TABLE J. — PATHOLOGY AND LABORATORY SERVICES … · TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs) v3.25 (January - December 2019) PAGE 1 of 31 NOTES:

TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)

v3.25 (January - December 2019)

PAGE 1 of 31

NOTES: CPT codes and descriptions only are copyright American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

1 - See end of table for note regarding Charge Methodology.

CPT/

HCPCS

Code

Modifier CPT/HCPCS Code Description

Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

36415 Blank COLLECTION VENOUS BLOOD VENIPUNCTURE Pathology 0.08 CLAB

78267 Blank UREA BREATH TEST C-14 ISOTOPIC ACQUISJ ANALYSIS Pathology 0.31 CLAB

78268 Blank UREA BREATH TEST C-14 ISOTOPIC ANALYSIS Pathology 2.62 CLAB

80047 Blank BASIC METABOLIC PANEL CALCIUM IONIZED Pathology 0.38 CLAB

80048 Blank BASIC METABOLIC PANEL CALCIUM TOTAL Pathology 0.29 CLAB

80050 Blank GENERAL HEALTH PANEL Pathology 1.03 FAIR Health

80051 Blank ELECTROLYTE PANEL Pathology 0.24 CLAB

80053 Blank COMPREHENSIVE METABOLIC PANEL Pathology 0.36 CLAB

80055 Blank OBSTETRIC PANEL Pathology 1.64 CLAB

80061 Blank LIPID PANEL Pathology 0.46 CLAB

80069 Blank RENAL FUNCTION PANEL Pathology 0.30 CLAB

80074 Blank ACUTE HEPATITIS PANEL Pathology 1.63 CLAB

80076 Blank HEPATIC FUNCTION PANEL Pathology 0.28 CLAB

80081 Blank OBSTETRIC PANEL Pathology 2.57 CLAB

80150 Blank DRUG SCREEN QUANTITATIVE AMIKACIN Pathology 0.52 CLAB

80155 Blank DRUG ASSAY CAFFEINE Pathology 1.07 CLAB

80156 Blank DRUG ASSAY CARBAMAZEPINE TOTAL Pathology 0.50 CLAB

80157 Blank DRUG ASSAY CARBAMAZEPINE FREE Pathology 0.45 CLAB

80158 Blank DRUG ASSAY CYCLOSPORINE Pathology 0.62 CLAB

80159 Blank DRUG ASSAY CLOZAPINE Pathology 0.63 CLAB

80162 Blank DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL Pathology 0.46 CLAB

80163 Blank DRUG SCREEN QUANTITATIVE DIGOXIN FREE Pathology 0.46 CLAB

80164 Blank DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL Pathology 0.46 CLAB

80165 Blank DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE Pathology 0.46 CLAB

80168 Blank DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE Pathology 0.56 CLAB

80169 Blank DRUG ASSAY EVEROLIMUS Pathology 0.47 CLAB

80170 Blank DRUG SCREEN QUANTITATIVE GENTAMICIN Pathology 0.56 CLAB

80171 Blank DRUG SCREEN QUANTITATIVE GABAPENTIN Pathology 0.60 CLAB

80173 Blank DRUG SCREEN QUANTITATIVE HALOPRIDOL Pathology 0.50 CLAB

80175 Blank DRUG SCREEN QUANTITATIVE LAMOTRIGINE Pathology 0.45 CLAB

80176 Blank DRUG SCREEN QUANTITATIVE LIDOCAINE Pathology 0.50 CLAB

80177 Blank DRUG SCREEN QUANTITATIVE LEVETIRACETAM Pathology 0.45 CLAB

80178 Blank DRUG SCREEN QUANTITATIVE LITHIUM Pathology 0.23 CLAB

80180 Blank DRUG SCREEN QUANTITATIVE MYCOPHENOLATE Pathology 0.62 CLAB

80183 Blank DRUG SCREEN QUANTITATIVE OXCARBAZEPINE Pathology 0.45 CLAB

80184 Blank DRUG SCREEN QUANTITATIVE PHENOBARBITAL Pathology 0.43 CLAB

80185 Blank DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL Pathology 0.45 CLAB

80186 Blank DRUG SCREEN QUANTITATIVE PHENYTOIN FREE Pathology 0.47 CLAB

80188 Blank DRUG SCREEN QUANTITATIVE PRIMIDONE Pathology 0.57 CLAB

80190 Blank DRUG SCREEN QUANTITATIVE PROCAINAMIDE Pathology 1.67 CLAB

80192 Blank DRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITE Pathology 0.57 CLAB

80194 Blank DRUG SCREEN QUANTITATIVE QUINIDINE Pathology 0.50 CLAB

80195 Blank DRUG SCREEN QUANTITATIVE SIROLIMUS Pathology 0.47 CLAB

80197 Blank DRUG SCREEN QUANTITATIVE TACROLIMUS Pathology 0.47 CLAB

80198 Blank DRUG SCREEN QUANTITATIVE THEOPHYLLINE Pathology 0.49 CLAB

80199 Blank DRUG SCREEN QUANTITATIVE TIAGABINE Pathology 0.75 CLAB

80200 Blank DRUG SCREEN QUANTITATIVE TOBRAMYCIN Pathology 0.55 CLAB

80201 Blank DRUG SCREEN QUANTITATIVE TOPIRAMATE Pathology 0.41 CLAB

80202 Blank DRUG SCREEN QUANTITATIVE VANCOMYCIN Pathology 0.46 CLAB



PAGE 2 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

80203 Blank DRUG SCREEN QUANTITATIVE ZONISAMIDE Pathology 0.45 CLAB

80299 Blank QUANTITATION DRUG NOT ELSEWHERE SPECIFIED Pathology 0.52 CLAB

80305 Blank DRUG TEST PRSMV DIR OPT OBS Pathology 0.37 CLAB

80306 Blank DRUG TEST PRSMV INSTRMNT Pathology 0.50 CLAB

80307 Blank DRUG TEST PRSMV CHEM ANLYZR Pathology 2.00 CLAB

80320 Blank DRUG SCREEN QUANTITATIVE ALCOHOLS Pathology 0.48 FAIR Health

80321 Blank DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 Pathology 0.61 FAIR Health

80322 Blank DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 3 OR MORE Pathology 0.87 FAIR Health

80323 Blank ALKALOIDS NOT OTHERWISE SPECIFIED Pathology 0.75 FAIR Health

80324 Blank DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 Pathology 0.60 FAIR Health

80325 Blank DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 Pathology 0.98 FAIR Health

80326 Blank DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE Pathology 1.10 FAIR Health

80327 Blank DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2 Pathology 1.00 FAIR Health

80329 Blank DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 Pathology 0.67 FAIR Health

80330 Blank DRUG SCREEN ANALGESICS NON-OPIOID 3-5 Pathology 0.97 FAIR Health

80331 Blank DRUG SCREEN ANALGESICS NON-OPIOID 6 OR MORE Pathology 0.32 FAIR Health

80332 Blank ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 Pathology 0.59 FAIR Health

80333 Blank ANTIDEPRESSANTS SEROTONERGIC CLASS 3-5 Pathology 0.74 FAIR Health

80334 Blank ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE Pathology 0.74 FAIR Health

80335 Blank ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 Pathology 0.51 FAIR Health

80336 Blank ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 3-5 Pathology 1.47 FAIR Health

80337 Blank ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE Pathology 1.72 FAIR Health

80338 Blank ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED Pathology 0.53 FAIR Health

80339 Blank ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3 Pathology 0.55 FAIR Health

80340 Blank ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 4-6 Pathology 0.60 FAIR Health

80341 Blank ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE Pathology 0.61 FAIR Health

80342 Blank ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 Pathology 0.63 FAIR Health

80343 Blank ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 4-6 Pathology 0.78 FAIR Health

80344 Blank ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 7/MORE Pathology 0.78 FAIR Health

80345 Blank DRUG SCREENING BARBITURATES Pathology 0.64 FAIR Health

80346 Blank DRUG SCREENING BENZODIAZEPINES 1-12 Pathology 0.88 FAIR Health

80347 Blank DRUG SCREENING BENZODIAZEPINES 13 OR MORE Pathology 2.27 FAIR Health

80348 Blank DRUG SCREENING BUPRENORPHINE Pathology 0.68 FAIR Health

80349 Blank DRUG SCREENING CANNABINOIDS NATURAL Pathology 0.55 FAIR Health

80350 Blank DRUG SCREENING CANNABINOIDS SYNTHETIC 1-3 Pathology 0.58 FAIR Health

80351 Blank DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6 Pathology 1.02 FAIR Health

80352 Blank DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE Pathology 1.50 FAIR Health

80353 Blank DRUG SCREENING COCAINE Pathology 0.48 FAIR Health

80354 Blank DRUG SCREENING FENTANYL Pathology 0.66 FAIR Health

80355 Blank DRUG SCREENING GABAPENTIN NON-BLOOD Pathology 0.54 FAIR Health

80356 Blank DRUG SCREENING HEROIN METABOLITE Pathology 0.60 FAIR Health

80357 Blank DRUG SCREENING KETAMINE AND NORKETAMINE Pathology 0.65 FAIR Health

80358 Blank DRUG SCREENING METHADONE Pathology 0.53 FAIR Health

80359 Blank DRUG SCREENING METHYLENEDIOXYAMPHETAMINES Pathology 0.57 FAIR Health

80360 Blank DRUG SCREENING METHYLPHENIDATE Pathology 0.53 FAIR Health

80361 Blank DRUG SCREENING OPIATES 1 OR MORE Pathology 0.91 FAIR Health

80362 Blank DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 Pathology 0.83 FAIR Health

80363 Blank DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 3 OR 4 Pathology 1.23 FAIR Health

80364 Blank DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE Pathology 1.88 FAIR Health





PAGE 3 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

80365 Blank DRUG SCREENING OXYCODONE Pathology 0.58 FAIR Health

80366 Blank DRUG SCREENING PREGABALIN Pathology 0.55 FAIR Health

80367 Blank DRUG SCREENING PROPOXYPHENE Pathology 0.59 FAIR Health

80368 Blank DRUG SCREENING SEDATIVE HYPNOTICS Pathology 0.59 FAIR Health

80369 Blank DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 Pathology 0.70 FAIR Health

80370 Blank DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE Pathology 0.86 FAIR Health

80371 Blank DRUG SCREENING STIMULANTS SYNTHETIC Pathology 0.73 FAIR Health

80372 Blank DRUG SCREENING TAPENTADOL Pathology 0.56 FAIR Health

80373 Blank DRUG SCREENING TRAMADOL Pathology 0.57 FAIR Health

80374 Blank DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS Pathology 0.41 FAIR Health

80375 Blank DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 Pathology 0.68 FAIR Health

80376 Blank DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4-6 Pathology 1.62 FAIR Health

80377 Blank DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE Pathology 0.84 FAIR Health

80400 Blank ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY Pathology 1.12 CLAB

80402 Blank ACTH STIMULATION PANEL 21 HYDROXYLASE DEFICIENCY Pathology 2.98 CLAB

80406 Blank ACTH STIMJ PANEL 3 BETA-HYDROXYDEHYD DEFNCY Pathology 2.68 CLAB

80408 Blank ALDOSTERONE SUPPRESSION EVALUATION PANEL Pathology 4.30 CLAB

80410 Blank CALCITONIN STIMULATION PANEL Pathology 0.92 CLAB

80412 Blank CORTICOTROPIC RELEASING HORM STIMJ PANEL Pathology 22.27 CLAB

80414 Blank CHORNC GONAD STIMJ PANEL TSTOSTERONE RESPONSE Pathology 1.77 CLAB

80415 Blank CHORNC GONAD STIMJ PANEL ESTRADIOL RESPONSE Pathology 1.92 CLAB

80416 Blank RENAL VEIN RENIN STIMULATION PANEL Pathology 5.81 CLAB

80417 Blank PERIPHERAL VEIN RENIN STIMULATION PANEL Pathology 1.51 CLAB

80418 Blank COMBINED RAPID ANT PITUITARY EVALUATION PANEL Pathology 19.87 CLAB

80420 Blank DEXMETHASONE SUPPRESSION PANEL 48 HR Pathology 4.50 CLAB

80422 Blank GLUCOSE TOLERANCE PANEL INSULINOMA Pathology 1.58 CLAB

80424 Blank GLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMA Pathology 1.73 CLAB

80426 Blank GONADOTROPIN RELEASING HORMONE STIMJ PANEL Pathology 5.09 CLAB

80428 Blank GROWTH HORMONE STIMULATION PANEL Pathology 2.29 CLAB

80430 Blank GROWTH HORMONE SUPRJ PANEL GLUCOSE ADMN Pathology 3.59 CLAB

80432 Blank INSULIN-INDUCED C-PEPTIDE SUPRESSION PANEL Pathology 4.63 CLAB

80434 Blank INSULIN TOLERANCE PANEL ACTH INSUFFICIENCY Pathology 7.92 CLAB

80435 Blank INSULIN TOLERANCE PANEL GROWTH HORM DEFNCY Pathology 3.53 CLAB

80436 Blank METYRAPONE PANEL Pathology 3.13 CLAB

80438 Blank THYROTROPIN RELEASING HORMONE STMLJ PANEL 1 HR Pathology 1.73 CLAB

80439 Blank THYROTROPIN RELEASING HORMONE STMLJ PANEL 2 HR Pathology 2.31 CLAB

81000 Blank URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY Pathology 0.11 CLAB

81001 Blank URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY Pathology 0.11 CLAB

81002 Blank URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP Pathology 0.10 CLAB

81003 Blank URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY Pathology 0.08 CLAB

81005 Blank URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS Pathology 0.07 CLAB

81007 Blank URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK Pathology 0.83 CLAB

81015 Blank URINALYSIS MICROSCOPIC ONLY Pathology 0.10 CLAB

81020 Blank URINALYSIS 2/3 GLASS TEST Pathology 0.13 CLAB

81025 Blank URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS Pathology 0.24 CLAB

81050 Blank VOLUME MEASUREMENT TIMED COLLECTION EACH Pathology 0.10 CLAB

81099 Blank UNLISTED URINALYSIS PROCEDURE Pathology 0.10 Unlisted

81105 Blank HPA-1 GENOTYPING Pathology 4.19 CLAB






PAGE 4 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1







81120 Blank IDH1 COMMON VARIANTS Pathology 5.37 CLAB

81121 Blank IDH2 COMMON VARIANTS Pathology 8.22 CLAB

81161 Blank DMD DUPLICATION/DELETION ANALYSIS Pathology 7.75 CLAB

81162 Blank BRCA1&BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS Pathology 62.58 CLAB

81163 Blank BRCA1&2 GENE FULL SEQ ALYS Pathology 66.55 Other

81164 Blank BRCA1&2 GEN FUL DUP/DEL ALYS Pathology 15.36 Other

81165 Blank BRCA1 GENE FULL SEQ ALYS Pathology 36.15 Other

81166 Blank BRCA1 GENE FULL DUP/DEL ALYS Pathology 36.15 Other

81170 Blank ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS Pathology 8.33 CLAB

81175 Blank ASXL1 FULL GENE SEQUENCE Pathology 19.64 CLAB

81176 Blank ASXL1 GENE TARGET SEQ ALYS Pathology 8.30 CLAB

81200 Blank ASPA GENE ANALYSIS COMMON VARIANTS Pathology 1.31 CLAB

81201 Blank APC GENE ANALYSIS FULL GENE SEQUENCE Pathology 21.67 CLAB

81202 Blank APC GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 7.78 CLAB

81203 Blank APC GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 5.56 CLAB

81205 Blank BCKDHB GENE ANALYSIS COMMON VARIANTS Pathology 2.64 CLAB

81206 Blank BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE Pathology 5.62 CLAB

