Physician Office Laboratory Tests

M.D.IPA, M.D.IPA Preferred, Optimum Choice and Optimum Choice Preferred STAT Laboratory List Revised Jan. 5, 2017

M.D.IPA, M.D.IPA Preferred, Optimum Choice and Optimum Choice Preferred STAT Laboratory List Revised Jan. 5, 2017 If laboratory results are required on a STAT basis, the designated commercial medical laboratory

Sage Program Reimbursement Rates (Effective Jan 1, 2018 through Dec 31, 2018)

Sage Program Reimbursement Rates Code Description of Service Allowable Rates New Patient 99201 History, exam, straight forward decision-making; 10 $44.47 99202 Expanded history; exam, straightforward decision-making;

In-OfficeLabTesting. Effective date: August 1, 2017

Effective date: August 1, 2017 In-OfficeLabTesting The lab services below can be performed and reimbursed in an office setting. All other office-based lab services must be submitted through our contracted

In Office Lab Testing

Effective January 1, 201, the lab services below can be performed and reimbursed in an office setting. All other office-based lab services must be submitted through our contracted laboratory providers.

Effective June 1, 2018

EMPIRE PHYSICIAN OFFICE LAB (POL) LIST Approved Laboratory Tests for Physician Offices Reimbursement is only available if the benefit is covered under the member's contract. Medical Policy edits will apply.

Epic Labs Orderable As STAT PRIORITY As of 06/22/2016

ABG+HB(CORDARTERIAL) - BABY A ABG+HB(CORD ARTERIAL)- BABY B ABG+HB(CORD ARTERIAL)- BABY C ACETAMINOPHEN LEVEL ALANINE AMINOTRANSFERASE (ALT) ALBUMIN, FLUID ALBUMIN, PLEURAL FLUID ALBUMIN, SYNOVIAL FLUID

Medicaid Family Planning Waiver Services CPT Codes and ICD-10 Diagnosis Codes

CPT Code Description of Covered Codes Evaluation and Management 99384FP 99385FP Family planning new visit 99386FP 99394FP 99395FP Family planning established visit 99396FP 99401FP HIV counseling (pre-test)

Sutter Health Plus Effective for Calendar Year 2015

Sutter Health Plus Effective for Calendar Year 2015 CPTs CPT Descriptions 2015 Cost Under Deducible (Single Unit) Doctor's Office Visit for a New Patient (Also Urgent Care) 99201 Low Level Visit $99.00

Chapter 17 Worksheet Code It

Class: Date: Chapter 17 Worksheet 3 2 1 Code It True/False Indicate whether the statement is true or false. 1. CPT laboratory codes include collection of the specimen. 2. A dipstick is a small piece of

Inspector's Accreditation Unit Activity Menu

01/12/20XX 15:58:57 Laboratory Accreditation Program Page 1 of 9 CHEMISTRY 1501 ALT, serum/plasma 1502 Albumin, serum/plasma 1504 Alkaline phosphatase, serum/plasma 1506 Amylase, serum/plasma 1508 Bilirubin,

2017 NBCCEDP Allowable Procedures and Relevant CPT Codes

2017 NBCCEDP Allowable Procedures and Relevant CPT Codes Listed below are allowable procedures and the corresponding suggested Current Procedural Terminology (CPT) codes for use in the National Breast

Analyte Specimen Demographic Reference Range Units

Acetone Negative titer Alanine aminotransferase (ALT/SGPT) 10-49 U/L Albumin 3.2-4.8 g/dl Alcohol < 10 Alpha-fetoprotein (AFP) < 1.3-8.1 ng/ml Alkaline phosphatase 0 7 days 7 30 days 1 3 3 6 6 12 1 3 3

Chemistry Reference Ranges and Critical Values

Alanine Aminotransferase (ALT, SGPT) 3-9 years 9-18 years 1-9 years 9-18 years 10-30 U/L 10-30 U/L 10-20 U/L Albumin 0-6 days 6 days - 37 months 37 months - 7 years 7-20 years 2.6-3.6 g/dl 3.4-4.2 g/dl

