In-Office Laboratory Testing And Procedures List

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UnitedHealthcare OxfordReimbursement PolicyIN-OFFICE LABORATORY TESTING AND PROCEDURES LISTPolicy Number: LAB 003.31 T0Table of ContentsPageINSTRUCTIONS FOR USE . 1APPLICABLE LINES OF BUSINESS/PRODUCTS . 1APPLICATION . 1OVERVIEW . 1REIMBURSEMENT GUIDELINES . 2APPLICABLE CODES . 2REFERENCES . 5POLICY HISTORY/REVISION INFORMATION . 5Effective Date: January 1, 2018Related Policies Infertility Diagnosis and Treatment New York Participating Provider Laboratory &Pathology ProtocolINSTRUCTIONS FOR USEThe services described in Oxford policies are subject to the terms, conditions and limitations of the member's contractor certificate. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage members. Oxford reservesthe right, in its sole discretion, to modify policies as necessary without prior written notice unless otherwise requiredby Oxford's administrative procedures or applicable state law. The term Oxford includes Oxford Health Plans, LLC andall of its subsidiaries as appropriate for these policies.Certain policies may not be applicable to Self-Funded members and certain insured products. Refer to the memberspecific benefit plan document or Certificate of Coverage to determine whether coverage is provided or if there areany exclusions or benefit limitations applicable to any of these policies. If there is a difference between any policy andthe member specific benefit plan document or Certificate of Coverage, the member specific benefit plan document orCertificate of Coverage will govern.UnitedHealthcare may also use tools developed by third parties, such as the MCG Care Guidelines, to assist us inadministering health benefits. The MCG Care Guidelines are intended to be used in connection with the independentprofessional medical judgment of a qualified health care provider and do not constitute the practice of medicine ormedical advice.APPLICABLE LINES OF BUSINESS/PRODUCTSThis policy applies to Oxford Commercial plan membership.APPLICATIONThis policy applies to all network physicians providing laboratory testing/procedures provided in an office setting.Note: Certain physician contracts allow for additional laboratory testing/procedures that Oxford to be considered forreimbursement when provided in the physician’s office. Review the provider contract for additional coverageguidelines.OVERVIEWThe In-Office Laboratory Testing and Procedures List is a list of testing/laboratory procedure codes that Oxfordwill consider for reimbursement to its Network physicians when performed in their office. This list represents the onlylaboratory testing/procedures that Oxford Network physicians may provide in their offices. All other laboratorytesting/procedures must be performed by one of the participating laboratories in Oxford's network.Refer to the New York Participating Provider Laboratory & Pathology Protocol for commercial members enrolled onNew York (NY) products and to the Provider Administrative Guide for additional information on participating providerresponsibilities for all other commercial plan membership (New Jersey and Connecticut commercial products).In-Office Laboratory Testing and Procedures ListUnitedHealthcare Oxford Reimbursement Policy 1996-2018, Oxford Health Plans, LLCPage 1 of 5Effective 01/01/2018