81207 Blank BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE Pathology 4.97 CLAB

81208 Blank BCR/ABL1 OTHER BREAKPNT QUALITATIVE/QUANTITATIVE Pathology 5.96 CLAB

81209 Blank BLM GENE ANALYSIS 2281DEL6INS7 VARIANT Pathology 1.09 CLAB

81210 Blank BRAF GENE ANALYSIS V600 VARIANT(S) Pathology 4.87 CLAB

81212 Blank BRCA1&BRCA2 ANAL 185DELAG5385INSC/6174DELT Pathology 12.22 CLAB

81215 Blank BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT Pathology 10.42 CLAB

81216 Blank BRCA2 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 5.14 CLAB

81217 Blank BRCA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT Pathology 10.42 CLAB

81218 Blank CEBPA GENE ANALYSIS FULL GENE SEQUENCE Pathology 8.30 CLAB

81219 Blank CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 Pathology 4.17 CLAB

81220 Blank CFTR GENE ANALYSIS COMMON VARIANTS Pathology 15.46 CLAB

81221 Blank CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 2.70 CLAB

81222 Blank CFTR GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 12.09 CLAB

81223 Blank CFTR GENE ANALYSIS FULL GENE SEQUENCE Pathology 13.86 CLAB

81224 Blank CFTR GENE ANALYSIS INTRON 8 POLY-T ANALYSIS Pathology 4.69 CLAB

81225 Blank CYP2C19 GENE ANALYSIS COMMON VARIANTS Pathology 8.09 CLAB

81226 Blank CYP2D6 GENE ANALYSIS COMMON VARIANTS Pathology 12.53 CLAB

81227 Blank CYP2C9 GENE ANALYSIS COMMON VARIANTS Pathology 4.86 CLAB

81228 Blank CYTOGENOM CONST MICROARRAY COPY NUMBER VARIANTS Pathology 25.00 CLAB

81229 Blank CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR Pathology 32.22 CLAB

81230 Blank CYP3A4 GENE COMMON VARIANTS Pathology 4.86 CLAB

81231 Blank CYP3A5 GENE COMMON VARIANTS Pathology 4.86 CLAB

81232 Blank DPYD GENE COMMON VARIANTS Pathology 4.86 CLAB

81235 Blank EGFR GENE ANALYSIS COMMON VARIANTS Pathology 9.02 CLAB

81238 Blank F9 FULL GENE SEQUENCE Pathology 16.67 CLAB

81240 Blank F2 GENE ANALYSIS 20210G >A VARIANT Pathology 1.82 CLAB





PAGE 5 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

81241 Blank F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT Pathology 2.10 CLAB

81242 Blank FANCC GENE ANALYSIS COMMON VARIANT Pathology 1.02 CLAB

81243 Blank FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES Pathology 1.58 CLAB

81244 Blank FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES Pathology 1.25 CLAB

81245 Blank FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS Pathology 4.60 CLAB

81246 Blank FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS Pathology 2.31 CLAB

81247 Blank G6PD GENE ALYS CMN VARIANT Pathology 4.86 CLAB

81248 Blank G6PD KNOWN FAMILIAL VARIANT Pathology 10.42 CLAB

81249 Blank G6PD FULL GENE SEQUENCE Pathology 16.67 CLAB

81250 Blank G6PC GENE ANALYSIS COMMON VARIANTS Pathology 1.62 CLAB

81251 Blank GBA GLUCOSIDASE/BETA/ACID ANAL COMM VARIANTS Pathology 1.31 CLAB

81252 Blank GJB2 GENE ANALYSIS FULL GENE SEQUENCE Pathology 2.81 CLAB

81253 Blank GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 1.71 CLAB

81254 Blank GJB6 GENE ANALYSIS COMMON VARIANTS Pathology 0.97 CLAB

81255 Blank HEXA GENE ANALYSIS COMMON VARIANTS Pathology 1.43 CLAB

81256 Blank HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS Pathology 2.24 CLAB

81257 Blank HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT Pathology 2.84 CLAB

81258 Blank HBA1/HBA2 GENE FAM VRNT Pathology 10.42 CLAB

81259 Blank HBA1/HBA2 FULL GENE SEQUENCE Pathology 16.67 CLAB

81260 Blank IKBKAP GENE ANALYSIS COMMON VARIANTS Pathology 1.09 CLAB

81261 Blank IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED Pathology 6.79 CLAB

81262 Blank IGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBE Pathology 1.90 CLAB

81263 Blank IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS Pathology 10.10 CLAB

81264 Blank IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP Pathology 5.12 CLAB

81265 Blank COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC Pathology 7.37 CLAB

81266 Blank COMPARATIVE ANAL STR MARKERS EA ADDL SPECIMEN Pathology 8.47 CLAB

81267 Blank CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION Pathology 7.11 CLAB

81268 Blank CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA Pathology 8.94 CLAB

81269 Blank HBA1/HBA2 GENE DUP/DEL VRNTS Pathology 5.62 CLAB

81270 Blank JAK2 GENE ANALYSIS P.VAL617PHE VARIANT Pathology 3.14 CLAB

81272 Blank KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS Pathology 9.15 CLAB

81273 Blank KIT GENE ANALYSIS D816 VARIANT(S) Pathology 3.47 CLAB

81275 Blank KRAS GENE ANALYSIS VARIANTS IN EXON 2 Pathology 5.37 CLAB

81276 Blank KRAS GENE ANALYSIS ADDITIONAL VARIANT(S) Pathology 5.37 CLAB

81283 Blank IFNL3 GENE Pathology 2.10 CLAB

81287 Blank MGMT METHYLATION ANALYSIS Pathology 3.46 CLAB

81288 Blank MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS Pathology 5.34 CLAB

81290 Blank MCOLN1 MUCOLIPIN1 GENE ANALYSIS COMMON VARIANTS Pathology 1.09 CLAB

81291 Blank MTHFR GENE ANALYSIS COMMON VARIANTS Pathology 1.82 CLAB

81292 Blank MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 18.76 CLAB

81293 Blank MLH1 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 9.19 CLAB

81294 Blank MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 5.62 CLAB

81295 Blank MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 10.60 CLAB

81296 Blank MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 9.38 CLAB

81297 Blank MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 5.93 CLAB

81298 Blank MSH6 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 17.83 CLAB

81299 Blank MSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 8.56 CLAB

81300 Blank MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA Pathology 6.61 CLAB

81301 Blank MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF Pathology 9.93 CLAB





PAGE 6 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

81302 Blank MECP2 GENE ANALYSIS FULL SEQUENCE Pathology 14.66 CLAB

81303 Blank MECP2 GENE ANALYSIS KNOWN FAMILIAL VARIANT Pathology 3.33 CLAB

81304 Blank MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT Pathology 4.17 CLAB

81310 Blank NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS Pathology 6.85 CLAB

81311 Blank NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 Pathology 8.22 CLAB

81313 Blank PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO Pathology 7.08 CLAB

81314 Blank PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS Pathology 9.15 CLAB

81315 Blank PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT Pathology 7.11 CLAB

81316 Blank PML/RARALPHA SINGLE BREAKPOINT QUAL/QUAN Pathology 7.11 CLAB

81317 Blank PMS2 GENE ANALYSIS FULL SEQUENCE Pathology 19.64 CLAB

81318 Blank PMS2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 9.19 CLAB

81319 Blank PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 5.65 CLAB

81321 Blank PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 16.67 CLAB

81322 Blank PTEN GENE ANALYSIS KNOWN FAMILIAL VARIANT Pathology 1.47 CLAB

81323 Blank PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT Pathology 8.33 CLAB

81324 Blank PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS Pathology 21.07 CLAB

81325 Blank PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 21.38 CLAB

81326 Blank PMP22 GENE ANALYSIS KNOWN FAMILIAL VARIANT Pathology 1.47 CLAB

81327 Blank SEPT9 GEN PRMTR MTHYLTN ALYS Pathology 1.94 FAIR Health

81328 Blank SLCO1B1 GENE COM VARIANTS Pathology 4.86 CLAB

81330 Blank SMPD1 GENE ANALYSIS COMMON VARIANTS Pathology 1.31 CLAB

81331 Blank SNRPN/UBE3A METHYLATION ANALYSIS Pathology 1.42 CLAB

81332 Blank SERPINA1 GENE ANALYSIS COMMON VARIANTS Pathology 1.50 CLAB

81334 Blank RUNX1 GENE TARGETED SEQ ALYS Pathology 9.15 CLAB

81335 Blank TPMT GENE COM VARIANTS Pathology 4.86 CLAB

81340 Blank TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD Pathology 7.16 CLAB

81341 Blank TRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGY Pathology 1.70 CLAB

81342 Blank TRG@ GENE REARRANGEMENT ANALYSIS Pathology 6.91 CLAB

81346 Blank TYMS GENE COM VARIANTS Pathology 4.86 CLAB

81350 Blank UGT1A1 GENE ANALYSIS COMMON VARIANTS Pathology 6.50 CLAB

81355 Blank VKORC1 GENE ANALYSIS COMMON VARIANT(S) Pathology 2.45 CLAB

81361 Blank HBB GENE COM VARIANTS Pathology 4.86 CLAB

81362 Blank HBB GENE KNOWN FAM VARIANT Pathology 10.42 CLAB

81363 Blank HBB GENE DUP/DEL VARIANTS Pathology 5.62 CLAB

81364 Blank HBB FULL GENE SEQUENCE Pathology 9.02 CLAB

81370 Blank HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&DQB Pathology 13.79 CLAB

81371 Blank HLA I&LI LOW RESOLUTION HLA-A -B&-DRB1 Pathology 11.24 CLAB

81372 Blank HLA CLASS I TYPING LOW RESOLUTION COMPLETE Pathology 11.21 CLAB

81373 Blank HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH Pathology 3.82 CLAB

81374 Blank HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH Pathology 2.49 CLAB

81375 Blank HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1 Pathology 7.57 CLAB

81376 Blank HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA Pathology 4.19 CLAB

81377 Blank HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA Pathology 3.15 CLAB

81378 Blank HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1 Pathology 11.85 CLAB

81379 Blank HLA CLASS I TYPING HIGH RESOLUTION COMPLETE Pathology 11.50 CLAB

81380 Blank HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EA Pathology 6.08 CLAB

81381 Blank HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP Pathology 4.72 CLAB

81382 Blank HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA Pathology 4.24 CLAB

81383 Blank HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP Pathology 3.74 CLAB





PAGE 7 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

81400 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 Pathology 1.78 CLAB









81410 Blank AORTIC DYSFUNCTION/DILATION GENOMIC SEQ ANALYSIS Pathology 14.00 CLAB

81411 Blank AORTIC DYSFUNCTION/DILATION DUP/DEL ANALYSIS Pathology 37.51 CLAB

81412 Blank ASHKENAZI JEWISH ASSOC DSRDRS GEN SEQ ANAL 9 GEN Pathology 68.02 CLAB

81413 Blank CAR ION CHNNLPATH INC 10 GNS Pathology 20.06 CLAB

81414 Blank CAR ION CHNNLPATH INC 2 GNS Pathology 20.06 CLAB

81415 Blank EXOME SEQUENCE ANALYSIS Pathology 132.78 CLAB

81416 Blank EXOME SEQUENCE ANALYSIS EACH COMPARATOR EXOME Pathology 333.34 CLAB

81417 Blank EXOME RE-EVAL OF PREVIOUSLY OBTAINED EXOME SEQ Pathology 8.89 CLAB

81420 Blank FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS Pathology 21.08 CLAB

81422 Blank FETAL CHRMOML MICRODELTJ Pathology 21.08 CLAB

81430 Blank HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES Pathology 45.14 CLAB

81431 Blank HEARING LOSS DUP/DEL ANALYSIS Pathology 18.88 CLAB

81432 Blank HEREDITARY BRST CA-RELATED GEN SEQ ANALYS 14 GEN Pathology 23.29 CLAB

81433 Blank HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS Pathology 15.05 CLAB

81434 Blank HEREDITARY RETINAL DSRDRS GEN SEQ ANALYS 15 GEN Pathology 16.61 CLAB

81435 Blank HEREDITARY COLON CA DSRDRS GEN SEQ ANALYS 10 GEN Pathology 20.06 CLAB

81436 Blank HEREDITARY COLON CA DSRDRS DUP/DEL ANALYS 5 GEN Pathology 20.06 CLAB

81437 Blank HEREDTRY NURONDCRN TUM DSRDRS GEN SEQ ANAL 6 GEN Pathology 15.05 CLAB

81438 Blank HEREDTRY NURONDCRN TUM DSRDRS DUP/DEL ANALYSIS Pathology 15.05 CLAB

81439 Blank HRDTRY CARDMYPY GENE PANEL Pathology 20.06 CLAB

81440 Blank NUCLEAR MITOCHONDRIAL 100 GENE GENOMIC SEQ Pathology 92.33 CLAB

81442 Blank NOONAN SPECTRUM DISORDERS GEN SEQ ANALYS 12 GEN Pathology 59.55 CLAB

81445 Blank GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE Pathology 16.61 CLAB

81448 Blank HRDTRY PERPH NEURPHY PANEL Pathology 20.06 CLAB

81450 Blank GEN SEQ ANALYS HEMATOLYMPHOID NEO 5-50 GENE Pathology 21.10 CLAB

81455 Blank GEN SEQ ANALYS SOL ORG/HEMTOLMPHOID NEO 51/> GEN Pathology 81.10 CLAB

81460 Blank WHOLE MITOCHONDRIAL GENOME Pathology 35.75 CLAB

81465 Blank WHOLE MITOCHONDRIAL GENOME ANALYSIS PANEL Pathology 26.00 CLAB

81479 Blank UNLISTED MOLELCULAR PATHOLOGY PROCEDURE Pathology 5.14 Unlisted

81490 Blank AUTOIMMUNE RHEUMATOID ARTHRTS ANALYS 12 BIOMRKRS Pathology 23.35 CLAB

81493 Blank COR ART DISEASE MRNA GENE EXPRESSION 23 GENES Pathology 29.17 CLAB

81500 Blank ONCO (OVARIAN) BIOCHEMICAL ASSAY TWO PROTEINS Pathology 7.24 CLAB

81503 Blank ONCO (OVARIAN) BIOCHEMICAL ASSAY FIVE PROTEINS Pathology 24.92 CLAB

81504 Blank ONCOLOGY TISSUE OF ORIGIN SIMILAR SCOR ALGORITHM Pathology 14.44 CLAB

81506 Blank ENDOCRINOLOGY BIOCHEMICAL ASSAY SEVEN ANAL Pathology 2.25 CLAB

81507 Blank FETAL ANEUPLOIDY 21 18 13 SEQ ANALY TRISOM RISK Pathology 22.08 CLAB

81508 Blank FETAL CONGENITAL ABNOR ASSAY TWO PROTEINS Pathology 1.51 CLAB

81509 Blank FETAL CONGENITAL ABNOR ASSAY 3 PROTEINS Pathology 41.32 CLAB

81510 Blank FETAL CONGENITAL ABNOR ASSAY THREE ANAL Pathology 1.54 CLAB

81511 Blank FETAL CONGENITAL ABNOR ASSAY FOUR ANAL Pathology 4.26 CLAB





PAGE 8 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

81512 Blank FETAL CONGENITAL ABNOR ASSAY FIVE ANAL Pathology 1.93 CLAB

81519 Blank ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES Pathology 107.58 CLAB

