing 80100 - 80103
Therapeutic Drug Assays 80150 - 80299
Evocative/Suppression Testing 80400 - 80440
Consultations (Clinical Pathology) 80500 - 80502
Urinalysis 81000 - 81099
Chemistry 82000 - 84999
Hematology and Coagulation 85002 - 85999
Immunology 86000 - 86849
Transfusion Medicine 86850 - 86999
Microbiology 87001 - 87999
Anatomic Pathology 88000 - 88099
Cytopathology 88104 - 88199
Cytogenetic Studies 88230 - 88299
Surgical Pathology 88300 - 88399
Transcutaneous Procedures 88400
Other Procedures 89050 - 89399
Getting Payment from Medicare for Clinical Laboratory Services codes
Certain clinical diagnosis procedures listed in the Pathology and Laboratory sections of the Physicians' Current Procedural Terminology (CPT) (1) are not considered a part of the laboratory fee schedule. The procedures listed below are paid from the Physician Fee Schedule at 80% of the amount listed on that fee schedule. The beneficiary is responsible for the remaining 20% once the annual deductible has been met. These procedures are not subject to national limitations:
Clinical pathology consultations
Bone marrow smears and biopsy
Blood bank physician services
Skin tests
Anatomical and surgical pathology services
Duodenal and gastric intubation
Sputum and sweat collection
Medicare tests must be billed on an assigned basis. This means that the provider must accept the Medicare reimbursement as payment in full for any covered laboratory test. Medicare patients may not be billed for any additional amounts for covered tests. (See below for policies regarding tests that are not covered by Medicare). Medicare patients may be billed for non-covered services. The mandatory assignment requirement for laboratory tests applies regardless of whether the physician is participating (accepts assignment for all Medicare services) or non-participating (does not accept assignment for all Medicare services).
Direct billing is also required for all Medicare-reimbursed laboratory tests. Tests must be billed directly to Medicare by the laboratory or physician performing the tests. If an outside laboratory performs a test on a referral from a physician, only the reference laboratory may legally bill Medicare for the procedure.
However, hospitals and reference laboratories that send specimens to other laboratories may bill Medicare for tests performed by the other laboratories if the referring laboratory meets any one of the following three exceptions:
(a) The referring laboratory is located in or is part of a rural hospital;
(b) The referring laboratory is wholly owned by the reference laboratory, or the referring laboratory wholly owns the reference laboratory, or both referring laboratory and reference laboratory are wholly owned by a third entity; or
(c) No more than 30% of the clinical diagnostic tests for which a laboratory receives requests annually are performed by another laboratory other than an ownership-related laboratory.
For the purpose of the 30% exception, each CPT code billed counts as one test.
For example, when CPT code 80054 is billed, it is counted as one test although 12 tests are performed.
Lab CPT codes list which can be performed by CLIA certified providers . Providers with a CLIA certificate may conduct the following laboratory tests in their offices:
Description Codes Description Codes
Urinalysis 81000- 81003
Crystal Identification 89060
Glucose 82947- 82948
ESR 85651, 85652
Prothrombin time 85610
BM Aspiration 85097
Tuberculosis Intra-Dermal Skin Test 86580
Platelet 85007
Urine Pregnancy Test 81025
Bilirubin Direct 82248
Tissue Exam (KOH) Prep 87220
Bilirubin Total 82247
Wet Mounts 87177, 87210
Hemoglobin Glycated 83036
FOBT (Hemocult) 82270
Blood Smear 85060
Strep Test Group A 87070, 87880
Molecular Cytogenetics Chromosomal 88273
CBC 85025- 85048
Molecular Cytogenetics Interphase 88274
BUN, Creatinine 82565
Special Stains Group I 88312
Potassium 84132
Special Stains Group II 88313
Hemoglobin 85018
Clinical Pathology Consultation Limited 80500
Semen Analysis 89300 - 89320
Clinical Pathology Consultation Comprehensive 80502
Sperm Evaluation 89329
Lead Testing 83655
Cervical Mucus Penetration Test 89330
Rapid Flu Test 87804
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