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September 1, 2006

Dear AmeriHealth Mercy Provider:

Effective July 17, 2006, the Pennsylvania Department of Public Welfare (DPW) has end-dated

several local procedure codes pertaining to services offered in Acute Care General Hospitals and

Hospital-Based Medical Clinics. These local procedures codes were cross-walked by DPW to

national procedure codes many of which are already listed on the Medical Assistance (MA)

Program Fee Schedule. However, in some cases, the correlating national procedure code requires

the addition of a pricing and/or informational modifier when billing the replacement national

procedure code. Pricing modifiers should be placed in the 1

st

modifier position, with

informational modifiers placed in the subsequent position. Failure to use the appropriate national

procedure code and modifier(s) combination will result in inappropriate claim payment or claim

denial. Additionally, payment for the correlating national procedure code may be reimbursed at

a higher or lower amount than its counterpart.

As a result of the changes outlined by DPW in

MA Bulletin 01-06-05, Keystone Mercy Health

Plan is implementing the following changes:

If your facility currently bills for services using

any of the local codes appearing on Attachment A, you may continue to bill using the local

procedure code for services rendered on or before September 30, 2006. When billing for

services rendered on or after October 1, 2006, you will need to begin using the corresponding

national procedure code along with any pricing or informational modifier as it appears on

Attachment A.

If you have any questions regarding this change in reimbursement, please contact your Provider

Contracting Representative, or call Provider Services at (800) 521-6007. Thank you for your

participation in our network and your commitment to AmeriHealth Mercy Health Plan members.

Sincerely,

Charles J. Russo

Associate Vice President

Provider & Community Affairs

(2)

W0663 service(s) T1015 U8 GP Clinic visit/encounter, all-inclusive

W0664 Outpatient hospital occupational

service(s) T1015 U8 GO Clinic visit/encounter, all-inclusive

W0665 Outpatient hospital speech therapy service(s) T1015 U8 GN Clinic visit/encounter, all-inclusive

W0666 Outpatient hospital physical therapy

service(s) T1015 U7 GP Clinic visit/encounter, all-inclusive

W0667 Outpatient hospital occupational service(s) T1015 U7 GO Clinic visit/encounter, all-inclusive

W0668 Outpatient hospital speech therapy

service(s) T1015 U7 GN Clinic visit/encounter, all-inclusive

W6013 Packed cells, per unit P9021 Red Blood Cells, each unit

W6014 Platelets, per unit P9019 Platelets, each unit

W9045

ER Support Services, Special Non-emergency services (Enrollment Approval Required)

99281 U5

Emergency department visit for the evaluation and management of a patient, which requiresthese three components: a problem focused history; a problem focused examination; and straightforward medical decision making.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

(3)

W9045

ER Support Services, Special Non-emergency services (Enrollment Approval Required)

99281 U5 Q6

patient, which requiresthese three components: a problem focused history; a problem focused examination; and straightforward medical decision making.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

W9045

ER Support Services, Special Non-emergency services (Enrollment Approval Required)

99282 U5

Emergency department visit for the evaluation and management of a patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of low to moderate severity

(4)

W9045

ER Support Services, Special Non-emergency services (Enrollment Approval Required)

99282 U5 Q6

patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of low to moderate severity

W9045

ER Support Services, Special Non-emergency services (Enrollment Approval Required)

99283 U5

Emergency department visit for the evaluation and management of a patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity

(5)

W9045

ER Support Services, Special Non-emergency services (Enrollment Approval Required)

99284 U5

patient, which requires these three components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of high severity and require urgent evaluation by the physician but do not pose an immediate threat to life or physiologic function.

W9045

ER Support Services, Special Non-emergency services (Enrollment Approval Required)

99285 U5

Emergency department visit for the evaluation and management of a patient, which requires these three components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status; a comprehensive examination; and medical decision making of high complexity.

Counseling and/or coordination of care with the nature of the

problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of high severity and pose and immediate threat to life or physiologic funnction.

(6)

W9046 ER Support Services, Basic,

Non-emergency services 99281 U4

patient, which requires these three components: a problem focused history; a problem focused examination; and straightforward medical decision making.

Counseling and/or coordination of care with other provders or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

W9046 ER Support Services, Basic, Non-emergency services 99281 U4 Q6

Emergency department visit for the evaluation and management of a patient, which requires these three components: a problem focused history; a problem focused examination; and straightforward medical decision making.

Counseling and/or coordination of care with other provders or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

(7)

W9046 ER Support Services, Basic, Non-emergency services 99282 U4

patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of low to moderate severity.