REIMBURSEMENT GUIDELINESIn-Office Laboratory Testing and ProceduresReimbursement of network physicians for the performance of in-office laboratory testing/procedures is limited tothose codes listed on the in-office laboratory testing and procedures list. Reimbursement for some of the Laboratorytesting/procedures is limited to certain physician specialties. Refer to the Applicable Codes section below for a list ofspecific CPT codes.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 tohave one laboratory test/procedure performed, per visit, out of all of the codes designated with the single *. Marked with a # symbol, will only be considered for reimbursement if the member has an infertility benefit andthe provider has the appropriate specialty. Refer to the policy titled Infertility Diagnosis and Treatment foradditional information related to infertility coverage.Specimen Handling and VenipunctureWhen specimen handling and venipuncture codes are billed; With a laboratory/procedure code on the in-office laboratory testing and procedures list, only the laboratorytesting/procedure and venipuncture codes will be considered for reimbursement. Note: The laboratorytesting/procedure code will only be considered for reimbursement if the code is listed in the Applicable Codessection 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 othernon-laboratory testing/procedure services, the specimen handling and venipuncture codes will be considered forreimbursement.APPLICABLE CODESThe following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be allinclusive. Listing of a code in this policy does not imply that the service described by the code is a covered or noncovered health service. Benefit coverage for health services is determined by the member specific benefit plandocument and applicable laws that may require coverage for a specific service. The inclusion of a code does not implyany right to reimbursement or guarantee claim payment. Other Policies may apply.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 tohave 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 benefitand the provider has the appropriate specialty. Refer to the policy titled Infertility Diagnosis and Treatment foradditional information related to infertility coverage.CPT CodePrimary Care Physicians and SpecialistsDescription80305Drug test(s), presumptive, any number of drug classes, any number of devices orprocedures; capable of being read by direct optical observation only (e.g., utilizingimmunoassay [e.g., dipsticks, cups, cards, or cartridges]), includes sample validationwhen performed, per date of service80306Drug test(s), presumptive, any number of drug classes, any number of devices orprocedures; read by instrument assisted direct optical observation (e.g., utilizingimmunoassay [e.g., dipsticks, cups, cards, or cartridges]), includes sample validationwhen performed, per date of service81000*Urinalysis, non-automated, with microscopy81001*Urinalysis, automated, with microscopy81002*Urinalysis, non-automated, without microscopy81003*Urinalysis, automated, without microscopy81025Urine pregnancy test, by visual color comparison methods82270*****Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutivecollected specimens with single determination, for colorectal neoplasm screening(i.e., patient was provided three cards or single triple card for consecutive collection)In-Office Laboratory Testing and Procedures ListUnitedHealthcare Oxford Reimbursement Policy 1996-2018, Oxford Health Plans, LLCPage 2 of 5Effective 01/01/2018

CPT CodePrimary Care Physicians and SpecialistsDescription82271*****Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; other sources82272*****Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3simultaneous determinations, performed for other than colorectal neoplasmscreening82948Glucose; blood, reagent strip82962Glucose, blood sugar by glucometer83014Helicobacter pylori, breath test analysis; drug administration (Note: Dianon isproviding test kit free of charge — call 800-328-2666)83026Hemoglobin; by copper sulfate method, non-automated83655Lead85013***Blood count; spun microhematocrit85018***Blood count; hemoglobin (Hgb)85025***For Stat Purposes OnlyBlood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)and automated differential WBC count85651Sedimentation rate, erythrocyte; non-automated86403****Particle agglutination, screen, each antibody86485-86580Skin tests; various87070**Culture, bacterial; any other source but urine, blood or stool, with isolation andpresumptive identification of isolates.87081**Culture, bacterial, screening only, for single organisms87177Ova and parasites, direct smears, concentration and identification.87210Smear, wet mount with simple stain, for bacteria, fungi, ova, and/or parasites87220Tissue examination for fungi (e.g., KOH slide)87804Infectious agent antigen detection by immunoassay with direct optical observation;Influenza87880****Infectious agent detection by immunoassay-streptococcus group A88738Hemoglobin (Hgb), quantitative, transcutaneous89100Duodenal intubation and aspiration; single specimen plus appropriate test89105Duodenal intubation and aspiration; collection of multiple fractional specimens withpancreatic or gallbladder stimulation, single or double lumen tube89130-89141Gastric intubation and aspiration; various89350Sputum, obtaining specimen, aerosol-induced technique99195Phlebotomy, therapeutic (separate procedure)Primary Care Physicians (including Adolescent Medicine, Family Practice, General Practitioner, InternalMedicine and Obstetricians/Gynecologists)87651Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A,amplified probe technique.Pediatricians80305Drug test(s), presumptive, any number of drug classes, any number of devices orprocedures; capable of being read by direct optical observation only (e.g., utilizingimmunoassay [e.g., dipsticks, cups, cards, or cartridges]), includes sample validationwhen performed, per date of service80306Drug test(s), presumptive, any number of drug classes, any number of devices orprocedures; read by instrument assisted direct optical observation (e.g., utilizingimmunoassay [e.g., dipsticks, cups, cards, or cartridges]), includes sample validationwhen performed, per date of service82247Bilirubin, total87651Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A,amplified probe technique.In-Office Laboratory Testing and Procedures ListUnitedHealthcare Oxford Reimbursement Policy 1996-2018, Oxford Health Plans, LLCPage 3 of 5Effective 01/01/2018