Chemistry Reference Ranges and Critical Values

Alanine Aminotransferase (ALT, SGPT) 3-9 years 9-18 years 1-9 years 9-18 years 10-25 U/L 10-35 U/L 10-30 U/L 10-25 U/L 10-30 U/L 10-35 U/L 10-25 U/L 10-35 U/L 10-25 U/L 10-20 U/L 10-35 U/L Albumin 0-6

BASIC METABOLIC PANEL

Update 2/12/2018 BASIC METABOLIC PANEL CPT 80048 Stability: 3 days at 15-25 C; 7 days at 2-8 C; > 7 days at -70 C Colorimetric Assay, Rate reaction, ISE Components: BUN, Calcium, Chloride, CO2, Creatinine,

Online catalog

This catalog contains information about tests performed at Green Clinic Laboratory. For samples to be sent to Quest Diagnostics or any other reference lab please contact the Green Clinic Laboratory (318-251-6378)

Refugee Health Funding Models: A Review of PA Models and A Vision for the Future

Refugee Health Funding Models: A Review of PA Models and A Vision for the Future Gretchen Shanfeld, MPH Director of Health and Wellness, Nationalities Service Center Coordinator, Philadelphia Refugee Health

lab Test Name notes on collection container type CBC AUTO HEMOGLOBIN & HEMATOCRIT

lab Test Name notes on collection container type CBC AUTO HEMOGLOBIN & HEMATOCRIT CBC HEMOGRAM LAV HEMOGLOBIN HEMATOCRIT PLATELET COUNT & IPF LAV ERYTHROCYTE SEDIMENTATION RATE MALARIA SMEAR RETICULOCYTE

Rapid Laboratories In House Tests

Electrolytes CL CL (CHLORIDE) Electrolytes CO2 CO2 (BICARBONATE) Electrolytes K K (POTASSIUM) Electrolytes NA NA (SODIUM) Basic Metabolic Panel (BMP) GLU GLU (GLUCOSE) Basic Metabolic Panel (BMP) CA CA

CERTIFICATE OF ACCREDITATION

CERTIFICATE OF ACCREDITATION LANCET KENYA LIMITED UPPERHILL NAIROBI LABORATORY Co. Reg. No.: C168507 Facility Accreditation Number: is a South African National Accreditation System accredited laboratory

Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK

2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK Pathology Laboratory Contact: Gavyn Barrett BMI Blackheath Hospital Tel: +44 (0)20 7307 7373 40-42 Lee Terrace E-Mail: Gavyn.barrett@tdlpathology.com

GENERAL INFORMATION CLINICAL LABORATORY PHONE DIRECTORY

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PROCEDURE/DIAGNOSIS/REVENUE CODES

PROCEDURE/DIAGNOSIS/REVENUE CODES TAKE CHARGE offers a limited benefit package of services which includes professional services, outpatient services, and laboratory/radiology and pharmaceutical services.

Anthem Central Region Clinical Claims Edit

Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Cytopathology, Cervical or Vaginal with Evaluation and Management

Procedure Description Modifier 33 Required? Screening test of visual acuity, quantitative, bilateral No Z Z00.129

Policy Name: Preventive Health Guidelines - Newborns and Children This policy applies only to non-grandfathered plans as defined in the Affordable Care Act section 1251. The following chart contains procedure,

Tables of Normal Values (As of February 2005)

Tables of Normal Values (As of February 2005) Note: Values and units of measurement listed in these Tables are derived from several resources. Substantial variation exists in the ranges quoted as normal

CERTIFICATE OF ACCREDITATION

CERTIFICATE OF ACCREDITATION In terms of section 22(2) (b) of the Accreditation for Conformity Assessment, Calibration and Good Laboratory Practice Act, 2006 (Act 19 of 2006), read with sections 23(1),

1. Purpose 1.1. To define testing locations, schedule and order priority for each test performed in the core laboratory.

Department Of Pathology GEN.1017.03 Integrated Test Schedule Version# 5 Department Specimen Processing POLICY NO. 1938 PAGE NO. 1 OF 6 Printed copies are for reference only. Please refer to the electronic

Test Result Reference Range Flag

Date of Last Result Test Result Reference Range Flag Dec 07, 2016 25-Hydroxy Vitamin D Total 53 ng/ml 30-100 ng/ml Activated Partial Thromboplast Time Alanine Aminotransferase (ALT/SGPT) 25 sec 24-35 sec

Specimen Collection Requirements

The following is a job aid listing the specimen collection requirements for laboratory testing at Colchester East Hants Health Center. Specimens must be accompanied by the Patient Information Form G09.