W9046 ER Support Services, Basic,

Non-emergency services 99282 U4 Q6

Emergency department visit for the evaluation and management of a patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of low to moderate severity.

(8)

W9046 ER Support Services, Basic, Non-emergency services 99283 U4

patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

W9046 ER Support Services, Basic, Non-emergency services 99284 U4

Emergency department visit for the evaluation and management of a patient, which requires these three components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of high severity and require urgent

evalutation by the physician but do not pose an immediate significant threat to life or physiologic function.

(9)

W9046 ER Support Services, Basic, Non-emergency services 99285 U4

patient, which requires these three components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive

examination; and medical decision making of high complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate threat to life or physiologic function.

W9047

ER Support Services, Special Emergency Services (Enrollment Approval Required)

99281 U5

Emergency department visit for the evaluation and management of a patient, which requires these three components: a problem focused history; a problem focused examination; and straightforward medical decision making.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

(10)

W9047

ER Support Services, Special Emergency Services (Enrollment Approval Required)

99281 U5 Q6

patient, which requires these three components: a problem focused history; a problem focused examination; and straightforward medical decision making.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

W9047

ER Support Services, Special Emergency Services (Enrollment Approval Required)

99282 U5

Emergency department visit for the evaluation and management of a patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of low to moderate severity.

(11)

W9047

ER Support Services, Special Emergency Services (Enrollment Approval Required)

99282 U5 Q6

patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of low to moderate severity.

W9047

ER Support Services, Special Emergency Services (Enrollment Approval Required)

99283 U5

Emergency department visit for the evaluation and management of a patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

(12)

W9047

ER Support Services, Special Emergency Services (Enrollment Approval Required)

99284 U5

patient, which requires these three components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of high severity and require urgent

evalutation by the physician but do not pose an immediate significant threat to life or physiologic function.

(13)

W9047

ER Support Services, Special Emergency Services (Enrollment Approval Required)

99285 U5

patient, which requires these three components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive

examination; and medical decision making of high complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate threat to life or physiologic function.

W9048 ER Support Services, Basic, Emergency Services 99281 U4

Emergency department visit for the evaluation and management of a patient, which requires these three components: a problem focused history; a problem focused examination; and straightforward medical decision making.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

(14)

W9048 ER Support Services, Basic, Emergency Services 99281 U4 Q6

patient, which requires these three components: a problem focused history; a problem focused examination; and straightforward medical decision making.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

W9048 ER Support Services, Basic, Emergency Services 99282 U4

Emergency department visit for the evaluation and management of a patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of low to moderate severity.

(15)

W9048 ER Support Services, Basic, Emergency Services 99282 U4 Q6

patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of low to moderate severity.

W9048 ER Support Services, Basic, Emergency

Services 99283 U4

Emergency department visit for the evaluation and management of a patient, which requires these three components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

(16)

W9048 ER Support Services, Basic, Emergency

Services 99284 U4

patient, which requires these three components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of high severity and require urgent

evalutation by the physician but do not pose an immediate significant threat to life or physiologic function.

(17)

W9048 ER Support Services, Basic, Emergency Services 99285 U4

patient, which requires these three components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive

examination; and medical decision making of high complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate threat to life or physiologic function.

W9049 Hospital outpatient clinic visit (enrollment approval required) T1015 U5 Clinic visit/encounter, all-inclusive

W9051 Basic hospital outpatient clinic visit T1015 U4 Clinic visit/encounter, all-inclusive

W9064 Medical school clinic visit (enrollment

approval required) T1015 U5 Clinic visit/encounter, all-inclusive

W9254 Electronystagmography, complete 92541

Spontaneous nystagmus test, including gaze and fixation mystagmus, with recording

W9416 Peak expiratory flow rate (PERF) 94010

Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation

W9564 Administration of Rho(D) Immune Globulin 90384

Rho(D) immune globin (Rhlg), human, full-dose, for intramuscular use

(18)

W9564 Administration of Rho(D) Immune Globulin 90386 Rho(D) immune globin (RhlgIV), human, for intravenous use W9591

Electromyography, including nerve conduction velocites, one extremity and related para-spinal area

95860

Needle electromyography, one extremity with or without related paraspinal areas

W9592

Electromyography, including nerve conduction velocites, two extremities and related para-spinal area

95861

Needle electromyography, two extremities with or without related paraspinal areas

W9593

Electromyography, including nerve conduction velocites, three extremities and related para-spinal area

95863

Needle electromyography, three extremities with or without related paraspinal areas