CPT ctive adotropin; follicle stimulating hormone (FSH)83002Gonadotropin; luteinizing hormone (LH)84144Progesterone84702Gonadotropin, chorionic (hCG); quantitative89250#Culture of oocyte(s)/embryo(s), less than 4 days89253#Assisted Embryo hatching, microtechniques (any method)89254#Oocyte identification from follicular fluid89255#Preparation of embryo for transfer (any method)89257#Sperm identification from aspiration (other than seminal fluid)89260#Sperm isolation; simple prep (e.g., sperm wash and swim-up) for insemination ordiagnosis with semen analysis89261#Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) forinsemination or diagnosis with semen analysis89300#Semen analysis; presence and/or motility of sperm including Huhner test (post coital)89310Semen analysis; motility and count (not including Huhner test)89320Semen analysis; volume, count, motility and differential89321Semen analysis; sperm presence and motility of sperm, if performed89325#Sperm antibodies89330#Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit testReproductive roid stimulating hormone (TSH)89264#Sperm identification from testis tissue, fresh or cryopreserved89268#Insemination of oocytes89272#Extended culture of oocyte(s)/embryo(s), 4-7 days89280#Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes89281#Assisted oocyte fertilization, microtechnique; greater than 10 oocytes89322Semen analysis; volume, count, motility, and differential using strict morphologiccriteria (e.g., Kruger)89352#Thawing of cryopreserved; embryo(s)Endocrinologists88172Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study todetermine adequacy for diagnosis, first evaluation episode, each site88177Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study todetermine adequacy for diagnosis, each separate additional evaluation episode, samesite (List separately in addition to code for primary athology consultation during surgery; first tissue block, with frozen section(s),single specimen88332Pathology consultation during surgery; each additional tissue block with frozensection(s) (List separately in addition to code for primary procedure)Hematologists/Oncologists/Pediatric Hematologists85007***Blood count; automated differential WBC count blood smear, microscopicexamination with manual differential WBC count85025***Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)and automated differential WBC count85027***Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)In-Office Laboratory Testing and Procedures ListUnitedHealthcare Oxford Reimbursement Policy 1996-2018, Oxford Health Plans, LLCPage 4 of 5Effective 01/01/2018

CPT CodeHematologists/Oncologists/Pediatric HematologistsDescription85097Bone marrow; smear interpretation only, with or without differential cell count86077Blood bank physician services; difficult cross-match and/or evaluation of irregularantibody(s), interpretation and written report86078Blood bank physician services; investigation of transfusion reaction, includingsuspicion of transmissible disease, interpretation and written report86079Blood bank physician services; authorization for deviation from standard bloodbanking procedures, with written report86927-86999Transfusion medicineOphthalmologists and Connecticut CLIA Certified OptometristsNote: 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 noteligible for reimbursement.83861Microfluidic analysis utilizing an integrated collection and analysis device, tearosmolarityOphthalmologists and Optometrists83516Immunoassay for analyte other than infectious agent antibody or infectious agentantigen; qualitative or semiquantitative, multiple step method87809Infectious agent antigen detection by immunoassay with direct optical observation;adenovirusPulmonologists82803Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculatedO2 saturation)Rheumatologists89060Crystal Identification by light microscopy with or without polarizing lens analysis;tissue or any body fluid (except urine)89264#Sperm identification from testis tissue, fresh or cryopreserved89300Semen analysis; presence and/or motility of sperm including Huhner test (post coital)89310Semen analysis; motility and count (not including Huhner test)89320Semen analysis; volume, count, motility and differential89321Semen analysis; sperm presence and motility of sperm, if performed89322Semen analysis; volume, count, motility, and differential using strict morphologiccriteria (e.g., Kruger)UrologistsREFERENCESAmerican Medical Association. Current Procedural Terminology: CPT Professional Edition.How to Apply for a CLIA Certificate, Including International Laboratories from the CMS.gov web gislation/CLIA/How to Apply for a CLIA Certificate International Laboratories.htmlPOLICY HISTORY/REVISION INFORMATIONDate 01/01/2018 Action/DescriptionUpdated list of applicable CPT codes to reflect annual code edits; reviseddescription for 80305 and 80306Archived previous policy version LAB 003.30 T0In-Office Laboratory Testing and Procedures ListUnitedHealthcare Oxford Reimbursement Policy 1996-2018, Oxford Health Plans, LLCPage 5 of 5Effective 01/01/2018

The In-Office Laboratory Testing and Procedures List is a list of testing/laboratory procedure codes that Oxford will consider for reimbursement to its Network physicians when performed in their office. This list represents the only laboratory testing/procedures that Oxford Network physicians may provide in their offices. All other laboratory

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