CPT Codes  

A Cost-Benefit Analysis lists the following tests as those that are most likely performed at the point of care. This information is intended to enable payors to reimburse for APOCT by simply programming their systems to accept these CPT codes and reimbursement amounts.

  • Laboratory Chemistry Tests
  • Laboratory Microbiology/Immunology Tests
  • Laboratory Urinalysis/Microscopic Examinations/Misc. Tests
  • Laboratory Blood Tests for Anemia, Leukemia, Infection, Bleeding Disorders: Hematology Tests
  • Laboratory Immunohematology Tests
  • Holter Monitoring
  • Spirometry Tests
  • Bone Mineral Density Tests
  • Pulse Oximetry
  • Exercise Testing
  • Resting ECG
  • Ambulatory Blood Pressure (ABP)
  • Colposcopy
  • Rhinolaryngoscopy
  • Sigmoidoscopy

  • Updated Laboratory CPT Codes

     

    Laboratory Chemistry Tests |Top

    Test CPT  Fee
    Hepatic Function Panel (6 tests) 80058 $10.81
    Basic Metabolic Panel (7 tests) 80049 11.29
    Electrolyte Panel (4 tests) 80051 9.69
    Comprehensive Metabolic Panel (12 tests) 80054 12.48
    Lipid Panel (Chol, HDL, Triglycerides) 80061 18.51
       
    Cardiac/Liver/Biliary Tests:    
    CK/CPK 82550 $9.01
    CK,MB 82553 15.95
    LD 83615 8.35
    AST 84450 7.14
     ALT

     84460

     7.32

     ALP

    84075

     7.15

     GGT

    82977

     9.95

     Bilirubin, total

    82247

     6.94

     Bilirubin, direct

    82248

     6.94

     Total Protein

    84155

     5.06

     Albumin

     82040

     6.85

     Lipid Metabolism Tests    
     Total Cholesterol

     82465

     $6.02

     HDL

     83718

     11.31

     LDL

     83721

     13.18

     Triglycerides

     84478

     7.95

     Lp(a) Apolipoprotein

     82172

     21.41

     Diabetes Tests    
     Glucose, quantitative blood type

     82947

     $5.42

     Glucose on home use meter-type device

     82962/82962

     3.23

     Hemoglobin A1c

     83036

     13.42

     Glucose Tolerance Test, initial 3 specimens

     82951

     17.80

     Glucose Tolerance Test, each additional specimen > 3

     82952

     5.42

     Fructosamine

     82985

     20.83

     Renal Function Tests    
     BUN

     84520

     5.45

     Creatinine

     82565

     7.07

     Individual Chemistry Tests    
     Phosphorous

     84100

     6.56

     Calcium

     82310

     7.12

     Uric Acid

     84550

     6.25

     Amylase

     82150

     8.96

     Magnesium

     83735

     9.26

     Iron

     83540

     8.95

     TIBC

     83550

     12.08

     Ferritin

     82728

     18.83

     Prostate Specific Antigen (PSA)

     84153

     25.42

     Troponin T

     84512

     0.00

     Therapeutic Drug Monitoring:    
     Theophylline

     80198

     19.56

    Digoxin

     80162

     18.35

     Drug Screening (THC, Cocaine, etc.) multiple drug classes

     80100

     20.10

     Thyroid Tests:    
     TSH

     84443

     23.21

     Thyroxine, total

     84436

     9.50

     T3 Uptake

     84479

     8.95

         
     Pregnancy Tests: HCG quantitative serum

     84702

     20.80

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    LABORATORY MICROBIOLOGY/
    IMMUNOLOGY TESTS |Top

    Test CPT  Fee
    Strep Thoat Tests:    
    Strep A Kits 87880 $16.58
    Ulcer Tests:    
    H. pylori Kits 86677 $20.05
    Chlamydia Kit Tests:    
    Chlamydia Ab Test 86631  $16.35
    Chlamydia Antigen Test, EIA 86631  $16.35
    Mononucleosis Kit Tests 86308 7.15
    Rheumatoid Factor Tests 86430 7.85
    Syphilis Kit Tests 86592 5.90
    Herpes Kit Tests 86694 19.89
    Sexually Transmitted Disease Tests    
     candida, DNA Direct Probe Tests

     87480

     27.71

     trichomonas, DNA Direct Probe Tests

     87797

     27.71

     gardnerella, DNA Direct Probe Tests

     87510

     27.71

     Influenza Kit Tests

     87449

     16.58

     Tests For Infections  

     $3.55

     Urine Screen, non-culture kit

     81007

    3.55
     Urine, culture

     87087

     
     Urine, colony count

     87086

    11.16
     Urine, presumptive identification of bacteria

     87088

    11.18
     Urine, antibiotic susceptibility test

     87184

    9.53
     Throat, culture for Strep A

     87082

    9.16
     Cervical/Urethral, culture for N. gonorrhoeae

     87081

    9.16
     Allergy Kit Tests:

     86005

     $11.02

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    LABORATORY URINALYSIS/MICROSCOPIC EXAMINATIONS/MISCELLANEOUS TESTS |Top

    Test CPT  Fee
    Semen Analysis: 89300 12.32
    Urinalysis Tests:    
    Strip Urine Tests, manual w/out microscopy 81002 3.54
    Strip Urine Tests, manual w/ microscopy 81000 4.37
    Strip Urine Tests, automated w/out microscopy 81003 3.10
    Strip Urine Tests, automated w/ microscopy 81001 4.37
    Tests for Vaginal/Skin Infections:    
    Wet/KOH Prep (for yeast, bacteria, cells, etc.) 87210  5.90
    Tests for Allergies:    
    Nasal Smear for Eosinophils 89190 6.56
    Tests for Colon Cancer:    
     Fecal Occult Blood Screening Test