81520 Blank ONC BREAST MRNA 58 GENES Pathology 86.08 CLAB

81521 Blank ONC BREAST MRNA 70 GENES Pathology 107.58 CLAB

81525 Blank ONCOLOGY COLON MRNA GENE EXPRESSION 12 GENES Pathology 86.56 CLAB

81528 Blank ONCOLOGY COLORECTAL SCREENING QUAN 10 DNA MARKRS Pathology 14.14 CLAB

81535 Blank ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP 1ST Pathology 16.10 CLAB

81536 Blank ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP ADD Pathology 4.93 CLAB

81538 Blank ONCOLOGY LUNG MS 8-PROTEIN SIGNATURE Pathology 79.75 CLAB

81539 Blank ONCOLOGY PROSTATE PROB SCORE Pathology 21.11 CLAB

81540 Blank ONCOLOGY TUM UNKNOWN ORIGIN MRNA 92 GENES Pathology 104.17 CLAB

81541 Blank ONC PROSTATE MRNA 46 GENES Pathology 107.58 CLAB

81545 Blank ONCOLOGY THYROID GENE EXPRESSION 142 GENES Pathology 100.00 CLAB

81551 Blank ONC PROSTATE 3 GENES Pathology 23.39 FAIR Health

81595 Blank CARDIOLOGY HRT TRNSPL MRNA GENE EXPRESS 20 GENES Pathology 90.00 CLAB

81599 Blank UNLISTED MULTIANALYTE ASSAY ALGORITHMIC ANALYSIS Pathology 1.23 Unlisted

82009 Blank KETONE BODIES SERUM QUALITATIVE Pathology 0.16 CLAB

82010 Blank KETONE BODIES SERUM QUANTITATIVE Pathology 0.28 CLAB

82013 Blank ASSAY OF ACETYLCHOLINESTERASE Pathology 0.38 CLAB

82016 Blank ACYLCARNITINES QUALITATIVE EACH SPECIMEN Pathology 0.48 CLAB

82017 Blank ACYLCARNITINES QUANTIATIVE EACH SPECIMEN Pathology 0.58 CLAB

82024 Blank ADRENOCORTICOTROPIC HORMONE ACTH Pathology 1.32 CLAB

82030 Blank ADENOSINE 5-MONOPHOSPHATE CYCLIC Pathology 0.88 CLAB

82040 Blank ALBUMIN SERUM PLASMA/WHOLE BLOOD Pathology 0.17 CLAB

82042 Blank ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN Pathology 0.22 CLAB

82043 Blank ALBUMIN URINE MICROALBUMIN QUANTIATIVE Pathology 0.20 CLAB

82044 Blank ALBUMIN URINE MICROALBUMIN SEMIQUANTITATIVE Pathology 0.17 CLAB

82045 Blank ALBUMIN ISCHEMIA MODIFIED Pathology 1.16 CLAB

82075 Blank ASSAY OF ALCOHOL BREATH Pathology 0.83 CLAB

82085 Blank ASSAY OF ALDOLASE Pathology 0.33 CLAB

82088 Blank ASSAY OF ALDOSTERONE Pathology 1.40 CLAB

82103 Blank ALPHA-1-ANTITRYPSIN TOTAL Pathology 0.46 CLAB

82104 Blank ALPHA-1-ANTITRYPSIN PHENOTYPE Pathology 0.50 CLAB

82105 Blank ALPHA-FETOPROTEIN SERUM Pathology 0.58 CLAB

82106 Blank ALPHA-FETOPROTEIN AMNIOTIC FLUID Pathology 0.58 CLAB

82107 Blank AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO Pathology 2.21 CLAB

82108 Blank ASSAY OF ALUMINUM Pathology 0.87 CLAB

82120 Blank AMINES VAGINAL FLUID QUALITATIVE Pathology 0.17 CLAB

82127 Blank AMINO ACIDS 1 QUALITATIVE EACH SPECIMEN Pathology 0.48 CLAB

82128 Blank AMINO ACIDS MULTIPLE QUALITATIVE EACH SPECIMEN Pathology 0.48 CLAB

82131 Blank AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN Pathology 0.64 CLAB

82135 Blank AMINOLEVULINIC ACID DELTA Pathology 0.56 CLAB

82136 Blank AMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPEC Pathology 0.58 CLAB

82139 Blank AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE Pathology 0.58 CLAB

82140 Blank ASSAY OF AMMONIA Pathology 0.50 CLAB

82143 Blank AMNIOTIC FLU SCAN Pathology 0.26 CLAB

82150 Blank ASSAY OF AMYLASE Pathology 0.22 CLAB

82154 Blank ANDROSTANEDIOL GLUCURONIDE Pathology 0.99 CLAB

82157 Blank ANDROSTENEDIONE Pathology 1.00 CLAB





PAGE 9 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

82160 Blank ANDROSTERONE Pathology 0.86 CLAB

82163 Blank ANGIOTENSIN II Pathology 0.70 CLAB

82164 Blank ANGIOTENSIN I-CONVERTING ENZYME Pathology 0.50 CLAB

82172 Blank APOLIPOPROTEIN EACH Pathology 0.59 CLAB

82175 Blank ASSAY OF ARSENIC Pathology 0.65 CLAB

82180 Blank ASSAY OF ASCORBIC ACID BLOOD Pathology 0.34 CLAB

82190 Blank ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE Pathology 0.51 CLAB

82232 Blank BETA-2 MICROGLOBULIN Pathology 0.55 CLAB

82239 Blank BILE ACIDS TOTAL Pathology 0.59 CLAB

82240 Blank BILE ACIDS CHOLYLGLYCINE Pathology 0.91 CLAB

82247 Blank BILIRUBIN TOTAL Pathology 0.17 CLAB

82248 Blank BILIRUBIN DIRECT Pathology 0.17 CLAB

82252 Blank BILIRUBIN FECES QUALITATIVE Pathology 0.16 CLAB

82261 Blank BIOTINIDASE EACH SPECIMEN Pathology 0.58 CLAB

82270 Blank BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER Pathology 0.12 CLAB

82271 Blank BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES Pathology 0.15 CLAB

82272 Blank BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC Pathology 0.12 CLAB

82274 Blank BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 Pathology 0.55 CLAB

82286 Blank BRADYKININ Pathology 0.18 CLAB

82300 Blank CADMIUM Pathology 0.79 CLAB

82306 Blank 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED Pathology 1.02 CLAB

82308 Blank CALCITONIN Pathology 0.92 CLAB

82310 Blank CALCIUM TOTAL Pathology 0.18 CLAB

82330 Blank CALCIUM IONIZED Pathology 0.47 CLAB

82331 Blank CALCIUM AFTER CALCIUM INFUSION TEST Pathology 0.37 CLAB

82340 Blank CALCIUM URINE QUANTITATIVE TIMED SPECIMEN Pathology 0.21 CLAB

82355 Blank CALCULUS QUALITATIVE ANALYSIS Pathology 0.40 CLAB

82360 Blank CALCULUS QUANTITATIVE CHEMICAL Pathology 0.44 CLAB

82365 Blank CALCULUS INFRARED SPECTROSCOPY Pathology 0.44 CLAB

82370 Blank CALCULUS XRAY DIFFRACTION Pathology 0.43 CLAB

82373 Blank CARBOHYDRATE DEFICIENT TRANSFERRIN Pathology 0.62 CLAB

82374 Blank CARBON DIOXIDE BICARBONATE Pathology 0.17 CLAB

82375 Blank CARBOXYHEMOGLOBIN QUANTITATIVE Pathology 0.42 CLAB

82376 Blank CARBOXYHEMOGLOBIN QUALITATIVE Pathology 0.39 CLAB

82378 Blank CARCINOEMBRYONIC ANTIGEN CEA Pathology 0.65 CLAB

82379 Blank CARNITINE QUANTITATIVE EACH SPECIMEN Pathology 0.58 CLAB

82380 Blank CAROTENE Pathology 0.32 CLAB

82382 Blank CATECHOLAMINES TOTAL URINE Pathology 0.76 CLAB

82383 Blank CATECHOLAMINES BLOOD Pathology 0.86 CLAB

82384 Blank CATECHOLAMINES FRACTIONATED Pathology 0.87 CLAB

82387 Blank CATHEPSIN-D Pathology 0.62 CLAB

82390 Blank CERULOPLASMIN Pathology 0.37 CLAB

82397 Blank CHEMILUMINESCENT ASSAY Pathology 0.48 CLAB

82415 Blank CHLORAMPHENICOL Pathology 0.43 CLAB

82435 Blank CHLORIDE BLD Pathology 0.16 CLAB

82436 Blank CHLORIDE URINE Pathology 0.17 CLAB

82438 Blank CHLORIDE OTHER SOURCE Pathology 0.17 CLAB

82441 Blank CHLORINATED HYDROCARBONS SCREEN Pathology 0.21 CLAB

82465 Blank CHOLESTEROL SERUM/WHOLE BLOOD TOTAL Pathology 0.15 CLAB





PAGE 10 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

82480 Blank CHOLINESTERASE SERUM Pathology 0.27 CLAB

82482 Blank CHOLINESTERASE RBC Pathology 0.27 CLAB

82485 Blank CHONDROITIN B SULFATE QUANTITATIVE Pathology 0.71 CLAB

82495 Blank ASSAY OF CHROMIUM Pathology 0.70 CLAB

82507 Blank ASSAY OF CITRATE Pathology 0.95 CLAB

82523 Blank COLLAGEN CROSS LINKS ANY METHOD Pathology 0.64 CLAB

82525 Blank ASSAY OF COPPER Pathology 0.43 CLAB

82528 Blank CORTICOSTERONE Pathology 0.77 CLAB

82530 Blank CORTISOL FREE Pathology 0.57 CLAB

82533 Blank CORTISOL TOTAL Pathology 0.56 CLAB

82540 Blank ASSAY OF CREATINE Pathology 0.16 CLAB

82542 Blank COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC Pathology 0.67 CLAB

82550 Blank CREATINE KINASE TOTAL Pathology 0.22 CLAB

82552 Blank CREATINE KINASE ISOENZYMES Pathology 0.46 CLAB

82553 Blank CREATINE KINASE MB FRACTION ONLY Pathology 0.40 CLAB

82554 Blank CREATINE KINASE ISOFORMS Pathology 0.41 CLAB

82565 Blank CREATININE BLOOD Pathology 0.18 CLAB

82570 Blank CREATININE OTHER SOURCE Pathology 0.18 CLAB

82575 Blank CREATININE CLEARANCE Pathology 0.32 CLAB

82585 Blank ASSAY OF CRYOFIBRN Pathology 0.39 CLAB

82595 Blank CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE Pathology 0.22 CLAB

82600 Blank ASSAY OF CYANIDE Pathology 0.67 CLAB

82607 Blank CYANOCOBALAMIN VITAMIN B-12 Pathology 0.52 CLAB

82608 Blank CYANOCOBALAMIN VIT B-12 UNSAT BINDING CAPACITY Pathology 0.49 CLAB

82610 Blank CYSTATIN C Pathology 0.51 CLAB

82615 Blank CSTINE&HOMOCSTINE URINE QUALITATIVE Pathology 0.28 CLAB

82626 Blank DEHYDROEPIANDROSTERONE Pathology 0.87 CLAB

82627 Blank DEHYDROEPIANDROSTERONE-SULFATE Pathology 0.76 CLAB

82633 Blank DESOXYCORTICOSTERONE 11- Pathology 1.06 CLAB

82634 Blank DEOXYCORTISOL 11- Pathology 1.00 CLAB

82638 Blank ASSAY OF DIBUCAINE NUMBER Pathology 0.42 CLAB

82652 Blank 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED Pathology 1.32 CLAB

82656 Blank ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN Pathology 0.40 CLAB

82657 Blank NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA Pathology 0.62 CLAB

82658 Blank NZYM ACTV BLOOD CELLS/TISS RADACT SUBSTRATE EA Pathology 1.22 CLAB

82664 Blank ELCTROPHORETIC TECHNIQUE NOT ELSEWHERE SPECIFIED Pathology 1.71 CLAB

82668 Blank ASSAY OF ERYTHROPOIETIN Pathology 0.64 CLAB

82670 Blank ASSAY OF ESTRADIOL Pathology 0.96 CLAB

82671 Blank ASSAY OF ESTROGENS FRACTIONATED Pathology 1.11 CLAB

82672 Blank ASSAY OF ESTROGENS TOTAL Pathology 0.74 CLAB

82677 Blank ASSAY OF ESTRIOL Pathology 0.83 CLAB

82679 Blank ASSAY OF ESTRONE Pathology 0.86 CLAB

82693 Blank ASSAY OF ETHYLENE GLYCOL Pathology 0.51 CLAB

82696 Blank ASSAY OF ETIOCHOLANOLONE Pathology 0.81 CLAB

82705 Blank FAT/LIPIDS FECES QUALITATIVE Pathology 0.17 CLAB

82710 Blank FAT/LIPIDS FECES QUANTITATIVE Pathology 0.58 CLAB

82715 Blank FAT DIFFIAL FECES QUANTITATIVE Pathology 0.64 CLAB

82725 Blank FATTY ACIDS NONESTERIFIED Pathology 0.52 CLAB

82726 Blank VERY LONG CHAIN FATTY ACIDS Pathology 0.62 CLAB





PAGE 11 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

82728 Blank ASSAY OF FERRITIN Pathology 0.47 CLAB

82731 Blank FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN Pathology 2.21 CLAB

82735 Blank ASSAY OF FLUORIDE Pathology 0.64 CLAB

82746 Blank ASSAY OF FOLIC ACID SERUM Pathology 0.50 CLAB

82747 Blank ASSAY OF FOLIC ACID RBC Pathology 0.59 CLAB

82757 Blank ASSAY OF FRUCTOSE SEMEN Pathology 0.59 CLAB

82759 Blank ASSAY OF GALACTOKINASE RBC Pathology 0.74 CLAB

82760 Blank ASSAY OF GALACTOSE Pathology 0.38 CLAB

82775 Blank GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE QUAN Pathology 0.72 CLAB

82776 Blank GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE SCREEN Pathology 0.33 CLAB

82777 Blank GALECTIN-3 Pathology 1.23 CLAB

82784 Blank ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH Pathology 0.32 CLAB

82785 Blank ASSAY OF GAMMAGLOBULIN IGE Pathology 0.56 CLAB

82787 Blank GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES Pathology 0.28 CLAB

82800 Blank GASES BLOOD PH ONLY Pathology 0.31 CLAB

82803 Blank BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 Pathology 0.72 CLAB

82805 Blank GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY Pathology 2.19 CLAB

82810 Blank GASES BLOOD O2 SATURATION ONLY DIRECT MEAS Pathology 0.30 CLAB

82820 Blank HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN Pathology 0.37 CLAB

82930 Blank GASTRIC ACID ANALYIS W/PH EACH SPECIMEN Pathology 0.19 CLAB

82938 Blank GASTRIN AFTER SECRETIN STIMULATION Pathology 0.61 CLAB

82941 Blank ASSAY OF GASTRIN Pathology 0.60 CLAB

82943 Blank ASSAY OF GLUCAGON Pathology 0.49 CLAB

82945 Blank GLUCOSE BODY FLUID OTHER THAN BLOOD Pathology 0.13 CLAB

82946 Blank GLUCOSE TOLERANCE TEST Pathology 0.52 CLAB

82947 Blank GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP Pathology 0.13 CLAB

82948 Blank GLUCOSE BLOOD REAGENT STRIP Pathology 0.14 CLAB

82950 Blank GLUCOSE POST GLUCOSE DOSE Pathology 0.16 CLAB

82951 Blank GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS Pathology 0.44 CLAB

82952 Blank GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS Pathology 0.13 CLAB

82955 Blank GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE Pathology 0.33 CLAB

82960 Blank GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN Pathology 0.21 CLAB

82962 Blank GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE Pathology 0.09 CLAB

82963 Blank ASSAY OF GLUCOSIDASE BETA Pathology 0.74 CLAB

82965 Blank ASSAY OF GLUTAMATE DEHYDROGENASE Pathology 0.37 CLAB

82977 Blank ASSAY OF GLUTAMYLTRASE GAMMA Pathology 0.25 CLAB

82978 Blank ASSAY OF GLUTATHIONE Pathology 0.49 CLAB

82979 Blank ASSAY OF GLUTATHIONE REDUCTASE RBC Pathology 0.32 CLAB

82985 Blank ASSAY OF GLYCATED PROTEIN Pathology 0.52 CLAB

83001 Blank GONADOTROPIN FOLLICLE STIMULATING HORMONE Pathology 0.64 CLAB

83002 Blank GONADOTROPIN LUTEINIZING HORMONE Pathology 0.64 CLAB

83003 Blank ASSAY OF GROWTH HORMONE HUMAN Pathology 0.57 CLAB

83006 Blank GROWTH STIMULATION EXPRESSED GENE 2 Pathology 2.10 CLAB

83009 Blank HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE Pathology 2.31 CLAB

83010 Blank ASSAY OF HAPTOGLOBIN QUANTITATIVE Pathology 0.43 CLAB

83012 Blank ASSAY OF HAPTOGLOBIN PHENOTYPES Pathology 0.75 CLAB

83013 Blank HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE Pathology 2.31 CLAB

83014 Blank HPYLORI DRUG ADMINISTRATION Pathology 0.27 CLAB

83015 Blank HEAVY METAL SCREEN Pathology 0.65 CLAB





PAGE 12 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

83018 Blank HEAVY METAL QUANTIATIVE EACH Pathology 0.75 CLAB

83020 Blank HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS Pathology 0.44 CLAB

83021 Blank HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY Pathology 0.62 CLAB