W9630 General medical examination T1015 U7 Clinic visit/encounter, all-inclusive

W9633

Comprehensive medical examination by general practitioner when requested by the Department to determine eligibility

T1015 U7 Clinic visit/encounter, all-inclusive

W9640 Administration of Chemotherapy for malignant disease; perfusion 96408 Chemotherapy administration, intravenous; push technique W9640 Administration of Chemotherapy for malignant disease; perfusion 96410

Chemotherapy administration, intravenous; infusion technique, up to one hour

W9640 Administration of Chemotherapy for

malignant disease; perfusion 96412

Chemotherapy administration, intravenous; infusion technique, one to eight hours, each additional hour

W9640 Administration of Chemotherapy for malignant disease; perfusion 96414

Chemotherapy administration, intravenous, infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump

(19)

W9640 Administration of Chemotherapy for

malignant disease; perfusion 96422 arterial; infusion technique, up to one hour

W9640 Administration of Chemotherapy for malignant disease; perfusion 96423

Chemotherapy administration, intra-arterial; infusion technique, one to eight hours, each additional hour

W9640 Administration of Chemotherapy for malignant disease; perfusion 96425

Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours) requiring the use of a portable or implantable pump W9715

Physical therapy, two or more modalities and/or two or more procedures; initial 30 minutes

T1015 U7 GP Clinic visit/encounter, all-inclusive

W9871 General Assistance Exception. Independent/Basic Hospital Clinic Visit T1015 U7 SC Clinic visit/encounter, all-inclusive

W9872 General Assisatnce Exception, Hospital or Medical School Clinic Visit T1015 U8 SC Clinic visit/encounter, all-inclusive

X1101 Debridement of Ulcer, foot; initial 11040 Debridement; skin, partial thickness

X1101 Debridement of Ulcer, foot; initial 11041 Debridement; skin, full thickness

X1101 Debridement of Ulcer, foot; initial 11042 Debridement; skin, subcutaneous tissue

X1101 Debridement of Ulcer, foot; initial 11043 Debridement; skin, subcutaneous

tissue and muscle

X1101 Debridement of Ulcer, foot; initial 11044 Debridement; skin, subcutaneous

(20)

X1102 Debridement of Ulcer, foot; subsequent 11001

Debridement of extensive

eczematous or infected skin; each additional 10% of the body surface

X1166 Debridement of hypertrophic nails; initial, multiple 11720 Debridement of nail(s) by any method(s); one to five

X1166 Debridement of hypertrophic nails; initial, multiple 11721 Debridement of nail(s) by any method(s); six or more

X1167 Debridement of hypertrophic nails; subsequent, multiple 11720 Debridement of nail(s) by any method(s); one to five

X1167 Debridement of hypertrophic nails; subsequent, multiple 11721 Debridement of nail(s) by any method(s); six or more

X1172 Avulsion of nail, partial, one nail 11730 T1-T9, TA,

F1-F9, FA

Avulsion of nail plate, partial or complete, simple; single

X1172 Avulsion of nail, partial, one nail 11732 T1-T9, TA,

F1-F9, FA

Avulsion of nail plate, partial or complete, simple; single; each additional nail plate

X1175 Excision of nail and nail matrix; partial, one nail 11750 T1-T9, TA, F1-F9, FA

Exclusion of nail or nail matrix, partial or complete, (e.g. ingrown or deformed nail) for permanent removal

X1177 Excision of nail and nail matrix; complete, one nail 11750 T1-T9, TA, F1-F9, FA

Exclusion of nail or nail matrix, partial or complete, (e.g. ingrown or deformed nail) for permanent removal

X1720

Plantar verruca or verrucae, removal by any method except excision, such as superficial cutting or paring,

chemotherapy, etc; subsequent treatment

17000

Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative

(21)

X1720

Plantar verruca or verrucae, removal by any method except excision, such as superficial cutting or paring,

chemotherapy, etc; subsequent treatment

17003

chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; second through 14 lesions, each (list separately in addition to code for first lesion)

X1720

Plantar verruca or verrucae, removal by any method except excision, such as superficial cutting or paring,

chemotherapy, etc; subsequent treatment

17004

Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions

X3643 Transfusion, blood or blood components; direct 36430 Transfusion, blood or blood components

X5741 Gynecological

examination-asymptomatic patient T1015 U7 Clinic visit/encounter, all-inclusive

X5746 Intensive Colposcopic examination with

biopsy and/or excision of lesion(s) 57421

Colposcopy of the entire vagina, with cervix if present; with biopsy(s) X5746 Intensive Colposcopic examination with biopsy and/or excision of lesion(s) 57454

Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage

X5746 Intensive Colposcopic examination with

biopsy and/or excision of lesion(s) 57455

Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix

(22)

X5746 Intensive Colposcopic examination with

biopsy and/or excision of lesion(s) 57460

Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix

X5746 Intensive Colposcopic examination with

biopsy and/or excision of lesion(s) 57461

Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix Y7030

Radiology diagnostic, both mandible and temporomandibular joints, panoramic views

70330

Radiologic examination,

temporomandibular joint, open and closed mouth; bilateral

Y7202 Radiologic examination, spine, three views, any level 72040 Radiologic examination, spine, cervical; two or three views

Y7202 Radiologic examination, spine, three views, any level 72050 Radiologic examination, spine, cervical; minimum of four views

Y7202 Radiologic examination, spine, three views, any level 72072 Radiologic examination, spine, thoracic, three views

Y7202 Radiologic examination, spine, three views, any level 72074 Radiologic examination, spine, thoracic, minimum of four views

Y7202 Radiologic examination, spine, three

views, any level 72100

Radiologic examination, spine, lumbosacral; two or three views

Y7202 Radiologic examination, spine, three

views, any level 72110

Radiologic examination, spine, lumbosacral; minimum of four views

Y7202 Radiologic examination, spine, three

views, any level 72120

Radiologic examination, spine, lumbosacral, bending views only, minimum of four views

Y7211

Radiologic diagnostic, lumbal spine and pelvis; complete lumbal spine with anteroposterior views of pelvis

72010

Radiologic examination, spine, entire, survey study,

anteroposterior and lateral

(23)

Y7311 Radiology diagnostic, hand and wrist; limited, fewer that three views 73100 RT, LT 50 Radiologic examination, wrist; two views

Y7311 Radiology diagnostic, hand and wrist;

limited, fewer that three views 73120 RT, LT 50

Radiologic examination, hand; two views

Y7312 Radiology diagnostic, hand and wrist; complete, fewer that three views 73110 RT, LT 50 Radiologic examination, wrist; complete, minimum of three views Y7312 Radiology diagnostic, hand and wrist; complete, fewer that three views 73130 RT, LT 50 Radiologic examination, hand; complete, minimum of three views Y7322

Magnetic Resonance (e.g., Proton) Imaging, upper extremity, other that joint with contrast material

73219 RT, LT 50

Magnetic resonance imaging, upper extremity, other that joint with contrast materials

Y7323

Magnetic Resonance Imaging, upper extremity, other that joint, without contrast materials, followed by contrast material

73220 RT, LT 50

Magnetic resonance imaging, upper extremity, other that joint, without contrast materials and further sequencing

Y7324

Magnetic Resonance (e.g., Proton) Imaging, any joint of upper extremity; with contrast material

73222 RT, LT 50

Magnetic resonance (e.g., proton) imaging, any joint of upper extremity; with contrast material(s)

Y7325

Magnetic resonance imaging, any joint of upper extremity without contrast material, followed by contrast materials

73223 RT, LT 50

Magnetic resonance imaging, any joint of upper extremity without contrast material, followed by contrast material(s) and further sequences

Y7360 Radiologic examination, ankle;

comprehensive, minimum of five views 73610 RT, LT 50

Radiologic examination, ankle, complete, minimum of 3 views Y7419

Magnetic resonance imaging, abdomen; without contrast material, followed by contrast material

74183

Magnetic resonance imaging, abdomen; without contrast material, followed by contrast material(s) and further sequences

(24)

Y7600 fluoroscopy (radiological guidance), per 30 minutes

76001 nephrostolithotomy, ERCP,

bronchoscopy, transbronchial biopsy)

Z0832 Pregnancy Test 81025 Urine pregnancy test, by visual color comparison methods

Z0832 Pregnancy Test 84702 Gonadotropin, chronic (hCG);

quantitative

Z0832 Pregnancy Test 84703 Gonadotropin, chronic (hCG); qualitative

Z2100 Alcohol (Ethanol), blood; quantitative (all

methods) 82055

Alcohol (ethanol); any specimen except breath

Z2101 Alcohol(ethanol), urine; qualitative (all methods) 82055 Alcohol (ethanol); any specimen except breath

Z2102 Alcohol(ethanol), urine; quantitative (all methods) 82055 Alcohol (ethanol); any specimen except breath

Z2103

Drug screen (amphetamines,

barbiturates, benzodiazepine, cocaine, methadone, methaqualone, opiates, phencyclidine (PCP), propoxyphene, THC (all methods) 1-5

80100

Drug screen, qualitative; multiple drug classes chromatographic method, each procedure