Specimen Collection Requirements

The following is a job aid listing the specimen collection requirements for laboratory testing at Colchester East Hants Health Center. Specimens must be accompanied by the Patient Information Form G09.

CLIA APPROVED PROFICIENCY TESTING PROGRAMS ACCUTEST, INC. P.O. Box 999 Westford, Massachusetts (800)

ACCUTEST, INC. P.O. Box 999 Westford, Massachusetts 01886 (800) 665-2575 MICROBIOLOGY Bacteriology Aerobic Culture and Identification Antibiotic Susceptibility Testing Direct Antigen Detection Gram Stain

SPECTRA EAST, INC. Rockleigh, NJ

A2LA has accredited SPECTRA EAST, INC. Rockleigh, NJ for technical competence in the field of Medical Testing This laboratory is accredited in accordance with the recognized International Standard ISO/IEC

ISO 15189:2012 Internationally-Recognized Accredited Laboratory. SPECTRA EAST, INC. Rockleigh, NJ

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Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK

Schedule of ccreditation United Kingdom ccreditation Service HSL (nalytics) LLP ccredited to Department of Clinical iochemistry (Chemical Pathology) arnet and Chase Farm Hospitals Wellhouse Lane arnet

BCCCNP Service CPT Code FY19 Rate. $ $97.98 $ Diagnostic Breast Tomosynthesis (Bilateral) 3D Mammogram a. Global

1 Screening Mammogram (Bilateral) 2 Screening Breast Tomosynthesis (Bilateral) 3D Mammogram ** Can only be paid w/ screening mammography (77067))** 3 Diagnostic Mammogram (Unilateral) 4 Diagnostic Mammogram

FY 2017 MCRCEDP Procedure Code Reference Chart

45378-53 45380 45381 45382 45384 45385 48388 45390 ; Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon

FY 2017 BCCCNP Unit Cost Reimbursement Rate Schedule

1 Screening Mammogram (Bilateral) 1a. ** NEW **- 01/01/2017- ** Replaces 77057** Screening Mammogram (Bilateral) 2 Digital Screening Mammogram (Bilateral) Service CPT Code 2a. Screening Breast Tomosynthesis

TEST LIST SAMPLE REQUIREMENT. 1 ml serum None

ALBUMIN TEST NAME ALKALINE PHOSPHATASE ALLERGY PROFILE, FOOD 30 allergens ALLERGY PROFILE, INHALANT 30 Allergens ALT AMYLASE ANA ANTI- TG ANTI-GLIADIN IGG ANTI-GLIADIN IGA ANTI-HBS ANTI-HCV ANTI-TPO APOLIPOPROTEIN

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CERTIFICATE OF ACCREDITATION

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NORMAL LABORATORY VALUES FOR CHILDREN

Pediatric Drug Lookup Normal Laboratory Values for NORMAL LABORATORY VALUES FOR CHILDREN CHEMISTRY Normal Values Albumin 0-1 y 2.0-4.0 g/dl 1 y to adult 3.5-5.5 g/dl Ammonia Newborns 90-150 mcg/dl 40-120

Be Healthy. Be Healthy. Using Your Wellness Benefits. Helping You Stay Healthy. Wellness Benefits

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FY 2015 BCCCP Procedure Code Reference Chart

Procedure Reference Chart 77057 G0202 77055 G0206 77056 G0204 Screening mammography, bilateral (two view film study of each breast) Screening mammography producing direct digital image, bilateral, all

Hamilton Regional Laboratory Medicine Program

Created: April 2002 of Review: February 2004 of Review: June 2006 of Review: July 2007, St. Joseph s Healthcare went live with Meditech as of June18, 2007. of Review: August 2009 of Review: December 2011;

