PCP Office Lab List – covered list
81000 – Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy
81001 – Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy
81002 – Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy
81003 – Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy
81005 – Urinalysis; qualitative or semiquantitative, except immunoassays
81025 Urine pregnancy test, by visual color comparison methods
82044 Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay)
82270-Blood, occult, by peroxidase activity (eg, guaiac); feces, 1-3 simultaneous determinations
82271 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources
82272 Blood, occult, byperoxidase activity, single specimen
82274 Blood, occult, byfecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations
82947 Glucose; quantitative, blood (except reagent strip)
82948 Glucose; blood, reagent strip
82962 Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use
83036 Hem oglobin; glycosylated (Al C)
83037 Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use
83014 Helicobacterpylori; drug administration
84030 Phenylalanine (PKU), blood
84703 Gonadotropin, chorionic (hCG); qualitative
85004 Blood count; automated differential wbc count
85007 Blood count; manual differential WBC count (includes RBC morphology and platelet estimation)
85013 Blood count; spun microhematocrit
85014 Blood count; other than spun hematocrit
85018 Blood count; hemaglobin
85025 Blood count; hemogram and platelet count. automated, and automated complete differential WBC count (CBC)
85027 Blood count; hemogram and platelet count, automated
85032 Blood count; manual cell count (erythrocyte leukocyte or platelet) each
85049 Blood count; platelet automated
85610 Prothrombin time
85651 Sedimentation rate, erythrocyte; non-automated
85730 Thromboplastin time, partial (PTT); plasma or whole blood
86308 Heterophile antbodies; screening
86403 Particle agglutination; screen, each antibody
86580 Skin test; tuberculosis, intradermal
86710 Antibody; influenza virus
87070 Culture, bacterial; any other source except urine, blood or stool, with isolation and presumptive identification of isolates
87081 Culture, presumptive, pathogenic organisms, screening only
87086 Culture, bacterial; quantitative colony count, urine
87088 Culture, bacterial; with isolation and presumptive identification of isolates, urine
87177 Ova and parasites, direct smears, concentration and identification
87205 Smear, primary source with interpretation, Gram or Giemsa stain for bacteria, fungi, or cell types
87210 Smear, primary source with interpretation; wet mount for infectious agents (e.g., saline, India ink, KOH preps)
87220 Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (e.g., scabies)
87400 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Influenza, A or B, each
87430 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Streptococcus, group A
87480 Infectious agent detection by nucleic acid (DNA or RNA); candida species, direct probe technique
87510 Infectious agent detection by nucleic acid (DNA or RNA); gardnerella vaginalis, direct probe
technique
87660 Infectious agent detection by nucleic acid (DNA or RNA); trichomonas vaginalis, direct probe technique
87802 Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B
87803 Infectious agent antigen detection by immunoassay with direct optical observation; Clostridium difficile toxin A
87804 Infectious agent antigen detection by immunoassay with direct optical observation; Influenza
87807 Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
87880 Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A
88738 Hemoglobin (Hgb), quantitative, trancutaneous
89055 Leukocyte count fecal
G0306 Complete CBC, automated (HgB, HCT, RBC, WBC, without platelet count) and automated WBC differential count
G0307 Complete (CBC), automated (HgB, HCT, RBC, WBC, without platelet count)
00111 Wet mounts, including preparation of vaginal, cervical or skin specimens
S3620 Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g. galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d, phenylanine (PKU); and thyroxine, total