83026 Blank HEMOGLOBIN COPPER SULFATE METHOD NON-AUTOMATED Pathology 0.11 CLAB

83030 Blank HEMOGLOBIN F FETAL CHEMICAL Pathology 0.30 CLAB

83033 Blank HEMOGLOBIN F FETAL QUALITATIVE Pathology 0.22 CLAB

83036 Blank HEMOGLOBIN GLYCOSYLATED A1C Pathology 0.33 CLAB

83037 Blank HGB GLYCOSYLATED DEVICE CLEARED FDA HOME USE Pathology 0.33 CLAB

83045 Blank HEMOGLOBIN METHEMOGLOBIN QUALITATIVE Pathology 0.18 CLAB

83050 Blank HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE Pathology 0.25 CLAB

83051 Blank ASSAY OF HEMOGLOBIN PLASMA Pathology 0.25 CLAB

83060 Blank HEMOGLOBIN SULFHEMOGLOBIN QUANTITATIVE Pathology 0.28 CLAB

83065 Blank HEMOGLOBIN THERMOLABILE Pathology 0.25 CLAB

83068 Blank HEMOGLOBIN UNSTABLE SCREEN Pathology 0.29 CLAB

83069 Blank ASSAY OF HEMOGLOBIN URINE Pathology 0.14 CLAB

83070 Blank ASSAY OF HEMOSIDERIN QUALITATIVE Pathology 0.16 CLAB

83080 Blank ASSAY OF B-HEXOSAMINIDASE EACH ASSAY Pathology 0.58 CLAB

83088 Blank ASSAY OF HISTAMINE Pathology 1.01 CLAB

83090 Blank ASSAY OF HOMOCYSTEINE Pathology 0.58 CLAB

83150 Blank ASSAY OF HOMOVANILLIC ACID Pathology 0.66 CLAB

83491 Blank HYDROXYCORTICOSTEROIDS 17 Pathology 0.60 CLAB

83497 Blank ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA Pathology 0.44 CLAB

83498 Blank ASSAY OF HYDROXYPROGESTERONE 17-D Pathology 0.93 CLAB

83500 Blank ASSAY OF HYDROXYPROLINE FREE Pathology 0.78 CLAB

83505 Blank ASSAY OF HYDROXYPROLINE TOTAL Pathology 0.83 CLAB

83516 Blank IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP Pathology 0.40 CLAB

83518 Blank IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP Pathology 0.29 CLAB

83519 Blank IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY Pathology 0.51 CLAB

83520 Blank IMMUNOASSAY ANALYTE QUANTITATIVE NOS Pathology 0.48 CLAB

83525 Blank ASSAY OF INSULIN TOTAL Pathology 0.39 CLAB

83527 Blank ASSAY OF INSULIN FREE Pathology 0.44 CLAB

83528 Blank ASSAY OF INTRINSIC FACTOR Pathology 0.55 CLAB

83540 Blank ASSAY OF IRON Pathology 0.22 CLAB

83550 Blank IRON BINDING CAPACITY Pathology 0.30 CLAB

83570 Blank ISOCITRIC DEHYDROGENASE Pathology 0.30 CLAB

83582 Blank ASSAY OF KETOGENIC STEROIDS FRACTIONATION Pathology 0.49 CLAB

83586 Blank ASSAY OF KETOSTEROIDS 17- TOTAL Pathology 0.44 CLAB

83593 Blank KETOSTEROIDS 17- FRACTIONATION Pathology 0.90 CLAB

83605 Blank ASSAY OF LACTATE Pathology 0.37 CLAB

83615 Blank LACTATE DEHYDROGENASE LDH Pathology 0.21 CLAB

83625 Blank LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN Pathology 0.44 CLAB

83630 Blank LACTOFERRIN FECAL QUALITATIVE Pathology 0.67 CLAB

83631 Blank LACTOFERRIN FECAL QUANTITATIVE Pathology 0.67 CLAB

83632 Blank LACTOGEN HPL HUMAN CHORIONIC SOMATOMAMMOTROPIN Pathology 0.69 CLAB

83633 Blank LACTOSE URINE QUALITATIVE Pathology 0.31 CLAB

83655 Blank ASSAY OF LEAD Pathology 0.42 CLAB

83661 Blank FETAL LUNG MATURITY LECITHIN SPHINGOMYELIN RATIO Pathology 0.75 CLAB

83662 Blank FETAL LUNG MATURITY FOAM STABILITY TEST Pathology 0.65 CLAB

83663 Blank FETAL LUNG MATURITY FLUORESCENCE POLARIZATION Pathology 0.65 CLAB





PAGE 13 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

83664 Blank FETAL LUNG MATURITY LAMELLAR BODY DENSITY Pathology 0.65 CLAB

83670 Blank LEUCINE AMINOPEPTIDASE LAP Pathology 0.31 CLAB

83690 Blank ASSAY OF LIPASE Pathology 0.24 CLAB

83695 Blank LIPOPROTEIN (A) Pathology 0.44 CLAB

83698 Blank LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 Pathology 1.29 CLAB

83700 Blank LIPOPROTEIN BLOOD ELECTROPHORECTIC SEP&QUAN Pathology 0.39 CLAB

83701 Blank LIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASS Pathology 0.94 CLAB

83704 Blank LIPOPROTEIN BLOOD QUAN NUMBERS&SUBCLASSES Pathology 1.08 CLAB

83718 Blank LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL Pathology 0.28 CLAB

83719 Blank LIPOPROTEIN DIRECT MEASUREMENT VLDL CHOLESTEROL Pathology 0.40 CLAB

83721 Blank LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL Pathology 0.33 CLAB

83727 Blank LUTEINIZING RELEASING FACTOR Pathology 0.59 CLAB

83735 Blank ASSAY OF MAGNESIUM Pathology 0.23 CLAB

83775 Blank ASSAY OF MALATE DEHYDROGENASE Pathology 0.25 CLAB

83785 Blank ASSAY OF MANGANESE Pathology 0.84 CLAB

83789 Blank MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA Pathology 0.67 CLAB

83825 Blank ASSAY OF MERCURY QUANTITATIVE Pathology 0.56 CLAB

83835 Blank METANEPHRINES Pathology 0.58 CLAB

83857 Blank METHEMALBUMIN Pathology 0.37 CLAB

83861 Blank MICROFLUIDIC ANALYSIS TEAR OSMOLARITY Pathology 0.62 CLAB

83864 Blank MUCOPOLYSACCHARIDES ACID QUANTITATIVE Pathology 0.79 CLAB

83872 Blank MUCIN SYNOVIAL FLUID ROPES TEST Pathology 0.20 CLAB

83873 Blank MYELIN BASIC PROTEIN CEREBROSPINAL FLUID Pathology 0.59 CLAB

83874 Blank MYOGLOBIN Pathology 0.44 CLAB

83876 Blank MYELOPEROXIDASE MPO Pathology 1.41 CLAB

83880 Blank NATRIURETIC PEPTIDE Pathology 1.16 CLAB

83883 Blank ASSAY OF NEPHELOMETRY EACH ANALYTE NES Pathology 0.47 CLAB

83885 Blank ASSAY OF NICKEL Pathology 0.84 CLAB

83915 Blank ASSAY OF NUCLEOTIDASE 5'- Pathology 0.38 CLAB

83916 Blank OLIGOCLONAL IMMUNE Pathology 0.76 CLAB

83918 Blank ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN Pathology 0.66 CLAB

83919 Blank ORGANIC ACIDS QUALITATIVE EACH SPECIMEN Pathology 0.56 CLAB

83921 Blank ORGANIC ACID 1 QUANTITATIVE Pathology 0.59 CLAB

83930 Blank ASSAY OF OSMOLALITY BLOOD Pathology 0.23 CLAB

83935 Blank ASSAY OF OSMOLALITY URINE Pathology 0.23 CLAB

83937 Blank ASSAY OF OSTEOCALCIN Pathology 1.02 CLAB

83945 Blank ASSAY OF OXALATE Pathology 0.44 CLAB

83950 Blank ONCOPROTEIN HER-2/NEU Pathology 2.21 CLAB

83951 Blank ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP Pathology 2.21 CLAB

83970 Blank ASSAY OF PARATHORMONE Pathology 1.42 CLAB

83986 Blank PH BODY FLUID NOT ELSEWHERE SPECIFIED Pathology 0.12 CLAB

83987 Blank PH EXHALED BREATH CONDENSATE Pathology 0.12 CLAB

83992 Blank ASSAY OF PHENCYCLIDINE Pathology 0.42 FAIR Health

83993 Blank ASSAY OF CALPROTECTIN FECAL Pathology 0.67 CLAB

84030 Blank ASSAY OF PHENYLALANINE BLOOD Pathology 0.19 CLAB

84035 Blank ASSAY OF PHENYLKETONES QUALITATIVE Pathology 0.13 CLAB

84060 Blank ASSAY OF PHOSPHATASE ACID TOTAL Pathology 0.25 CLAB

84066 Blank ASSAY OF PHOSPHATASE ACID PROSTATIC Pathology 0.33 CLAB

84075 Blank ASSAY OF PHOSPHATASE ALKALINE Pathology 0.18 CLAB





PAGE 14 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

84078 Blank ASSAY OF PHOSPHATASE ALKALINE HEAT STABLE Pathology 0.25 CLAB

84080 Blank ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES Pathology 0.51 CLAB

84081 Blank PHOSPHATIDYLGLYCEROL Pathology 0.57 CLAB

84085 Blank PHOSPHOGLUCONATE 6-DEHYD RBC Pathology 0.32 CLAB

84087 Blank ASSAY OF PHOSPHOHEXOSE ISOMERASE Pathology 0.35 CLAB

84100 Blank ASSAY OF PHOSPHORUS INORGANIC Pathology 0.16 CLAB

84105 Blank ASSAY OF PHOSPHORUS INORGANIC URINE Pathology 0.18 CLAB

84106 Blank PORPHOBILINOGEN URINE QUALITATIVE Pathology 0.16 CLAB

84110 Blank ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE Pathology 0.29 CLAB

84112 Blank EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN Pathology 2.73 CLAB

84119 Blank PORPHYRINS URINE QUALITATAIVE Pathology 0.37 CLAB

84120 Blank PORPHYRINS URINE QUANTITATION & FRACTIONATION Pathology 0.50 CLAB

84126 Blank PORPHYRINS FECES QUANTITATIVE Pathology 1.09 CLAB

84132 Blank POTASSIUM SERUM PLASMA/WHOLE BLOOD Pathology 0.16 CLAB

84133 Blank POTASSIUM URINE Pathology 0.15 CLAB

84134 Blank PREALBUMIN Pathology 0.50 CLAB

84135 Blank PREGNANEDIOL Pathology 0.66 CLAB

84138 Blank PREGNANETRIOL Pathology 0.65 CLAB

84140 Blank PREGNENOLONE Pathology 0.71 CLAB

84143 Blank 17-HYDROXYPREGNENOLONE Pathology 0.78 CLAB

84144 Blank ASSAY OF PROGESTERONE Pathology 0.72 CLAB

84145 Blank PROCALCITONIN (PCT) Pathology 0.92 CLAB

84146 Blank ASSAY OF PROLACTIN Pathology 0.66 CLAB

84150 Blank ASSAY OF PROSTAGLNDIN EACH Pathology 1.16 CLAB

84152 Blank ASSAY OF PROSTATE SPECIFIC ANTIGEN COMPLEXED Pathology 0.63 CLAB

84153 Blank ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL Pathology 0.63 CLAB

84154 Blank ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE Pathology 0.63 CLAB

84155 Blank PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD Pathology 0.13 CLAB

84156 Blank PROTEIN TOTAL XCPT REFRACTOMETRY URINE Pathology 0.13 CLAB

84157 Blank PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC Pathology 0.13 CLAB

84160 Blank PROTEIN TOTAL REFRACTOMETRY ANY SRC Pathology 0.18 CLAB

84163 Blank PREGNANCY-ASSOCIATED PLASMA PROTEIN-A Pathology 0.52 CLAB

84165 Blank PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM Pathology 0.37 CLAB

84166 Blank PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI Pathology 0.61 CLAB

84181 Blank PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID Pathology 0.58 CLAB

84182 Blank PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL Pathology 0.81 CLAB

84202 Blank PROTOPORPHYRIN RBC QUANTITATIVE Pathology 0.49 CLAB

84203 Blank PROTOPORPHYRIN RBC SCREEN Pathology 0.30 CLAB

84206 Blank ASSAY OF PROINSULIN Pathology 0.74 CLAB

84207 Blank ASSAY OF PYRIDOXAL PHOSPHATE Pathology 0.96 CLAB

84210 Blank ASSAY OF PYRUVATE Pathology 0.40 CLAB

84220 Blank ASSAY OF PYRUVATE KINASE Pathology 0.32 CLAB

84228 Blank ASSAY OF QUININE Pathology 0.40 CLAB

84233 Blank ASSAY OF RECEPTOR ASSAY ESTROGEN Pathology 2.44 CLAB

84234 Blank ASSAY OF RECEPTOR ASSAY PROGESTERONE Pathology 2.23 CLAB

84235 Blank RECEPTOR ASSAY ENDOCRINE OTH/THN ESTRGN/PROGST Pathology 1.98 CLAB

84238 Blank RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR Pathology 1.25 CLAB

84244 Blank ASSAY OF RENIN Pathology 0.75 CLAB

84252 Blank ASSAY OF RIBOFLAVIN-VITAMIN B-2 Pathology 0.69 CLAB





PAGE 15 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

84255 Blank ASSAY OF SELENIUM Pathology 0.88 CLAB

84260 Blank ASSAY OF SEROTONIN Pathology 1.06 CLAB

84270 Blank ASSAY OF SEX HORMONE BINDING GLOBULIN Pathology 0.75 CLAB

84275 Blank ASSAY OF SIALIC ACID Pathology 0.46 CLAB

84285 Blank ASSAY OF SILICA Pathology 0.81 CLAB

84295 Blank SODIUM SERUM PLASMA OR WHOLE BLOOD Pathology 0.17 CLAB

84300 Blank ASSAY OF URINE SODIUM Pathology 0.17 CLAB

84302 Blank ASSAY OF SODIUM OTHER SOURCE Pathology 0.17 CLAB

84305 Blank ASSAY OF SOMATOMEDIN Pathology 0.73 CLAB

84307 Blank ASSAY OF SOMATOSTATIN Pathology 0.63 CLAB

84311 Blank SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED Pathology 0.24 CLAB

84315 Blank SPECIFIC GRAVITY EXCEPT URINE Pathology 0.09 CLAB

84375 Blank SUGARS CHROMATOGRAPHIC TLC/PAPER CHROMATOGRAPHY Pathology 1.08 CLAB

84376 Blank SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC Pathology 0.19 CLAB

84377 Blank SUGARS MONO DI&OLIGOS MLT QUALITATIVE EACH SPE Pathology 0.19 CLAB

84378 Blank SUGARS MONO DI&OLIGOS 1 QUANTITATIVE EACH SPEC Pathology 0.40 CLAB

84379 Blank SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC Pathology 0.40 CLAB

84392 Blank ASSAY OF SULFATE URINE Pathology 0.16 CLAB

84402 Blank ASSAY OF TESTOSTERONE FREE Pathology 0.87 CLAB

84403 Blank ASSAY OF TESTOSTERONE TOTAL Pathology 0.89 CLAB

84410 Blank TESTOSTERONE BIOAVAILABLE Pathology 1.76 CLAB

84425 Blank ASSAY OF THIAMINE-VITAMIN B-1 Pathology 0.73 CLAB

84430 Blank ASSAY OF THIOCYANATE Pathology 0.40 CLAB

84431 Blank THROMBOXANE METABOLITE W/WO THROMBOXANE URINE Pathology 0.98 CLAB

84432 Blank ASSAY OF THYROGLOBULIN Pathology 0.55 CLAB

84436 Blank ASSAY OF THYROXINE TOTAL Pathology 0.24 CLAB

84437 Blank ASSAY OF THYROXINE REQUIRING ELUTION Pathology 0.22 CLAB

84439 Blank ASSAY OF FREE THYROXINE Pathology 0.31 CLAB

84442 Blank ASSAY OF THYROXINE BINDING GLOBULIN Pathology 0.51 CLAB

84443 Blank ASSAY OF THYROID STIMULATING HORMONE TSH Pathology 0.58 CLAB

84445 Blank THYROID STIMULATING IMMUNE GLOBULINS TSI Pathology 1.74 CLAB

84446 Blank ASSAY OF TOCOPHEROL ALPHA VITAMIN E Pathology 0.49 CLAB

84449 Blank ASSAY OF TRANSCORTIN CORTISOL BINDING GLOBULIN Pathology 0.62 CLAB

84450 Blank TRANSFERASE ASPARTATE AMINO AST SGOT Pathology 0.18 CLAB

84460 Blank TRANSFERASE ALANINE AMINO ALT SGPT Pathology 0.18 CLAB

84466 Blank ASSAY OF L7383TRANSFERRIN Pathology 0.44 CLAB

84478 Blank ASSAY OF TRIGLYCERIDES Pathology 0.20 CLAB

84479 Blank THYROID HORM UPTK/THYROID HORMONE BINDING RATIO Pathology 0.22 CLAB

84480 Blank ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 Pathology 0.49 CLAB

84481 Blank ASSAY OF TRIIODOTHYRONINE T3 FREE Pathology 0.58 CLAB

84482 Blank TRIIODOTHYRONINE T3 REVERSE Pathology 0.54 CLAB

84484 Blank ASSAY OF TROPONIN QUANTITATIVE Pathology 0.35 CLAB

84485 Blank ASSAY OF TRYPSIN DUODENAL FLUID Pathology 0.25 CLAB

84488 Blank ASSAY OF TRYPSIN FECES QUALITATIVE Pathology 0.25 CLAB

84490 Blank TRYPSIN FECES QUANTITATIVE 24-HR COLLECTION Pathology 0.28 CLAB

84510 Blank ASSAY OF TYROSINE Pathology 0.36 CLAB

84512 Blank ASSAY OF TROPONIN QUALITATIVE Pathology 0.28 CLAB

84520 Blank ASSAY OF UREA NITROGEN QUANTITATIVE Pathology 0.14 CLAB

84525 Blank ASSAY OF UREA NITROGEN SEMIQUANTITATIVE Pathology 0.14 CLAB





PAGE 16 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