Clinical Breast Examination N/A Yes Screening Mammogram $ TC $ 43.56

For the Period 07/01/2015 through 06/30/2016 Revised: 10/09/2015 Breast Procedures (1) Screening Clinical Breast Examination N/A Screening Mammogram 77057 $ 78.38 77057-TC $ 43.56 77057-26 $ 34.82 Follow-Up

South Carolina North Carolina Louisiana. Norplant implant removal. Diaphragm fitting with instructions

P a g e 1 00840 00851 00921 Anesthesia, intraperitoneal procedure, lower abdomen, Including laparoscopy; tubal ligation/transection Anesthesia for vaginal procedure 00952 (including biopsy of labia, vagina,

$ $97.98 $ a. Diagnostic Breast Tomosynthesis (Bilateral) 3D Mammogram a. Global. $47.61 b. Technical/Facility Only

1 Screening Mammogram (Bilateral) 2 Digital Screening Mammogram (Bilateral) 2a. Screening Breast Tomosynthesis (Bilateral) 3D Mammogram ** Can only be paid w/ screening mammography (77067))** 3 Diagnostic

BCCCNP Service CPT Code FY 2019 Rate Oct 1, 2018 Dec 31, 2018

1 Screening Mammogram (Bilateral); including CAD Service CPT Code 77067 77067-TC 77067-26 $111.40 $81.32 $30.08 $131.51 $93.70 $37.82 * Note: Breast tomosynthesis, unilateral (77061) and bilateral (77062)

Be Healthy. Be Healthy. Using Your Wellness Benefits. Helping You Stay Healthy. Wellness Benefits

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BCCCNP Service CPT Code FY 2019 Rate Oct 1, 2018 Dec 31, 2018

1 Screening Mammogram (Bilateral); including CAD 2 Screening Breast Tomosynthesis (Bilateral) 3D Mammogram ** Can only be paid w/ screening mammography (77067))** 3 Diagnostic Mammogram (Unilateral); including

Hamilton Regional Laboratory Medicine Program

Created: April 2002 of Review: February 2004 of Review: June 2006 of Review: July 2007, St. Joseph s Healthcare went live with Meditech as of June18, 2007. of Review: August 2009 of Review: December 2011;

Pathology and Laboratory

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Supplementary materials

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Alaska Native Medical Center Anchorage, AK

ANMC Lab Test Requirements Key: Room Temp (20-25C), Refrigerated (2-8C), (-15 to -25C), Hr (Hours), D (Days), W (Weeks), Mo (Months), Yr (Years). Basic Processing Instructions: Centrifuge all blood specimens

NOTE: Please append modifier 33 when indicated. If modifier 33 is not appended, regular plan benefits will be applied.

Policy name: Health Guidelines - Men This policy applies only to non-grandfathered plans as defined in the Affordable Care Act section 1251. The following chart contains procedure, diagnosis and modifier

Fullerton Healthcare Screening Centres

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CERTIFICATE OF ACCREDITATION

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The following is a list of Fee-for-Service (FFS) outpatient laboratory Facility Approval Categories by fee item.

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ROTUNDA HOSPITAL DEPARTMENT OF LABORATORY MEDICINE

This active test table informs the user of Biochemistry tests available in house. s referred to other sites are recorded in the Referred Table. Issue date: 4 TH April 2016 Contact Phone Number ext.1345/2522

HEALTH SCREEN CARE. VIGNE Healthcare provides a comprehensive Health Screening Package of EXCLUSIVE HEALTH SCREENING EXPERIENCE

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28. Bilirubin (total, total conjugated, unconjugated, direct and indirect).

1. 17-OH-Progesterone. 2. 5α-dihydrotestosterone (DHT). 3. Adrenocorticotropic Hormone ACTH. 4. Alanine Transaminase (ALT, SGPT). 5. Albumin, qualitative. 6. Aldosterone. 7. Allergen Specific IgG Antibody.

ENROLLMENT CONFIRMATION

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SCOPE OF ACCREDITATION TO ISO 15189:2012. SPECTRA, EAST LABORATORY 8 King Road Rockleigh, NJ Stylianos Lomvardias, M.D.