     G0107

     4.49

     Fecal Occult Blood Test

     82270

     4.49

     Tests for Allergies:    
     HCG qualitative Urine/Serum Kit Test

     81025

     8.74

     Bladder Cancer Tests:    
     BTA Stat Test

     83516

     16.38

     ACCU Dx Test

     86316

     28.76

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    LABORATORY BLOOD TESTS FOR ANEMIA, LEUKEMIA,

    INFECTION, BLEEDING DISORDERS: HEMOTOLOGY TESTS |Top

    Test CPT  Fee
    Complete Blood Count (including WBC
    differential & platelet count)
    85024-
    85025
    11.70
    10.74
    Hemoglobin/Hematocrit Test 85018
    85013
    3.27
    3.27
    Prothrombin Time Test (PT) 85610 5.43
    Activated Partial Thromboplastin Test (APTT) 85730 8.30
    Platelet Count, manual 85590 5.94
    Platelet Count, automated 85595 6.18
    Reticulocyte Count, manual 85044 5.94
    Sedimentation Rate Test, manual 85651 4.91
    Sedimentation Rate Test, automated 85652 3.73

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    Laboratory Immunohematology Tests

    Test CPT  Fee
    Blood Grouping & Typing 86900/
    86901
     
    4.12
    4.12

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    Updated Physiologic CPT Codes

     


    Holter Monitoring |Top

    Test CPT  Fee
    ECG monitoring for 24 hours with super-imposition scanning; includes recording, scanning analysis with report, physician review, and interpretation.  93224  152.62
    Recording  93225  45.48
    Scanning analysis with report  93226  80.05
    Physician review and interpretation  93227  27.09
    ECG monitoring for 24 hours without super-imposition scanning; includes recording, microprocessor-based analysis with report, physician review, and interpretation.  93230  162.09
    Recording  93231  55.56
    Microprocessor-based analysis with report  93232 79.34
    Physician review and interpretation  93233  27.09

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    Spirometry Tests |Top

    Test CPT  Fee
    Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate, and/or maximal voluntary ventilation. 94010  37.091 
    Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator or exercise 94060  62.88 
    Multiple spirometric determinations after bronchodilator with spirometry as in 94010  94070 85.25 
    Spirometry, slow vital capacity 94150  - 
    Maximum breathing capacity, max. vol. vent  94200 17.04 
    Respiratory flow volume loop 94375 28.99
    Aerosol or vapor inhalations; intitial 94664  20.38
    Subsequent 94665  17.87 

     

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    Bone Mineral Density Tests

    Test CPT  Fee
    Ultrasound tests, each 15 minutes 97035  10.24 

     

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    Pulse Oximetry

    Test CPT  Fee
    Pulse Oximetry, single determination 94760  4.34 
    Pulse Oximetry, multiple determinations  94761  6.83

     

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    Exercise Testing

    Test CPT  Fee
    Cardiovascular stress test, treadmill or bicycle exercise, continuous ECG monitoring and/or pharmacological stress; with physician supervision, with interpretation and report 93015  100.16 
    Physician supervision only, without interpretation and report  93016  23.13
     Tracing only, without interpretation and report  93017  61.05
     Interpretation and report only  93018  15.53

     

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    Resting ECG

    Test CPT  Fee
    Routine ECG with at least 12 leads; with interpretation and report 93000 25.41
    Tracing only, without interpretation and report 93005  16.38
    Interpretation and report only 93010  9.02 
    Rhythm ECG, one to three leads; with interpretation and report 93040  13.39 
    Tracing only without interpretation and report  93041  5.45
    Interpretation and report only  93042  7.93
    Electronic analysis of dual-chamber pacemaker system; without reprogramming  93731  42.02
    With reprogramming  93732  66.97
    Electronic analysis of single chamber pacemaker system; without reprogramming  93734  32.61
    With reprogramming  93735  55.01

     

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    Ambulatory Blood Pressure (ABP)

    Test CPT  Fee
    ABP monitoring, 24 hours, including recording, scanning analysis, interpretation and report 93784  39.92 

     

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    Coloscopy

    Test CPT  Fee
    Colposcopy 57452 $100.80
    Colposcopy with Biopsy 57454  118.85
    Colposcopy with Electrosurgical Loop Excision of the Cervix 57460  190.79 
    Cervical Biopsy  57500  131.98
    Cryotherapy of Cervix 57511  167.36
    Laser Ablation of Cervix 57513  174.28
    Conization of Cervix   57520 321.36
    Endometrial Biopsy 58100  114.48
    Vulvar Biopsy 56605   112.77
    Destruction of Vulvar Lesion 56501  148.62 
     Biopsy of Vagina Lesion  57100  106.54

     

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    Rhinolaryngoscopy

    Test CPT  Fee
    Diagnostic Nasopharyngoscopy with Endoscope 92511  $80.95

     

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    Sigmoidoscopy

    Test CPT  Fee
    Sigmoidoscopy, Flexible Fiberoptic; Diagnostic 45330  106.40 
    Sigmoicoscopy for biopsy and/or Collection of Specimen by Brushing or Washing  45331  130.73

     

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