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
stmodifier 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
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.
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
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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
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
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
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
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
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
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)
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
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