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Uni-Asia Scientific Instrument Company Limited. Stanbio Laboratory Product List

0130-430 Magnesium LiquiColor Test 0140-050 Sodium Test 0150-250 Calcium (CPC) LiquiColor Test 0153-030 Calcium Standard (10 mg/dl) 0155-225 Calcium (Arsenazo) LiquiColor Test 0160-050 Potassium Test 0210-250

Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK

2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK Spire Portsmouth Hospital Bartons Road Havant PO9 5NP United Kingdom Contact: Natalie Peck E-Mail: natalie.peck@spirehealthcare.com Website:

Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK

2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK Rapid Response Laboratory United Kingdom Contact: Gavyn Barrett Tel: +44 (0) 20 7307 7373 E-Mail: Gavyn.barrett@tdlpathology.com Website:

Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK

2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK Biochemistry Department Poole Hospital Longfleet Road Poole BH15 2JB Contact: Dr Fergus Jack Tel: +44 (0) 1202 442 497 E-Mail: Fergus.jack@poole.nhs.uk

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ICL Integrative Laboratory Services Test Menu Contact ICL Client Care x300

Alletess Food Sensitivity Fingerstick 96 Foods IgG with or without Wellness Program 184 Foods IgG with or without Wellness Program Alletess Food Allergy/Sensitivity Serum 96 Foods IgG with or without Wellness

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INDIANA HEALTH COVERAGE PROGRAMS

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Routine Clinic Lab Studies

Routine Lab Studies Routine Clinic Lab Studies With all lab studies, a Tacrolimus level will be obtained. These drug levels are routinely assessed to ensure that there is enough or not too much anti-rejection

Lab Values Explained. working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.

Patient Education Lab Values Explained Common Tests to Help Diagnose Kidney Disease Lab work, urine samples and other tests may be given as you undergo diagnosis and treatment for renal failure. The test

Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK

2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK Ltd Pathology Department Contact: Sally Curtis BMI The Priory Hospital Tel: +44 (0) 20 7307 7342 Priory Road E-Mail: sally.curtis@tdlpathology.com

2011 FITWAY Allowable CPT Codes (Modifiers are to be reported with appropriate CPT codes at the discretion of the Provider or Facility)

2011 FITWAY Allowable s (Modifiers are to be reported with appropriate CPT codes at the discretion of the Provider or Facility) Fecal Immunochemical Test (FIT) G0328/ 82274 Colorectal cancer screening

Eastern Maine Medical Center Patient Price Information Effective October 1, 2017 September 30, 2018

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Understanding Your Multiphasic Blood Analysis Test Results Mon General thanks you for participating in the multiphasic blood analysis. This test can be an early warning of health problems, including coronary

2012 FITWAY Allowable CPT Codes (Modifiers are to be reported with appropriate CPT codes at the discretion of the Provider or Facility)

2012 FITWAY Allowable s (Modifiers are to be reported with appropriate CPT codes at the discretion of the Provider or Facility) Fecal Immunochemical Test (FIT) G0328/ 82274 Colorectal cancer screening

Get to know yourself better. Attend our health screening event.

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BC Biomedical Laboratories Adult Reference Ranges

BC Biomedical Laboratories Adult s Name Age 25 OH VITAMIN D Blood B 0-100 nmol/l Interpretation: < 25 Deficient 25-74 Insufficient 75-199 Sufficient > 200 Toxic 5HIAA (CALC) Urine B 0-100

DEPARTMENT: Regulatory Compliance Support

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Services can be paid by BCHC only for breast and/or cervical cancer screening and diagnosis. BCHC does not require preauthorization. OFFICE VISITS New Patient - Office Visit (0 minutes face to face) 9920

Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK

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In compliance with state law, Western Reserve Hospital is providing this price list containing our charges for Room and Board, Emergency Department, Operating Room, Physical Therapy, Pain Medicine and

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Laboratory Values, Critical. ThedaCare. Date Last Reviewed: 4/5/2018 Reviewing Body(s): Quality; Laboratory Leadership

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