All In-Office Laboratory Testing and Procedures:
Marked with *, **, ***, ****, and ***** will be limited to one procedure within the same family of asterisks, per visit.
Example: All laboratory testing/procedure codes that are marked with one * will only be allowed to have one laboratory test/procedure performed, per visit, out of all of the codes designated with the single *.
Marked with the # symbol will only be considered for reimbursement if the member has an infertility benefit and the provider has the appropriate specialty. Refer to the policy titled Infertility Diagnosis and Treatment for additional information related to infertility coverage.
CPT Code Description
Primary Care Physicians and Specialists
80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (e.g., immunoassay); capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges) includes sample validation when
performed, per date of service
80306 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (e.g., immunoassay); read by instrument assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when
performed, per date of service
81000* Urinalysis, non-automated, with microscopy
81001* Urinalysis, automated, with microscopy
81003* Urinalysis, automated, without microscopy
81025 Urine pregnancy test, by visual color comparison methods
82270***** Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection)
CPT Code Description
85097 Bone marrow; smear interpretation only, with or without differential cell count
86077 Blood bank physician services; difficult cross-match and/or evaluation of irregular antibody(s), interpretation and written report
86078 Blood bank physician services; investigation of transfusion reaction, including suspicion of transmissible disease, interpretation and written report
86079 Blood bank physician services; authorization for deviation from standard bloodbanking procedures, with written report
86927-86999 Transfusion medicine Ophthalmologists and Connecticut CLIA Certified Optometrists
Note: Connecticut optometrists may be reimbursed for CPT code 83861 in the office if they are CLIA Certified (Clinical Laboratory Improvement Amendments of 1988 (CLIA)). If no CLIA certification is on file, the service is not eligible for reimbursement.
83861 Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity
Ophthalmologists and Optometrists
83516 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method
87809 Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus
Pulmonologists 82803 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation)
89060 Crystal Identification by light microscopy with or without polarizing lens analysis; tissue or any body fluid (except urine) Urologists
89264# Sperm identification from testis tissue, fresh or cryopreserved
89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital)
89310 Semen analysis; motility and count (not including Huhner test)
89320 Semen analysis; volume, count, motility and differential
89321 Semen analysis; sperm presence and motility of sperm, if performed
89322 Semen analysis; volume, count, motility, and differential using strict morphologic criteria (e.g., Kruger)
In-Office Laboratory Testing and Procedures
Reimbursement of network physicians for the performance of in-office laboratory testing/procedures is limited to those codes listed on the in-office laboratory testing and procedures list. Reimbursement for some of the Laboratory testing/procedures is limited to certain physician specialties. Refer to the Applicable Codes section below for a list of specific CPT codes.
Marked with a # symbol, will only be considered for reimbursement if the member has an infertility benefit and the provider has the appropriate specialty. Refer to the policy titled Infertility Diagnosis and Treatment for additional information related to infertility coverage.
Specimen Handling and Venipuncture CODE 36415
When specimen handling and venipuncture codes are billed;
With a laboratory/procedure code on the in-office laboratory testing and procedures list, only the laboratory testing/procedure and venipuncture codes will be considered for reimbursement. Note: The laboratory testing/procedure code will only be considered for reimbursement if the code is listed in the Applicable Codes section of the policy and the provider has the appropriate specialty, if required.
Without a laboratory testing/procedure code on the in-office laboratory testing and procedures list or with other non-laboratory testing/procedure services, the specimen handling and venipuncture codes will be considered for reimbursement.