84540 Blank ASSAY OF UREA NITROGEN URINE Pathology 0.16 CLAB

84545 Blank UREA NITROGEN CLEARANCE Pathology 0.23 CLAB

84550 Blank ASSAY OF BLOOD/URIC ACID Pathology 0.16 CLAB

84560 Blank ASSAY OF URIC ACID OTHER SOURCE Pathology 0.16 CLAB

84577 Blank ASSAY OF UROBILINOGEN FECES QUANTITATIVE Pathology 0.58 CLAB

84578 Blank ASSAY OF UROBILINOGEN URINE QUALITATIVE Pathology 0.12 CLAB

84580 Blank UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN Pathology 0.28 CLAB

84583 Blank ASSAY OF UROBILINOGEN URINE SEMIQUANTITATIVE Pathology 0.17 CLAB

84585 Blank ASSAY OF VANILLYLMANDELIC ACID URINE Pathology 0.53 CLAB

84586 Blank ASSAY OF VASOACTIVE INTESTINAL PEPTIDE Pathology 1.21 CLAB

84588 Blank ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE Pathology 1.16 CLAB

84590 Blank ASSAY OF VITAMIN A Pathology 0.40 CLAB

84591 Blank ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED Pathology 0.47 CLAB

84597 Blank ASSAY OF VITAMIN K Pathology 0.47 CLAB

84600 Blank ASSAY OF VOLATILES Pathology 0.55 CLAB

84620 Blank XYLOSE ABSORPTION TEST BLOOD &/URINE Pathology 0.41 CLAB

84630 Blank ASSAY OF ZINC Pathology 0.39 CLAB

84681 Blank ASSAY OF C-PEPTIDE Pathology 0.71 CLAB

84702 Blank GONADOTROPIN CHORIONIC QUANTITATIVE Pathology 0.52 CLAB

84703 Blank GONADOTROPIN CHORIONIC QUALITATIVE Pathology 0.26 CLAB

84704 Blank GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN Pathology 0.52 CLAB

84830 Blank OVULATION TEST VISUAL COLOR COMPARISON HLH Pathology 0.35 CLAB

84999 Blank UNLISTED CHEMISTRY PROCEDURE Pathology 0.33 Unlisted

85002 Blank BLEEDING TIME TEST Pathology 0.15 CLAB

85004 Blank BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT Pathology 0.22 CLAB

85007 Blank BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT Pathology 0.12 CLAB

85008 Blank BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT Pathology 0.12 CLAB

85009 Blank BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT Pathology 0.14 CLAB

85013 Blank BLOOD COUNT SPUN MICROHEMATOCRIT Pathology 0.19 CLAB

85014 Blank BLOOD COUNT HEMATOCRIT Pathology 0.08 CLAB

85018 Blank BLOOD COUNT HEMOGLOBIN Pathology 0.08 CLAB

85025 Blank BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC Pathology 0.27 CLAB

85027 Blank BLOOD COUNT COMPLETE AUTOMATED Pathology 0.22 CLAB

85032 Blank BLOOD COUNT MANUAL CELL COUNT EACH Pathology 0.15 CLAB

85041 Blank BLOOD COUNT RED BLOOD CELL AUTOMATED Pathology 0.10 CLAB

85044 Blank BLOOD COUNT RETICULOCYTE AUTOMATED Pathology 0.15 CLAB

85045 Blank BLOOD COUNT RETICULOCYTE AUTOMATED Pathology 0.14 CLAB

85046 Blank BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS Pathology 0.19 CLAB

85048 Blank BLOOD COUNT LEUKOCYTE WBC AUTOMATED Pathology 0.09 CLAB

85049 Blank BLOOD COUNT PLATELET AUTOMATED Pathology 0.15 CLAB

85055 Blank RETICULATED PLATELET ASSAY Pathology 0.99 CLAB

85130 Blank CHROMOGENIC SUBSTRATE ASSAY Pathology 0.41 CLAB

85170 Blank BLOOD CLOT RETRACTION Pathology 0.45 CLAB

85175 Blank CLOT LYSIS TIME WHOLE BLOOD DILUTION Pathology 0.57 CLAB

85210 Blank CLOTTING FACTOR II PROTHROMBIN SPECIFIC Pathology 0.45 CLAB

85220 Blank CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR Pathology 0.61 CLAB

85230 Blank CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR Pathology 0.61 CLAB

85240 Blank CLOTTING FACTOR VIII AHG 1 STAGE Pathology 0.61 CLAB

85244 Blank CLOTTING FACTOR VIII RELATED ANTIGEN Pathology 0.70 CLAB





PAGE 17 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

85245 Blank CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT Pathology 0.79 CLAB

85246 Blank CLOTTING FACTOR VIII VW FACTOR ANTIGEN Pathology 0.79 CLAB

85247 Blank CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS Pathology 0.79 CLAB

85250 Blank CLOTTING FACTOR IX PTC/CHRISTMAS Pathology 0.65 CLAB

85260 Blank CLOTTING FACTOR X STUART-PROWER Pathology 0.61 CLAB

85270 Blank CLOTTING FACTOR XI PTA Pathology 0.61 CLAB

85280 Blank CLOTTING FACTOR XII HAGEMAN Pathology 0.66 CLAB

85290 Blank CLOTTING FACTOR XIII FIBRIN STABILIZING Pathology 0.56 CLAB

85291 Blank CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB Pathology 0.31 CLAB

85292 Blank CLOTTING PREKALLIKREIN ASSAY FLETCHER FACT ASSAY Pathology 0.65 CLAB

85293 Blank CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY Pathology 0.65 CLAB

85300 Blank CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY Pathology 0.41 CLAB

85301 Blank CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY Pathology 0.37 CLAB

85302 Blank CLOTTING INHIBITORS PROTEIN C ANTIGEN Pathology 0.41 CLAB

85303 Blank CLOTTING INHIBITORS PROTEIN C ACTIVITY Pathology 0.47 CLAB

85305 Blank CLOTTING INHIBITORS PROTEIN S TOTAL Pathology 0.40 CLAB

85306 Blank CLOTTING INHIBITORS PROTEIN S FREE Pathology 0.53 CLAB

85307 Blank ACTIVATED PROTEIN C APC RESISTANCE ASSAY Pathology 0.53 CLAB

85335 Blank FACTOR INHIBITOR TEST Pathology 0.44 CLAB

85337 Blank THROMBOMODULIN Pathology 0.48 CLAB

85345 Blank COAGULATION TIME LEE AND WHITE Pathology 0.15 CLAB

85347 Blank COAGULATION TIME ACTIVATED Pathology 0.15 CLAB

85348 Blank COAGULATION TIME OTHER METHODS Pathology 0.13 CLAB

85360 Blank EUGLOBULIN LYSIS Pathology 0.29 CLAB

85362 Blank FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN Pathology 0.24 CLAB

85366 Blank FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ Pathology 2.24 CLAB

85370 Blank FIBRIN DGRADJ SPLT PRODUCTS QUANTITATIVE Pathology 0.39 CLAB

85378 Blank FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN Pathology 0.27 CLAB

85379 Blank FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE Pathology 0.35 CLAB

85380 Blank FIBRIN DGRADJ PRODUCTS D-DIMER ULTRASENSITIVE Pathology 0.35 CLAB

85384 Blank FIBRINOGEN ACTIVITY Pathology 0.29 CLAB

85385 Blank FIBRINOGEN ANTIGEN Pathology 0.40 CLAB

85390 Blank FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR Pathology 0.43 CLAB

85397 Blank COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANAL Pathology 0.86 CLAB

85400 Blank FIBRINOLYTIC FACTORS & INHIBITORS PLASMIN Pathology 0.26 CLAB

85410 Blank FBRNLYC FACTORS&INHIBITORS ALPHA-2 ANTIPLASMIN Pathology 0.26 CLAB

85415 Blank FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR Pathology 0.59 CLAB

85420 Blank FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS Pathology 0.22 CLAB

85421 Blank FBRNLYC FACTORS&INHIBITORS PLSMNG AGIC ASSAY Pathology 0.35 CLAB

85441 Blank HEINZ BODIES DIRECT Pathology 0.14 CLAB

85445 Blank HEINZ BODIES INDUCED ACETYL PHENYLHYDRAZINE Pathology 0.23 CLAB

85460 Blank HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS Pathology 0.27 CLAB

85461 Blank HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE Pathology 0.26 CLAB

85475 Blank HEMOLYSIN ACID Pathology 0.30 CLAB

85520 Blank HEPARIN ASSAY Pathology 0.45 CLAB

85525 Blank HEPARIN NEUTRALIZATION Pathology 0.41 CLAB

85530 Blank HEPARIN-PROTAMINE TOLERANCE TST Pathology 0.45 CLAB

85536 Blank IRON STAIN PERIPHERAL BLOOD Pathology 0.22 CLAB

85540 Blank WBC ALKALINE PHOSPHATASE COUNT Pathology 0.30 CLAB





PAGE 18 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

85547 Blank MECHANICAL FRAGILITY RBC Pathology 0.30 CLAB

85549 Blank MURAMIDASE Pathology 0.64 CLAB

85555 Blank OSMOTIC FRAGILITY RBC UNINCUBATED Pathology 0.23 CLAB

85557 Blank OSMOTIC FRAGILITY RBC INCUBATED Pathology 0.46 CLAB

85576 Blank PLATELET AGGREGATION IN VITRO EACH AGENT Pathology 0.74 CLAB

85597 Blank PHOSPHOLIPID NEUTRALIZATION PLATELET Pathology 0.62 CLAB

85598 Blank PHOSPHOLIPID NEUTRALIZATION HEXAGONAL Pathology 0.62 CLAB

85610 Blank PROTHROMBIN TIME Pathology 0.13 CLAB

85611 Blank PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH Pathology 0.14 CLAB

85612 Blank RUSSELL VIPER VENON TIME UNDILUTED Pathology 0.49 CLAB

85613 Blank RUSSELL VIPER VENOM TIME DILUTED Pathology 0.33 CLAB

85635 Blank REPTILASE TEST Pathology 0.34 CLAB

85651 Blank SEDIMENTATION RATE RBC NON-AUTOMATED Pathology 0.12 CLAB

85652 Blank SEDIMENTATION RATE RBC AUTOMATED Pathology 0.09 CLAB

85660 Blank SICKLING RBC REDUCTION Pathology 0.19 CLAB

85670 Blank THROMBIN TIME PLASMA Pathology 0.20 CLAB

85675 Blank THROMBIN TIME TITER Pathology 0.23 CLAB

85705 Blank THROMBOPLASTIN INHIBITION TISSUE Pathology 0.33 CLAB

85730 Blank THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD Pathology 0.21 CLAB

85732 Blank THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA Pathology 0.22 CLAB

85810 Blank VISCOSITY Pathology 0.40 CLAB

85999 Blank UNLISTED HEMATOLOGY & COAGULATION PROCEDURE Pathology 0.15 Unlisted

86000 Blank AGGLUTININS FEBRILE EACH ANTIGEN Pathology 0.24 CLAB

86001 Blank ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN Pathology 0.22 CLAB

86003 Blank ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN Pathology 0.18 CLAB

86005 Blank ALLERGEN SPECIFIC IGE QUAL MULTIALLERGEN SCREEN Pathology 0.27 CLAB

86008 Blank ALLG SPEC IGE RECOMB EA Pathology 0.62 CLAB

86021 Blank ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES Pathology 0.52 CLAB

86022 Blank ANTIBODY IDENTIFICATION PLATELET ANTIBODIES Pathology 0.63 CLAB

86023 Blank ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY Pathology 0.43 CLAB

86038 Blank ANTINUCLEAR ANTIBODIES ANA Pathology 0.41 CLAB

86039 Blank ANTINUCLEAR ANTIBODIES ANA TITER Pathology 0.38 CLAB

86060 Blank ANTISTREPTOLYSIN O TITER Pathology 0.25 CLAB

86063 Blank ANTISTREPTOLYSIN O SCREEN Pathology 0.20 CLAB

86140 Blank C-REACTIVE PROTEIN Pathology 0.18 CLAB

86141 Blank C-REACTIVE PROTEIN HIGH SENSITIVITY Pathology 0.44 CLAB

86146 Blank BETA 2 GLYCOPROTEIN I ANTIBODY EACH Pathology 0.87 CLAB

86147 Blank CARDIOLIPIN ANTIBODY EACH IG CLASS Pathology 0.87 CLAB

86148 Blank ANTI-PHOSPHATIDYLSERINE ANTIBODY Pathology 0.55 CLAB

86152 Blank CELL ENUMERATION IMMUNE SELECTJ & ID FLUID SPEC Pathology 8.43 CLAB

86153 Blank CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP Pathology 1.82 FAIR Health

86155 Blank CHEMOTAXIS ASSAY SPECIFY METHOD Pathology 0.55 CLAB

86156 Blank COLD AGGLUTININ SCREEN Pathology 0.23 CLAB

86157 Blank COLD AGGLUTININ TITER Pathology 0.28 CLAB

86160 Blank COMPLEMENT ANTIGEN EACH COMPONENT Pathology 0.41 CLAB

86161 Blank COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT Pathology 0.41 CLAB

86162 Blank COMPLEMENT TOTAL HEMOLYTIC Pathology 0.70 CLAB

86171 Blank COMPLEMENT FIXATION TESTS EACH ANTIGEN Pathology 0.34 CLAB

86200 Blank CYCLIC CITRULLINATED PEPTIDE ANTIBODY Pathology 0.44 CLAB





PAGE 19 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

86215 Blank DEOXYRIBONUCLEASE ANTIBODY Pathology 0.45 CLAB

86225 Blank DNA ANTIBODY NATIVE/DOUBLE STRANDED Pathology 0.47 CLAB

86226 Blank DNA ANTIBODY SINGLE STRANDED Pathology 0.42 CLAB

86235 Blank EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD Pathology 0.62 CLAB

86255 Blank FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY Pathology 0.41 CLAB

86256 Blank FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY Pathology 0.41 CLAB

86277 Blank GROWTH HORMONE HUMAN ANTIBODY Pathology 0.54 CLAB

86280 Blank HEMAGGLUTINATION INHIBITION TEST HAI Pathology 0.28 CLAB

86294 Blank IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE Pathology 0.71 CLAB

86300 Blank IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 Pathology 0.71 CLAB

86301 Blank IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 Pathology 0.71 CLAB

86304 Blank IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 Pathology 0.71 CLAB

86305 Blank HUMAN EPIDIDYMIS PROTEIN 4 (HE4) Pathology 0.71 CLAB

86308 Blank HETEROPHILE ANTIBODIES SCREEN Pathology 0.18 CLAB

86309 Blank HETEROPHILE ANTIBODIES TITER Pathology 0.22 CLAB

86310 Blank HETEROPHILE ANTIBODIES TITER AFTER ABSORPTION Pathology 0.25 CLAB

86316 Blank IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE Pathology 0.71 CLAB

86317 Blank IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS Pathology 0.51 CLAB

86318 Blank IMMUNOASSAY NFCT AGT ANTB QUAL/SEMIQUAN 1 STEP Pathology 0.50 CLAB

86320 Blank IMMUNOELECTROPHORESIS SERUM Pathology 0.83 CLAB

86325 Blank IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION Pathology 0.77 CLAB

86327 Blank IMMUNOELECTROPHORESIS CROSSED Pathology 0.83 CLAB

86329 Blank IMMUNODIFFUSION NOT ELSEWHERE SPECIFIED Pathology 0.48 CLAB

86331 Blank IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY Pathology 0.41 CLAB

86332 Blank IMMUNE COMPLEX ASSAY Pathology 0.84 CLAB

86334 Blank IMMUNOFIXJ ELECTROPHORESIS SERUM Pathology 0.77 CLAB

86335 Blank IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS Pathology 1.01 CLAB

86336 Blank INHIBIN A Pathology 0.53 CLAB

86337 Blank INSULIN ANTIBODIES Pathology 0.73 CLAB

86340 Blank INTRINSIC FACTOR ANTIBODIES Pathology 0.52 CLAB

86341 Blank ISLET CELL ANTIBODY Pathology 0.68 CLAB

86343 Blank LEUKOCYTE HISTAMINE RELEASE TEST LHR Pathology 0.43 CLAB

86344 Blank LEUKOCYTE PHAGOCYTOSIS Pathology 0.29 CLAB

86352 Blank CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE Pathology 4.66 CLAB

86353 Blank LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS Pathology 1.68 CLAB