Z2105 Drug screen, fentanyl, fentanyl derivatives (all methods) 80101

Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

Z2106

Drug screen (amphetamines,

barbiturates, benzodiazepine, cocaine, methadone, methaqualone, opiates, phencyclidine (PCP), propoxyphene, THC (all methods) 6-10

80100

Drug screen, qualitative; multiple drug classes chromatographic method, each procedure

Z8020

AIDS Profile III - lymphocyte subset

panel (includes Total B, Total T, T 86689

Antibody; HTLV or HIV antibody, confirmatory test (e.g., Western

(25)

Z8020

AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio)

86702 Antibody; HIV-2

Z8020

AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio)

86703 Anti-body; HIV-1 and HIV-2, single

assay

Z8020

AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio)

87390

Infectious agent antigen detection by enzyme immunoassay

technique, qualitative or semiquantitative, multiple step method; HIV-1

Z8020

AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio)

87391

Infectious agent antigen detection by enzyme immunoassay

technique, qualitative or semiquantitative, multiple step method; HIV-2

Z8227 Blood; occult feces, screening - asymptomatic patient 82270

Blood occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations

Z8294 Glucose; 2 hour postprandial 82947 Glucose; quantitative, blood (except

reagent strip)

Z8309 Haldol (Haloperidol) 80173 Haloperidol

Z8374 Ludiomil (Maprotiline) 80299 Quantitation of drug, not elsewhere

specified

Z8391 Norpace (Disopryamide) 80299 Quantitation of drug, not elsewhere specified

Z8503

Blood count, hemogram, manual, completed CBC (RBC, WBC, Hgb, Hct, Differential and Indicies) - Asymptomatic patient

85027 91

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)

(26)

patient and platelet count)

Z8555 Blood cont; hematocrit - asymptomatic

patient 85014 91 Blood count; hematocrit (Hct)

Z8555 Blood cont; hematocrit - asymptomatic patient 85014 Blood count; hematocrit (Hct)

Z8556 Blood count; Hematocrit and Hemoglobin (Hct and Hgb) 85025 91

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)

Z8556

Blood count; Hematocrit and Hemoglobin (Hct and Hgb) - asymptomatic patient

85025

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)

Z8557 Blood count; Hematocrit and Hemoglobin (Hct and Hgb) 85025 91

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)

Z8557 Blood count; Hematocrit and

Hemoglobin (Hct and Hgb) 85025

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)

Z8604 Anti-Parietal AB 86255 Fluorescent noninfectious agent antibody; screen, each antibody

Z8627 Antibody; Epstein-Barr Virus (EBV),

Complete Evaluation 86663

Antibody; Epstein-Barr (EB) virus, early antigen (EA)

Z8627 Antibody; Epstein-Barr Virus (EBV), Complete Evaluation 86664 Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)

Z8627 Antibody; Epstein-Barr Virus (EBV),

Complete Evaluation 86665

Epstein-Barr (EB) virus, viral capsid (VCA)

Z8631 Immunoassay for Prostate Specific Antigen (PSA); Asymptomatic Patient 84153 Prostate specific antigen (PSA); total

Z8636 Mast Allergy Test; up to 5 antigens 86003 semiquantitative, each allergenAllergen specific IgE; quantitative or

Z8637 Mast Allergy Test; 6 or more antigens 86003 Allergen specific IgE; quantitative or

(27)

Z8708

Culture, screening for organism

including sensitivity study, sources other than blood

87181

Susceptibility studies, antimicrobial agent, agar, dilution method, per agent (e.g., antibiotic gradient strip) Z8708

Culture, screening for organism

including sensitivity study, sources other than blood

87190

Susceptibility studies, antimicrobial agent, mycobacteria, proportion method, each agent

Z8712

Culture, urine; quantitative, with colony count including sensitivity study, screening

87086 Culture, bacteria; quantitative colony count urine

Z8712

Culture, urine; quantitative, with colony count including sensitivity study, screening

87181

Susceptibility studies, antimicrobial agent, agar, dilution method, per agent (e.g., antibiotic gradient strip) Z8712

Culture, urine; quantitative, with colony count including sensitivity study, screening

87190

Susceptibility studies, antimicrobial agent, mycobacteria, proportion method, each agent

Z8713

Culture urine; definitive and sensitivity study for specific microorganisms, with isolation of organism

87086 Culture, bacteria; quantitative colony count urine

Z8713

Culture urine; definitive and sensitivity study for specific microorganisms, with isolation of organism

87088

Culture, bacteria; with isolation and presumptive identification of isolates, urine

References

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