86355 Blank B CELLS TOTAL COUNT Pathology 1.29 CLAB

86356 Blank MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA Pathology 0.92 CLAB

86357 Blank NATURAL KILLER CELLS TOTAL COUNT Pathology 1.29 CLAB

86359 Blank T CELLS TOTAL COUNT Pathology 1.29 CLAB

86360 Blank T CELLS ABSOLUTE CD4&CD8 COUNT RATIO Pathology 1.61 CLAB

86361 Blank T CELLS ABSOLUTE CD4 COUNT Pathology 0.92 CLAB

86367 Blank STEM CELLS TOTAL COUNT Pathology 2.16 CLAB

86376 Blank MICROSOMAL ANTIBODIES EACH Pathology 0.50 CLAB

86382 Blank NEUTRALIZATION TEST VIRAL Pathology 0.58 CLAB

86384 Blank NITROBLUE TETRAZOLIUM DYE TEST NTD Pathology 0.39 CLAB

86386 Blank NUCLEAR MATRIX PROTEIN 22 NMP22 QUALITATIVE Pathology 0.61 CLAB

86403 Blank PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY Pathology 0.35 CLAB

86406 Blank PARTICLE AGGLUTINATION TITER EACH ANTIBODY Pathology 0.36 CLAB

86430 Blank RHEUMATOID FACTOR QUALITATIVE Pathology 0.19 CLAB





PAGE 20 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

86431 Blank RHEUMATOID FACTOR QUANTITATIVE Pathology 0.19 CLAB

86480 Blank TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON Pathology 2.13 CLAB

86481 Blank TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP Pathology 2.78 CLAB

86485 Blank SKIN TEST CANDIDA Pathology 0.21 FAIR Health

86590 Blank STREPTOKINASE ANTIBODY Pathology 0.38 CLAB

86592 Blank SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL Pathology 0.15 CLAB

86593 Blank SYPHILIS TEST QUANTITATIVE Pathology 0.15 CLAB

86602 Blank ANTIBODY ACTINOMYCES Pathology 0.35 CLAB

86603 Blank ANTIBODY ADENOVIRUS Pathology 0.44 CLAB

86606 Blank ANTIBODY ASPERGILLUS Pathology 0.52 CLAB

86609 Blank ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED Pathology 0.44 CLAB

86611 Blank ANTIBODY BARTONELLA Pathology 0.35 CLAB

86612 Blank ANTIBODY BLASTOMYCES Pathology 0.44 CLAB

86615 Blank ANTIBODY BORDETELLA Pathology 0.45 CLAB

86617 Blank ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST Pathology 0.53 CLAB

86618 Blank ANTIBODY BORRELIA BURGDORFERI LYME DISEASE Pathology 0.58 CLAB

86619 Blank ANTIBODY BORRELIA RELAPSING FEVER Pathology 0.46 CLAB

86622 Blank ANTIBODY BRUCELLA Pathology 0.31 CLAB

86625 Blank ANTIBODY CAMPYLOBACTER Pathology 0.45 CLAB

86628 Blank ANTIBODY CANDIDA Pathology 0.41 CLAB

86631 Blank ANTIBODY CHLAMYDIA Pathology 0.41 CLAB

86632 Blank ANTIBODY CHLAMYDIA IGM Pathology 0.44 CLAB

86635 Blank ANTIBODY COCCIDIOIDES Pathology 0.39 CLAB

86638 Blank ANTIBODY COXIELLA BURNETII Q FEVER Pathology 0.42 CLAB

86641 Blank ANTIBODY CRYPTOCOCCUS Pathology 0.49 CLAB

86644 Blank ANTIBODY CYTOMEGALOVIRUS CMV Pathology 0.49 CLAB

86645 Blank ANTIBODY CYTOMEGALOVIRUS CMV IGM Pathology 0.58 CLAB

86648 Blank ANTIBODY DIPHTHERIA Pathology 0.52 CLAB

86651 Blank ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE Pathology 0.45 CLAB

86652 Blank ANTIBODY ENCEPHALITIS EASTERN EQUINE Pathology 0.45 CLAB

86653 Blank ANTIBODY ENCEPHALITIS ST. LOUIS Pathology 0.45 CLAB

86654 Blank ANTIBODY ENCEPHALITIS WESTRN EQUINE Pathology 0.45 CLAB

86658 Blank ANTIBODY ENTEROVIRUS Pathology 0.45 CLAB

86663 Blank ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA Pathology 0.45 CLAB

86664 Blank ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA Pathology 0.52 CLAB

86665 Blank ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA Pathology 0.62 CLAB

86666 Blank ANTIBODY EHRLICHIA Pathology 0.35 CLAB

86668 Blank ANTIBODY FRANCISELLA TULARENSIS Pathology 0.39 CLAB

86671 Blank ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED Pathology 0.42 CLAB

86674 Blank ANTIBODY GIARDIA LAMBLIA Pathology 0.50 CLAB

86677 Blank ANTIBODY HELICOBACTER PYLORI Pathology 0.50 CLAB

86682 Blank ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED Pathology 0.45 CLAB

86684 Blank ANTIBODY HAEMOPHILUS INFLUENZA Pathology 0.54 CLAB

86687 Blank ANTIBODY HTLV-I Pathology 0.29 CLAB

86688 Blank ANTIBODY HTLV-II Pathology 0.48 CLAB

86689 Blank ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST Pathology 0.66 CLAB

86692 Blank ANTIBODY HEP DELTA AGENT Pathology 0.59 CLAB

86694 Blank ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST Pathology 0.49 CLAB

86695 Blank ANTIBODY HERPES SMPLX TYPE 1 Pathology 0.45 CLAB





PAGE 21 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

86696 Blank ANTIBODY HERPES SMPLX TYPE 2 Pathology 0.66 CLAB

86698 Blank ANTIBODY HISTOPLASMA Pathology 0.43 CLAB

86701 Blank ANTIBODY HIV-1 Pathology 0.30 CLAB

86702 Blank ANTIBODY HIV-2 Pathology 0.46 CLAB

86703 Blank ANTIBODY HIV-1&HIV-2 SINGLE RESULT Pathology 0.47 CLAB

86704 Blank HEPATITIS B CORE ANTIBODY HBCAB TOTAL Pathology 0.41 CLAB

86705 Blank HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY Pathology 0.40 CLAB

86706 Blank HEPATITIS B SURF ANTIBODY HBSAB Pathology 0.37 CLAB

86707 Blank HEPATITIS BE ANTIBODY HBEAB Pathology 0.40 CLAB

86708 Blank HEPATITIS A ANTIBODY HAAB Pathology 0.42 CLAB

86709 Blank HEPATITIS ANTIBODY HAAB IGM ANTIBODY Pathology 0.39 CLAB

86710 Blank ANTIBODY INFLUENZA VIRUS Pathology 0.46 CLAB

86711 Blank ANTIBODY JOHN CUNNINGHAM VIRUS Pathology 0.49 CLAB

86713 Blank ANTIBODY LEGIONELLA Pathology 0.52 CLAB

86717 Blank ANTIBODY LEISHMANIA Pathology 0.42 CLAB

86720 Blank ANTIBODY LEPTOSPIRA Pathology 0.45 CLAB

86723 Blank ANTIBODY LISTERIA MONOCYTOGENES Pathology 0.45 CLAB

86727 Blank ANTIBODY LYMPHOCYTIC CHORIOMENINGITIS Pathology 0.44 CLAB

86732 Blank ANTIBODY MUCORMYCOSIS Pathology 0.45 CLAB

86735 Blank ANTIBODY MUMPS Pathology 0.45 CLAB

86738 Blank ANTIBODY MYCOPLSM Pathology 0.45 CLAB

86741 Blank ANTIBODY NEISSERIA MENINGITIDIS Pathology 0.45 CLAB

86744 Blank ANTIBODY NOCARDIA Pathology 0.45 CLAB

86747 Blank ANTIBODY PARVOVIRUS Pathology 0.52 CLAB

86750 Blank ANTIBODY PLASMODIUM MALARIA Pathology 0.45 CLAB

86753 Blank ANTIBODY PROTOZOA NES Pathology 0.42 CLAB

86756 Blank ANTIBODY RESPIRATORY SYNCTIAL VIRUS Pathology 0.44 CLAB

86757 Blank ANTIBODY RICKETTSIA Pathology 0.66 CLAB

86759 Blank ANTIBODY ROTAVIRUS Pathology 0.51 CLAB

86762 Blank ANTIBODY RUBELLA Pathology 0.49 CLAB

86765 Blank ANTIBODY RUBEOLA Pathology 0.44 CLAB

86768 Blank ANTIBODY SALMONELLA Pathology 0.45 CLAB

86771 Blank ANTIBODY SHIGELLA Pathology 0.68 CLAB

86774 Blank ANTIBODY TETANUS Pathology 0.51 CLAB

86777 Blank ANTIBODY TOXOPLASMA Pathology 0.49 CLAB

86778 Blank ANTIBODY TOXOPLASMA IGM Pathology 0.49 CLAB

86780 Blank ANTIBODY TREPONEMA PALLIDUM Pathology 0.45 CLAB

86784 Blank ANTIBODY TRICHINELLA Pathology 0.43 CLAB

86787 Blank ANTIBODY VARICELLA-ZOSTER Pathology 0.44 CLAB

86788 Blank ANTIBODY WEST NILE VIRUS IGM Pathology 0.58 CLAB

86789 Blank ANTIBODY WEST NILE VIRUS Pathology 0.49 CLAB

86790 Blank ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED Pathology 0.44 CLAB

86793 Blank ANTIBODY YERSINIA Pathology 0.45 CLAB

86794 Blank ZIKA VIRUS IGM ANTIBODY Pathology 0.58 CLAB

86800 Blank THYROGLOBULIN ANTIBODY Pathology 0.55 CLAB

86803 Blank HEPATITIS C ANTIBODY Pathology 0.49 CLAB

86804 Blank HEPATITIS C ANTIBODY CONFIRMATORY TEST Pathology 0.53 CLAB

86805 Blank LYMPHOCYTOTOXICITY ASSAY VIS CROSSMATCH TITRATJ Pathology 5.26 CLAB

86806 Blank LMPHOCYTOTOXICITY ASSAY VIS CROSSMTCH W/O TITRAT Pathology 1.63 CLAB





PAGE 22 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

86807 Blank SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH Pathology 2.18 CLAB

86808 Blank SERUM SCREENING % REACTIVE ANTIBODY QUICK METH Pathology 1.02 CLAB

86812 Blank HLA TYPING A/B/C SINGLE ANTIGEN Pathology 0.89 CLAB

86813 Blank HLA TYPING A/B/C MULTIPLE ANTIGENS Pathology 1.99 CLAB

86816 Blank HLA TYPING DR/DQ SINGLE ANTIGEN Pathology 0.96 CLAB

86817 Blank HLA TYPING DR/DQ MULTIPLE ANTIGENS Pathology 2.95 CLAB

86821 Blank HLA TYPING LYMPHOCYTE CULTURE MIXED Pathology 1.25 CLAB

86825 Blank HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION Pathology 3.04 CLAB

86826 Blank HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION Pathology 1.01 CLAB

86828 Blank ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL Pathology 1.78 CLAB

86829 Blank ANTIBODY HLA CLASS I OR CLASS II ANTIGENS QUAL Pathology 1.78 CLAB

86830 Blank ANTIBODY HLA CLASS I PHENOTYPE PANEL QUALITATIVE Pathology 2.77 CLAB

86831 Blank ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL Pathology 2.37 CLAB

86832 Blank ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL Pathology 8.99 CLAB

86833 Blank ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL Pathology 9.05 CLAB

86834 Blank ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL Pathology 12.26 CLAB

86835 Blank ANTIBODY HLA CLASS II SEMIQUANTITATIVE PANEL Pathology 11.08 CLAB

86849 Blank UNLISTED IMMUNOLOGY Pathology 0.45 Unlisted

86850 Blank ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE Pathology 0.27 CLAB

86860 Blank ANTIBODY ELUTION RBC EACH ELUTION Pathology 0.65 FAIR Health

86870 Blank ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ Pathology 0.69 FAIR Health

86880 Blank ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM Pathology 0.18 CLAB

86885 Blank ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL Pathology 0.20 CLAB

86886 Blank ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER Pathology 0.18 CLAB

86890 Blank AUTOL BLD/COMPONENT COLLJ STORAGE PREDEPOSITED Pathology 1.45 FAIR Health

86891 Blank AUTOL BLD/COMPONENT COLLJ STORAGE SALVAGE Pathology 3.58 FAIR Health

86900 Blank BLOOD TYPING SEROLOGIC ABO Pathology 0.10 CLAB

86901 Blank BLOOD TYPING SEROLOGIC RH (D) Pathology 0.10 CLAB

86902 Blank BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH Pathology 0.18 CLAB

86904 Blank BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT Pathology 0.45 CLAB

86905 Blank BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH Pathology 0.13 CLAB

86906 Blank BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE Pathology 0.27 CLAB

86910 Blank BLOOD TYPING PATERNITY PR INDIV ABO RH&MN Pathology 0.75 ERBRVS

86911 Blank BLOOD TYPING PATERNITY INDIV ADDL ANTIGEN SYS Pathology 0.65 ERBRVS

86920 Blank COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE Pathology 0.83 FAIR Health

86921 Blank COMPATIBILITY EACH UNIT INCUBATION Pathology 0.35 FAIR Health

86922 Blank COMPATIBILITY EACH UNIT ANTIGLOBULIN Pathology 0.59 FAIR Health

86923 Blank COMPATIBILITY EACH UNIT ELECTRONIC Pathology 0.44 FAIR Health

86927 Blank FRESH FROZEN PLASMA THAWING EACH UNIT Pathology 0.18 FAIR Health

86930 Blank FROZEN BLOOD EACH UNIT FREEZING Pathology 3.43 ERBRVS

86931 Blank FROZEN BLOOD EACH UNIT THAWING Pathology 2.57 ERBRVS

86932 Blank FROZEN BLOOD EACH UNIT FREEZING & THAWING Pathology 2.92 ERBRVS

86940 Blank HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH Pathology 0.28 CLAB

86941 Blank HEMOLYSINS&AGGLUTININS INCUBATED Pathology 0.42 CLAB

86945 Blank IRRADIATION BLOOD PRODUCT EACH UNIT Pathology 0.66 FAIR Health

86950 Blank LEUKOCYTE TRANSFUSION Pathology 2.23 ERBRVS

86960 Blank VOLUME REDUCTION BLOOD/BLOOD PRODUCT EACH UNIT Pathology 0.85 FAIR Health

86965 Blank POOLING PLATELETS/OTHER BLOOD PRODUCTS Pathology 0.87 FAIR Health

86970 Blank PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA Pathology 0.82 FAIR Health





PAGE 23 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

86971 Blank PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH Pathology 0.62 ERBRVS

86972 Blank PRETX RBC ANTIBODY INCUBAT W/DENSITY GRAD SEP Pathology 0.92 ERBRVS

86975 Blank PRETX SERUM RBC ANTIBODY INCUBATION DRUGS EACH Pathology 0.93 ERBRVS

86976 Blank PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION Pathology 1.03 ERBRVS

86977 Blank PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA Pathology 1.03 ERBRVS

86978 Blank PRETX SERUM RBC ANTIBODY ID DIFFIAL EACH ABSRPJ Pathology 0.61 FAIR Health

86985 Blank SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT Pathology 0.53 FAIR Health

86999 Blank UNLISTED TRANSFUSION MEDICINE PROCEDURE Pathology 0.18 Unlisted

87003 Blank ANIMAL INOCULATION SMALL ANIMAL W/OBS&DSJ Pathology 0.58 CLAB

87015 Blank CONCENTRATION INFECTIOUS AGENTS Pathology 0.23 CLAB

87040 Blank CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES Pathology 0.35 CLAB

87045 Blank CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL Pathology 0.32 CLAB

87046 Blank CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA Pathology 0.32 CLAB

87070 Blank CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL Pathology 0.30 CLAB

87071 Blank CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL Pathology 0.32 CLAB

87073 Blank CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL Pathology 0.32 CLAB

87075 Blank CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID Pathology 0.32 CLAB

87076 Blank CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL Pathology 0.28 CLAB

87077 Blank CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL Pathology 0.28 CLAB

87081 Blank CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ Pathology 0.23 CLAB

87084 Blank CUL PRSMPTV PTHGNC ORGANISMS SCR DNS CHART Pathology 0.75 CLAB

87086 Blank CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE Pathology 0.28 CLAB

87088 Blank CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE Pathology 0.28 CLAB

87101 Blank CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL Pathology 0.26 CLAB

87102 Blank CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD Pathology 0.29 CLAB

87103 Blank CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD Pathology 0.57 CLAB

87106 Blank CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST Pathology 0.35 CLAB

87107 Blank CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD Pathology 0.35 CLAB

87109 Blank CULTURE MYCOPLASMA ANY SOURCE Pathology 0.53 CLAB

87110 Blank CULTURE CHLAMYDIA ANY SOURCE Pathology 0.67 CLAB

87116 Blank CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL Pathology 0.37 CLAB

87118 Blank CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL Pathology 0.41 CLAB

87140 Blank CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM Pathology 0.19 CLAB

87143 Blank CULTURE TYPING GAS/HIGH PRES LIQ CHROMATOGRAPHY Pathology 0.43 CLAB

87147 Blank CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES Pathology 0.18 CLAB

87149 Blank CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM Pathology 0.69 CLAB

87150 Blank CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM Pathology 1.20 CLAB

87152 Blank CULTURE TYPING IDENTIFJ PULSE FIELD GEL TYPING Pathology 0.22 CLAB

87153 Blank CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE Pathology 3.96 CLAB

87158 Blank CULTURE TYPING OTHER METHODS Pathology 0.22 CLAB

87164 Blank DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION Pathology 0.37 CLAB

87166 Blank DARK FIELD EXAM ANY SOURCE W/O SPECIMEN COLLECT Pathology 0.39 CLAB

87168 Blank MACROSCOPIC EXAMINATION ARTHROPOD Pathology 0.15 CLAB

87169 Blank MACROSCOPIC EXAMINATION PARASITE Pathology 0.15 CLAB

87172 Blank PINWORM EXAMINATION Pathology 0.15 CLAB

87176 Blank HOMOGENIZATION TISSUE CULTURE Pathology 0.20 CLAB

87177 Blank OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID Pathology 0.31 CLAB

87181 Blank SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ Pathology 0.16 CLAB

87184 Blank SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD Pathology 0.24 CLAB





PAGE 24 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

87185 Blank SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ Pathology 0.16 CLAB

87186 Blank SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ Pathology 0.30 CLAB

87187 Blank SUSCEPTIBLTY STDY ANTMCRB MICRO/AGAR DILUTJ EA Pathology 1.12 CLAB

87188 Blank SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT Pathology 0.23 CLAB

87190 Blank SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD Pathology 0.20 CLAB

87197 Blank SERUM BACTERICIDAL TITER Pathology 0.52 CLAB

87205 Blank SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL Pathology 0.15 CLAB

87206 Blank SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT Pathology 0.18 CLAB

87207 Blank SMR PRIM SRC SPEC STAIN BODIES/PARASITS Pathology 0.21 CLAB

87209 Blank SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS Pathology 0.62 CLAB

87210 Blank SMR PRIM SRC WET MOUNT NFCT AGT Pathology 0.16 CLAB

87220 Blank TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT Pathology 0.15 CLAB

87230 Blank TOXIN/ANTITOXIN ASSAY TISSUE CULTURE Pathology 0.68 CLAB

87250 Blank VIRUS INOCULATION EGGS/SM ANIMAL OBS&DSJ Pathology 0.67 CLAB

87252 Blank VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT Pathology 0.89 CLAB

87253 Blank VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE Pathology 0.69 CLAB

87254 Blank VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA Pathology 0.67 CLAB

87255 Blank VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC Pathology 1.16 CLAB

87260 Blank IAADI ADENOVIRUS Pathology 0.41 CLAB

87265 Blank IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS Pathology 0.41 CLAB

87267 Blank IAADI ENTEROVIRUS DIRECT FLUORESCENT ANTIBODY Pathology 0.41 CLAB

87269 Blank IAADI GIARDIA Pathology 0.41 CLAB

87270 Blank IAADI CHLAMYDIA TRACHOMATIS Pathology 0.41 CLAB

87271 Blank IAADI CYTOMEGALOVIRUS DIR FLUORESCENT ANTIBODY Pathology 0.41 CLAB

87272 Blank IAADI CRYPTOSPORIDIUM Pathology 0.41 CLAB

87273 Blank IAADI HERPES SMPLX VIRUS TYPE 2 Pathology 0.41 CLAB

87274 Blank IAADI HERPES SMPLX VIRUS TYPE 1 Pathology 0.41 CLAB

87275 Blank IAADI INFLUENZA B VIRUS Pathology 0.41 CLAB

87276 Blank IAADI INFFLUENZA A VIRUS Pathology 0.45 CLAB

87278 Blank IAADI LEGIONELLA PNEUMOPHILA Pathology 0.43 CLAB

87279 Blank IAADI PARAINFLUENZA VIRUS EACH TYPE Pathology 0.46 CLAB

87280 Blank IAADI RESPIRATORY SYNCTIAL VIRUS Pathology 0.41 CLAB

87281 Blank IAADI PNEUMOCUSTIS CARINII Pathology 0.41 CLAB

87283 Blank IAADI RUBEOLA Pathology 1.69 CLAB

87285 Blank IAADI TREPONEMA PALLIDUM Pathology 0.41 CLAB

87290 Blank IAADI VARICELLA ZOSTER VIRUS Pathology 0.41 CLAB

87299 Blank IAADI NOT OTHERWISE SPECIFIED EACH ORGANISM Pathology 0.45 CLAB

87300 Blank IAADI POLYV MLT ORGANISMS EA POLYV ANTISERUM Pathology 0.41 CLAB

87301 Blank IAAD IA ADENOVIRUS ENTERIC TYP 40/41 Pathology 0.41 CLAB

87305 Blank IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS Pathology 0.41 CLAB

87320 Blank IAAD IA CHLAMYDIA TRACHOMATIS Pathology 0.42 CLAB

87324 Blank IAAD IA CLOSTRIDIUM DIFFICILE TOXIN Pathology 0.41 CLAB

87327 Blank IAAD IA CRYPTOCOCCUS NEOFORMANS Pathology 0.41 CLAB

87328 Blank IAAD IA CRYPTOSPORIDIUM Pathology 0.41 CLAB

87329 Blank IAAD IA GIARDIA Pathology 0.41 CLAB

87332 Blank IAAD IA CYTOMEGALOVIRUS Pathology 0.41 CLAB

87335 Blank IAAD IA ESCHERICHIA COLI 0157 Pathology 0.41 CLAB

87336 Blank IAAD IA ENTAMOEBA HISTOLYTICA DISPAR GRP Pathology 0.44 CLAB

87337 Blank IAAD IA ENTAMOEBA HISTOLYTICA GRP Pathology 0.41 CLAB





PAGE 25 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

87338 Blank IAAD IA HPYLORI STOOL Pathology 0.49 CLAB

87339 Blank IAAD IA HPYLORI Pathology 0.44 CLAB

87340 Blank IAAD IA HEPATITIS B SURFACE ANTIGEN Pathology 0.35 CLAB

87341 Blank IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION Pathology 0.35 CLAB

87350 Blank IAAD IA HEPATITIS BE ANTIGEN Pathology 0.40 CLAB

87380 Blank IAAD IA HEPATITIS DELTA ANTIGEN Pathology 0.56 CLAB

87385 Blank IAAD IA HISTOPLASM CAPSULATUM Pathology 0.41 CLAB

87389 Blank IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE Pathology 0.83 CLAB

87390 Blank IAAD IA HIV-1 Pathology 0.67 CLAB

87391 Blank IAAD IA HIV-2 Pathology 0.61 CLAB

87400 Blank IAAD IA INFLUENZA A/B EACH Pathology 0.41 CLAB

87420 Blank IAAD IA RESPIRATORY SYNCTIAL VIRUS Pathology 0.41 CLAB

87425 Blank IAAD IA ROTAVIRUS Pathology 0.41 CLAB

87427 Blank IAAD IA SHIGA-LIKE TOXIN Pathology 0.41 CLAB

87430 Blank IAAD IA STREPTOCOCCUS GROUP A Pathology 0.47 CLAB

87449 Blank IAAD IA MULT STEP METHOD NOS EACH ORGANISM Pathology 0.41 CLAB

87450 Blank IAAD IA SINGLE STEP METHOD NOS EA ORGANISM Pathology 0.33 CLAB

87451 Blank IAAD IA POLYV MLT ORGANISMS EA POLYV ANTISERUM Pathology 0.33 CLAB

87471 Blank IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE Pathology 1.20 CLAB

87472 Blank IADNA BARTONELLA HENSELAE&QUINTANA QUANTJ Pathology 1.47 CLAB

87475 Blank IADNA BORRELIA BURGDORFERI DIRECT PROBE TQ Pathology 0.69 CLAB

87476 Blank IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87480 Blank IADNA CANDIDA SPECIES DIRECT PROBE TQ Pathology 0.69 CLAB

87481 Blank IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87482 Blank IADNA CANDIDA SPECIES QUANTIFICATION Pathology 1.55 CLAB

87483 Blank CNS DNA AMP PROBE TYPE 12-25 Pathology 14.29 CLAB

87485 Blank IADNA CHLAMYDIA PNEUMONIAE DIRECT PROBE TQ Pathology 0.69 CLAB

87486 Blank IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87487 Blank IADNA CHLAMYDIA PNEUMONIAE QUANTIFICATION Pathology 1.47 CLAB

87490 Blank IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ Pathology 0.69 CLAB

87491 Blank IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87492 Blank IADNA CHLAMYDIA TRACHOMATIS QUANTIFICATION Pathology 1.49 CLAB

87493 Blank INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE Pathology 1.20 CLAB

87495 Blank IADNA CYTOMEGALOVIRUS DIRECT PROBE TQ Pathology 0.83 CLAB

87496 Blank IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87497 Blank IADNA CYTOMEGALOVIRUS QUANTIFICATION Pathology 1.47 CLAB

87498 Blank IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP Pathology 1.20 CLAB

87500 Blank INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE Pathology 1.20 CLAB

87501 Blank INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE Pathology 1.76 CLAB

87502 Blank INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES Pathology 2.92 CLAB

87503 Blank NFCT AGENT DNA/RNA INFLUENZA >2 TYPES EA ADDL Pathology 0.81 CLAB

87505 Blank NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN Pathology 4.40 CLAB

87506 Blank IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 Pathology 7.32 CLAB

87507 Blank IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 Pathology 14.29 CLAB

87510 Blank IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ Pathology 0.69 CLAB

87511 Blank IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87512 Blank IADNA GARDNERELLA VAGINALIS QUANTIFICATION Pathology 1.43 CLAB

87516 Blank IADNA HEPATITIS B VIRUS AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87517 Blank IADNA HEPATITIS B VIRUS QUANTIFICATION Pathology 1.47 CLAB





PAGE 26 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

87520 Blank IADNA HEPATITIS C DIRECT PROBE TECHNIQUE Pathology 0.87 CLAB

87521 Blank IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR Pathology 1.20 CLAB

87522 Blank IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION Pathology 1.47 CLAB

87525 Blank IADNA HEPATITIS G DIRECT PROBE TECHNIQUE Pathology 0.83 CLAB

87526 Blank IADNA HEPATITIS G AMPLIFIED PROBE TECHNIQUE Pathology 1.20 CLAB

87527 Blank IADNA HEPATITIS G QUANTIFICATION Pathology 1.43 CLAB

87528 Blank IADNA HERPES SIMPLX VIRUS DIRECT PROBE TQ Pathology 0.69 CLAB

87529 Blank IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87530 Blank IADNA HERPES SOMPLX VIRUS QUANTIFICATION Pathology 1.47 CLAB

87531 Blank IADNA HERPES VIRUS-6 DIRECT PROBE TQ Pathology 1.61 CLAB

87532 Blank IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87533 Blank IADNA HERPES VIRUS-6 QUANTIFICATION Pathology 1.43 CLAB

87534 Blank IADNA HIV-1 DIRECT PROBE TECHNIQUE Pathology 0.69 CLAB

87535 Blank IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ Pathology 1.20 CLAB

87536 Blank IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION Pathology 2.92 CLAB

87537 Blank IADNA HIV-2 DIRECT PROBE TECHNIQUE Pathology 0.69 CLAB

87538 Blank IADNA HIV-2 AMPLIFIED PROBE & REVERSE TRANSCRIPJ Pathology 1.20 CLAB

87539 Blank IADNA HIV-2 QUANT & REVERSE TRANSCRIPTION Pathology 1.63 CLAB

87540 Blank IADNA LEGIONELLA PNEUMOPHILA DIRECT PROBE TQ Pathology 0.69 CLAB

87541 Blank IADNA LEGIONELLA PNEUMOPHILA AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87542 Blank IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION Pathology 1.43 CLAB

87550 Blank IADNA MYCOBACTERIA SPECIES DIRECT PROBE TQ Pathology 0.69 CLAB

87551 Blank IADNA MYCOBACTERIA SPECIES AMPLIFIED PROBE TQ Pathology 1.34 CLAB

87552 Blank IADNA MYCOBACTERIA SPECIES QUANTIFICATION Pathology 1.47 CLAB

87555 Blank IADNA MYCOBACTERIA TUBERCULOSIS DIR PRB Pathology 0.75 CLAB

87556 Blank IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB Pathology 1.20 CLAB

87557 Blank IADNA MYCOBACTERIA TUBERCULOSIS QUANTIFICATION Pathology 1.47 CLAB

87560 Blank IADNA MYCOBACTERIA AVIUM-INTRACLRE DIR PRB Pathology 0.76 CLAB

87561 Blank IADNA MYCOBACTERIA AVIUM-INTRACLRE AMP PRB Pathology 1.20 CLAB

87562 Blank IADNA MYCOBACTERIA AVIUM-INTRACELLULARE QUANT Pathology 1.47 CLAB

87580 Blank IADNA MYCOPLSM PNEUMONIAE DIRECT PROBE TQ Pathology 0.69 CLAB

87581 Blank IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87582 Blank IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION Pathology 8.41 CLAB

87590 Blank IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ Pathology 0.75 CLAB

87591 Blank IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87592 Blank IADNA NEISSERIA GONORRHOEAE QUANTIFICATION Pathology 1.47 CLAB

87623 Blank IADNA HUMAN PAPILLOMAVIRUS LOW-RISK TYPES Pathology 1.20 CLAB

87624 Blank IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES Pathology 1.20 CLAB

87625 Blank IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY Pathology 1.20 CLAB

87631 Blank IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS Pathology 4.40 CLAB

87632 Blank IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS Pathology 7.32 CLAB

87633 Blank IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET Pathology 14.29 CLAB

87634 Blank RSV DNA/RNA AMP PROBE Pathology 2.41 CLAB

87640 Blank IADNA S AUREUS AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87641 Blank IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ Pathology 1.20 CLAB

87650 Blank IADNA STREPTOCOCCUS GROUP A DIRECT PROBE TQ Pathology 0.69 CLAB

87651 Blank IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ Pathology 1.20 CLAB

87652 Blank IADNA STREPTOCOCCUS GROUP A QUANTIFICATION Pathology 1.43 CLAB

87653 Blank IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ Pathology 1.20 CLAB





PAGE 27 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

87660 Blank IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ Pathology 0.69 CLAB

87661 Blank IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH Pathology 1.20 CLAB

87662 Blank ZIKA VIRUS DNA/RNA AMP PROBE Pathology 1.76 CLAB

87797 Blank IADNA NOS DIRECT PROBE TQ EACH ORGANISM Pathology 0.83 CLAB

87798 Blank IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM Pathology 1.20 CLAB

87799 Blank IADNA NOS QUANTIFICATION EACH ORGANISM Pathology 1.47 CLAB

87800 Blank IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ Pathology 1.38 CLAB

87801 Blank IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ Pathology 2.41 CLAB

87802 Blank IAADIADOO STREPTOCOCCUS GROUP B Pathology 0.41 CLAB

87803 Blank IAADIADOO CLOSTRIDIUM DIFFICILE TOXIN Pathology 0.44 CLAB

87804 Blank IAADIADOO INFLUENZA Pathology 0.46 CLAB

87806 Blank IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES Pathology 0.91 CLAB

87807 Blank IAADIADOO RESPIRATORY SYNCTIAL VIRUS Pathology 0.41 CLAB

87808 Blank IAADIADOO TRICHOMONAS VAGINALIS Pathology 0.42 CLAB

87809 Blank INFECTIOUS AGENT IMMUNOASSAY OPTICAL ADENOVIRUS Pathology 0.60 CLAB

87810 Blank CHLAMYDIA TRACHOMATIS Pathology 0.98 CLAB

87850 Blank IAADIADOO NEISSERIA GONORRHOEAE Pathology 0.68 CLAB

87880 Blank IAADIADOO STREPTOCOCCUS GROUP A Pathology 0.46 CLAB

87899 Blank IAADIADOO NOT OTHERWISE SPECIFIED Pathology 0.45 CLAB

87900 Blank NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION Pathology 4.47 CLAB

87901 Blank NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS Pathology 8.83 CLAB

87902 Blank NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS Pathology 8.83 CLAB

87903 Blank NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS Pathology 16.76 CLAB

87904 Blank NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG Pathology 0.89 CLAB

87905 Blank INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS Pathology 0.42 CLAB

87906 Blank NFCT GEXYP DNA/RNA HIV 1 OTHER REGION Pathology 4.41 CLAB

87910 Blank NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS Pathology 8.83 CLAB

87912 Blank NFCT AGENT GENOTYPE HEPATITIS B VIRUS Pathology 8.83 CLAB

87999 Blank UNLISTED MICROBIOLOGY Pathology 0.35 Unlisted

88000 Blank NECROPSY GROSS EXAMINATION ONLY W/O CNS Pathology 6.19 ERBRVS

88005 Blank NECROPSY GROSS EXAMINATION W/BRAIN Pathology 7.22 ERBRVS

88007 Blank NECROPSY GROSS EXAMINATION W/BRAIN&SPINAL CORD Pathology 7.57 ERBRVS

88012 Blank NECROPSY GROSS EXAMINATION INFANT W/BRAIN Pathology 6.19 ERBRVS

88014 Blank NECROPSY GROSS EXAM STILLBORN/NEWBORN W/BRAIN Pathology 5.68 ERBRVS

88016 Blank NECROPSY GROSS EXAM MACERATED STILLBORN Pathology 7.91 ERBRVS

88020 Blank NECROPSY GROSS & MICROSCOPIC W/O CNS Pathology 10.66 ERBRVS

88025 Blank NECROPSY GROSS & MICROSCOPIC W/BRAIN Pathology 10.32 ERBRVS

88027 Blank NECROPSY GROSS&MCRSCP BRAIN & SPINAL CORD Pathology 11.01 ERBRVS

88028 Blank NECROPSY GROSS & MICROSCOPIC INFANT W/BRAIN Pathology 6.19 ERBRVS

88029 Blank NECROPSY GROSS&MCRSCP STILLBORN/NEWBORN BRAIN Pathology 6.19 ERBRVS

88036 Blank NECROPSY LIMITED GROSS&/MCRSCP REGIONAL Pathology 3.10 ERBRVS

88037 Blank NECROPSY LIMITD GROSS&/MCRSCP SINGLE ORGAN Pathology 2.75 ERBRVS

88040 Blank NECROPSY FORENSIC EXAMINATION Pathology 17.20 ERBRVS

88045 Blank NECROPSY CORONER CALL Pathology 1.72 ERBRVS

88099 Blank UNLISTED NECROPSY PROCEDURE Pathology 10.32 Unlisted

88130 Blank SEX CHROMATIN IDENTIFICATION BARR BODIES Pathology 0.62 CLAB

88140 Blank SEX CHROMATIN IDENTJ PERIPHERAL BLOOD SMEAR Pathology 0.27 CLAB

88142 Blank CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN Pathology 0.69 CLAB

88143 Blank CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS Pathology 0.69 CLAB





PAGE 28 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

88147 Blank CYTP SMRS C/V SCR AUTOMATED SYSTEM PHYS SUPV Pathology 1.40 CLAB

88148 Blank CYTP SMRS C/V SCR AUTO SYS MNL RESCR PHYS Pathology 0.52 CLAB

88150 Blank CYTP SLIDES C/V MNL SCR UNDER PHYS Pathology 0.41 CLAB

88152 Blank CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS Pathology 0.77 CLAB

88153 Blank CYTP SLIDES C/V MNL SCR&RESCR PHYS Pathology 0.67 CLAB

88155 Blank CYTP SLIDES C/V DEFINITIVE HORMONAL EVAL Pathology 0.41 CLAB

88164 Blank CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV Pathology 0.41 CLAB

88165 Blank CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV Pathology 1.17 CLAB

88166 Blank CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS SUPV Pathology 0.41 CLAB

88167 Blank CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&I Pathology 0.41 CLAB

88174 Blank CYTP C/V AUTO THIN LYR PREPJ SCR SYS PHYS Pathology 0.73 CLAB

88175 Blank CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS Pathology 0.91 CLAB

88199 Blank UNLISTED CYTOPATHOLOGY PROCEDURE Pathology 1.93 Unlisted

88199 26 UNLISTED CYTOPATHOLOGY PROCEDURE Pathology 0.81 Unlisted

88199 TC UNLISTED CYTOPATHOLOGY PROCEDURE Pathology 1.12 Unlisted

88230 Blank TISS CUL NON-NEO DISORDERS LYMPHOCYTE Pathology 4.00 CLAB

88233 Blank TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX Pathology 4.83 CLAB

88235 Blank TISS CUL NON-NEO DISORDERS AMNIOTIC/CHORNC CELLS Pathology 5.05 CLAB

88237 Blank TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS Pathology 4.33 CLAB

88239 Blank TISS CUL NEO DISORDERS SOLID TUMOR Pathology 5.06 CLAB

88240 Blank CRYOPRSRV FRZING&STORAGE CELLS EA CELL LINE Pathology 0.36 CLAB

88241 Blank THAWING&EXPANSION FROZEN CELLS EACH ALIQUOT Pathology 0.35 CLAB

88245 Blank CHRMSM BREAKAGE BASELINE SISTER 20-25 CLL Pathology 5.94 CLAB

88248 Blank CHRMSM BREAKAGE BASELINE BREAKAGE 50-100 CLL Pathology 5.94 CLAB

88249 Blank CHRMSM BREAKAGE SYNDS SCORE 100 CLL Pathology 5.94 CLAB

88261 Blank CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING Pathology 7.34 CLAB

88262 Blank CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING Pathology 4.27 CLAB

88263 Blank CHRMSM COUNT 45 CELL MOSAICISM 2KARYOTYPE Pathology 5.15 CLAB

88264 Blank CHRMSM ANALYZE 20-25 CELLS Pathology 4.27 CLAB

88267 Blank CHRMSM ALYS AMNIOTIC/VILLUS 15 CELL 1KARYOTYPE Pathology 6.17 CLAB

88269 Blank CHRMSM SITU AMNIOTIC CLL 6-12 COLONIES 1KARYOTYP Pathology 5.70 CLAB

88271 Blank MOLECULAR CYTOGENETICS DNA PROBE EACH Pathology 0.73 CLAB

88272 Blank MOLECULAR CYTOGENETICS CHRMOML ISH 3-5 CELLS Pathology 1.13 CLAB

88273 Blank MOLECULAR CYTOGENETICS CHRMOML ISH 10-30 CLL Pathology 1.10 CLAB

88274 Blank MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL Pathology 1.19 CLAB

88275 Blank MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL Pathology 1.42 CLAB

88280 Blank CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY Pathology 0.93 CLAB

88283 Blank CHRMSM ANALYSIS ADDL SPECIALIZED BANDING Pathology 2.35 CLAB

88285 Blank CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY Pathology 0.75 CLAB

88289 Blank CHRMSM ANALYSIS ADDL HIGH RESOLUTION STUDY Pathology 1.18 CLAB

88299 Blank UNLISTED CYTOGENETIC STUDY Pathology 1.19 Unlisted

88371 Blank PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO Pathology 0.76 CLAB

88372 Blank PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA Pathology 0.78 CLAB

88375 Blank OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT Pathology 1.40 ERBRVS

88399 Blank UNLISTED SURGICAL PATHOLOGY PROCEDURE Pathology 1.92 Unlisted

88399 26 UNLISTED SURGICAL PATHOLOGY PROCEDURE Pathology 1.09 Unlisted

88399 TC UNLISTED SURGICAL PATHOLOGY PROCEDURE Pathology 0.83 Unlisted

88720 Blank BILIRUBIN TOTAL TRANSCUTANEOUS Pathology 0.17 CLAB

88738 Blank HGB QUANTITATIVE TRANSCUTANEOUS Pathology 0.17 CLAB





PAGE 29 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

88740 Blank HEMOGLOBIN QUAN TC PER DAY CARBOXYHEMOGLOBIN Pathology 0.26 CLAB

88741 Blank HEMOGLOBIN QUANTITATIVE TC PER DAY METHEMOGLOBIN Pathology 0.26 CLAB

88749 Blank UNLISTED IN VIVO LABORTORY SERVICE Pathology 0.17 Unlisted

89050 Blank CELL COUNT MISCELLANEOUS BODY FLUIDS Pathology 0.16 CLAB

89051 Blank CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT Pathology 0.19 CLAB

89055 Blank LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE Pathology 0.15 CLAB

89060 Blank CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID Pathology 0.25 CLAB

89125 Blank FAT STAIN FECES URINE/RESPIR SECRETIONS Pathology 0.16 CLAB

89160 Blank MEAT FIBERS FECES Pathology 0.13 CLAB

89190 Blank NASAL SMEAR EOSINOPHILS Pathology 0.16 CLAB

89240 Blank UNLIS MISC PATH Pathology 0.16 Unlisted

89250 Blank CUL OOCYTE/EMBRYO <4 DAYS Pathology 12.56 FAIR Health

89251 Blank CUL OOCYTE/EMBRYO < 4 D CO-CULT OCYTE/EMBRY Pathology 13.91 FAIR Health

89253 Blank ASSTD EMBRYO HATCHING MICROTQS ANY METH Pathology 5.32 FAIR Health

89254 Blank OOCYTE ID FROM FOLLICULAR FLU Pathology 5.47 FAIR Health

89255 Blank PREPJ EMBRYO TR Pathology 3.84 FAIR Health

89257 Blank SPRM ID FROM ASPIR OTH/THN SEMINAL Pathology 4.24 FAIR Health

89258 Blank CRYOPRSRV EMBRYO Pathology 6.42 FAIR Health

89259 Blank CRYOPRSRV SPRM Pathology 1.46 FAIR Health

89260 Blank SPRM ISOL SMPL PREP INSEMINATION/DX SEMEN ALYS Pathology 1.43 FAIR Health

89261 Blank SPRM ISOL CPLX PREP INSEMINATION/DX SEMEN ALYS Pathology 1.87 FAIR Health

89264 Blank SPRM ID FROM TSTIS TISS FRSH/CRYOPRSRVD Pathology 5.08 FAIR Health

89268 Blank INSEMINATION OOCYTES Pathology 4.70 FAIR Health

89272 Blank EXTND CUL OOCYTE/EMBRYO 4-7 DAYS Pathology 7.90 FAIR Health

89280 Blank ASSTD FERTILIZATION MICROTQ </EQUAL 10 OOCYTES Pathology 13.16 FAIR Health

89281 Blank ASSTD FERTILIZATION MICROTQ > 10 OOCYTES Pathology 14.59 FAIR Health

89290 Blank BX OOCYTE MICROTQ </= 5 EMBRY Pathology 12.85 FAIR Health

89291 Blank BX OOCYTE MICROTQ >5 EMBRY Pathology 15.16 FAIR Health

89300 Blank SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER Pathology 0.31 CLAB

89310 Blank SEMEN ALYS MOTILITY&CNT X W/HUHNER TST Pathology 0.30 CLAB

89320 Blank SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT Pathology 0.41 CLAB

89321 Blank SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM Pathology 0.41 CLAB

89322 Blank SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA Pathology 0.53 CLAB

89325 Blank SPERM ANTIBODIES Pathology 0.37 CLAB

89329 Blank SPERM EVALUATION HAMSTER PENETRATION TEST Pathology 0.67 CLAB

89330 Blank SPERM EVALUATION CERVICAL MUCOUS PENETRATION Pathology 0.34 CLAB

89331 Blank SPERM EVALUATION RETROGRADE EJACULATION URINE Pathology 0.67 CLAB

89335 Blank CRYOPRSRV REPRODUCTIVE TISSUE TESTICULAR Pathology 2.57 FAIR Health

89337 Blank CRYOPRESERVATION MATURE OOCYTE(S) Pathology 9.54 FAIR Health

89342 Blank STORAGE PER YEAR EMBRYO Pathology 3.02 FAIR Health

89343 Blank STORAGE PER YEAR SPERM/SEMEN Pathology 2.12 FAIR Health

89344 Blank STORAGE PER YR REPRDTVE TISS TSTICULAR/OVARIAN Pathology 2.02 FAIR Health

89346 Blank STORAGE PER YEAR OOCYTE Pathology 3.04 FAIR Health

89352 Blank THAWING CRYOPRESERVED EMBRYO Pathology 5.40 FAIR Health

89353 Blank THAWING CRYOPRESERVED SPERM/SEMEN EACH ALIQUOT Pathology 0.80 FAIR Health

89354 Blank THAWING CRYOPRESERVED TESTICULAR/OVARIAN Pathology 1.56 FAIR Health

89356 Blank THAWING CRYOPRESERVED OOCYTES EACH ALIQUOT Pathology 4.64 FAIR Health

89398 Blank UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE Pathology 0.41 Unlisted

0357T Blank CRYOPRESERVATION IMMATURE OOCYTE(S) Pathology 5.78 v3.23





PAGE 30 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

G0027 Blank SEMEN ANALYSIS Pathology 0.22 CLAB

G0103 Blank PSA SCREENING Pathology 0.63 CLAB

G0123 Blank SCREEN CERV/VAG THIN LAYER Pathology 0.69 CLAB

G0143 Blank SCR C/V CYTO,THINLAYER,RESCR Pathology 0.75 CLAB



G0147 Blank SCR C/V CYTO, AUTOMATED SYS Pathology 0.41 CLAB

G0148 Blank SCR C/V CYTO, AUTOSYS, RESCR Pathology 0.89 CLAB

G0306 Blank CBC/DIFFWBC W/O PLATELET Pathology 0.27 CLAB

G0307 Blank CBC WITHOUT PLATELET Pathology 0.22 CLAB

G0328 Blank FECAL BLOOD SCRN IMMUNOASSAY Pathology 0.55 CLAB

G0432 Blank EIA HIV-1/HIV-2 SCREEN Pathology 0.54 CLAB

G0433 Blank ELISA HIV-1/HIV-2 SCREEN Pathology 0.51 CLAB

G0435 Blank ORAL HIV-1/HIV-2 SCREEN Pathology 0.41 CLAB

G0471 Blank VEN BLOOD COLL SNF/HHA Pathology 0.14 CLAB

G0472 Blank HEP C SCREEN HIGH RISK/OTHER Pathology 1.29 CLAB

G0475 Blank HIV COMBINATION ASSAY Pathology 0.83 CLAB

G0476 Blank HPV COMBO ASSAY CA SCREEN Pathology 1.20 CLAB

G0480 Blank DRUG TEST DEF 1-7 CLASSES Pathology 3.18 CLAB



G0483 Blank DRUG TEST DEF 22+ CLASSES Pathology 6.86 CLAB

G0659 Blank DRUG TEST DEF SIMPLE ALL CL Pathology 2.00 CLAB

G9143 Blank WARFARIN RESPON GENETIC TEST Pathology 4.14 CLAB

P2028 Blank CEPHALIN FLOCULATION TEST Pathology 0.17 CLAB

P2029 Blank CONGO RED BLOOD TEST Pathology 0.17 CLAB

P2031 Blank HAIR ANALYSIS Pathology 0.17 CLAB

P2033 Blank BLOOD THYMOL TURBIDITY Pathology 0.17 CLAB

P2038 Blank BLOOD MUCOPROTEIN Pathology 0.17 CLAB

P3000 Blank SCREEN PAP BY TECH W MD SUPV Pathology 0.41 CLAB

P7001 Blank CULTURE BACTERIAL URINE Pathology 0.73 FAIR Health

P9603 Blank ONE-WAY ALLOW PRORATED MILES Pathology 0.01 5% Sample

P9604 Blank ONE-WAY ALLOW PRORATED TRIP Pathology 0.15 FAIR Health

P9612 Blank CATHETERIZE FOR URINE SPEC Pathology 0.08 CLAB

P9615 Blank URINE SPECIMEN COLLECT MULT Pathology 0.08 CLAB

Q0111 Blank WET MOUNTS/ W PREPARATIONS Pathology 0.41 CLAB

Q0112 Blank POTASSIUM HYDROXIDE PREPS Pathology 0.16 CLAB

Q0113 Blank PINWORM EXAMINATIONS Pathology 0.15 CLAB

Q0114 Blank FERN TEST Pathology 0.27 CLAB

Q0115 Blank POST-COITAL MUCOUS EXAM Pathology 0.69 CLAB

S3600 Blank STAT LAB Pathology 0.19 FAIR Health

S3601 Blank STAT LAB HOME/NF Pathology 0.60 FAIR Health

S3620 Blank NEWBORN METABOLIC SCREENING Pathology 0.43 FAIR Health

S3630 Blank EOSINOPHIL BLOOD COUNT Pathology 0.21 v3.23

S3645 Blank HIV-1 ANTIBODY TESTING OF OR Pathology 0.19 FAIR Health

S3650 Blank SALIVA TEST, HORMONE LEVEL; Pathology 3.09 v3.23

S3652 Blank SALIVA TEST, HORMONE LEVEL; Pathology 2.51 v3.23





PAGE 31 of 31

CPT/

HCPCS

Code


Conversion

Factor/GAAF

Category

Total

RVUs

Charge

Methodology 1

S3655 Blank ANTISPERM ANTIBODIES TEST Pathology 0.51 v3.23

S3900 Blank SURFACE EMG Pathology 1.46 FAIR Health1 Charge Methodology:

5% Sample: RVUs based on the Medicare 5% Sample Part B database.

CLAB: RVUs derived from the Clinical Lab fee schedule.

ERBRVS: RVUs based on Essential RBRVS RVUs.

FAIR Health: Charge developed from FAIR Health database.

Unlisted: Developed based on the weighted median of the total RVUs of CPT/HCPCS codes within the series in which the unlisted procedure occurs.

v3.23: RVUs from v3.23 were adopted for v3.25.

Other: RVUs based on methods not specified above, including crosswalks from similar code charges.



TABLE J. — PATHOLOGY AND LABORATORY SERVICES … · TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs) v3.25 (January - December 2019) PAGE 1 of 31 NOTES:

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