2020 Clinical Diagnostic Laboratory Fee Schedule - Kentucky

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RQWQWSHORT DESCRIPTIONUrinalysis nonauto w/o scopeUrinalysis auto w/o scopeUrinalysis auto w/o scopeUrinalysisUrine screen for bacteriaUrine screen for bacteriaMicroscopic exam of urineUrinalysis glass testUrine pregnancy testUrinalysis volume measureHpa-1 genotypingHpa-2 genotypingHpa-3 genotypingHpa-4 genotypingHpa-5 genotypingHpa-6 genotypingHpa-9 genotypingHpa-15 genotypingIdh1 common variantsIdh2 common variantsDmd dup/delet analysisBrca1&2 gen full seq dup/delBrca1&2 gene full seq alysBrca1&2 gen ful dup/del alysBrca1 gene full seq alysBrca1 gene full dup/del alysBrca2 gene full dup/del alysAbl1 geneAff2 gene detc abnor allelesAff2 gene charac allelesAr gene full gene sequenceAr gene known famil variantAsxl1 full gene sequenceAsxl1 gene target seq alysAtn1 gene detc abnor allelesAtxn1 gene detc abnor alleleRATE 2020 3.48 2.25 2.25 2.17 29.98 29.98 3.05 4.70 8.61 3.64 122.22 122.22 122.22 122.22 122.22 122.22 122.22 122.22 193.25 295.79 279.00 1,824.88 936.00 584.23 565.76 301.35 282.88 300.00 137.00 274.83 301.35 185.20 676.50 241.90 137.00 137.00End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RSHORT DESCRIPTIONAtxn2 gene detc abnor alleleAtxn3 gene detc abnor alleleAtxn7 gene detc abnor alleleAtxn8os gen detc abnor allelAtxn10 gene detc abnor allelCacna1a gen detc abnor allelCacna1a gene full gene seqCacna1a gen known famil vrntCnbp gene detc abnor alleleCstb gene detc abnor alleleCstb gene full gene sequenceCstb gene known famil vrntAspa geneApc gene full sequenceApc gene known fam variantsApc gene dup/delet variantsAr gene charac allelesBckdhb geneBcr/abl1 gene major bpBcr/abl1 gene minor bpBcr/abl1 gene other bpBlm geneBraf geneBrca1&2 185&5385&6174 vrntBrca1 gene known famil vrntBrca2 gene full seq alysBrca2 gene known famil vrntCebpa gene full sequenceCalr gene com variantsCftr gene com variantsCftr gene known fam variantsCftr gene dup/delet variantsCftr gene full sequenceCftr gene intron poly tCyp2c19 gene com variantsCyp2d6 gene com variantsRATE 2020 137.00 137.00 137.00 137.00 137.00 137.00 846.27 185.20 137.00 137.00 274.83 185.20 47.25 780.00 280.00 200.00 137.00 94.99 163.96 144.84 214.62 39.31 175.40 440.00 375.25 185.12 375.25 241.90 121.63 556.60 97.22 435.07 499.00 168.75 291.36 450.91End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RSHORT DESCRIPTIONCyp2c9 gene com variantsCytogen micrarray copy nmbrCytogen m array copy no&snpCyp3a4 gene common variantsCyp3a5 gene common variantsDpyd gene common variantsBtk gene common variantsDmpk gene detc abnor alleleEgfr gene com variantsEzh2 gene full gene sequenceEzh2 gene common variantsF9 full gene sequenceDmpk gene charac allelesF2 geneF5 geneFancc geneFmr1 gene detectionFmr1 gene charac allelesFlt3 geneFlt3 gene analysisG6pd gene alys cmn variantG6pd known familial variantG6pd full gene sequenceG6pc geneGba geneGjb2 gene full sequenceGjb2 gene known fam variantsGjb6 gene com variantsHexa geneHfe geneHba1/hba2 geneHba1/hba2 gene fam vrntHba1/hba2 full gene sequenceIkbkap geneIgh gene rearrange amp methIgh gene rearrang dir probeRATE 2020 174.81 900.00 1,160.00 174.81 174.81 174.81 175.40 137.00 324.58 282.88 175.40 600.00 274.83 65.69 73.37 36.62 57.04 44.89 165.51 83.00 174.81 375.25 600.00 58.49 47.25 101.12 61.52 35.00 51.45 65.36 102.26 375.25 600.00 39.31 197.99 68.55End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RSHORT DESCRIPTIONIgh vari regional mutationIgk rearrangeabn clonal popStr markers specimen analStr markers spec anal addlChimerism anal no cell selecChimerism anal w/cell selectHba1/hba2 gene dup/del vrntsJak2 geneHtt gene detc abnor allelesKit gene targeted seq analysKit gene analys d816 variantHtt gene charac allelesKras gene variants exon 2Kras gene addl variantsCytogenomic neo microra alysIfnl3 geneFxn gene detc abnor allelesFxn gene charac allelesFxn gene full gene sequenceMgmt gene prmtr mthyltn alysMlh1 geneFxn gene known famil variantMcoln1 geneMthfr geneMlh1 gene full seqMlh1 gene known variantsMlh1 gene dup/delete variantMsh2 gene full seqMsh2 gene known variantsMsh2 gene dup/delete variantMsh6 gene full seqMsh6 gene known variantsMsh6 gene dup/delete variantMicrosatellite instabilityMecp2 gene full seqMecp2 gene known variantRATE 2020 294.52 172.73 233.07 304.81 207.46 260.79 202.40 91.66 137.00 329.51 124.87 274.83 193.25 193.25 1,160.00 73.37 137.00 274.83 274.83 124.64 192.32 185.20 39.31 65.34 675.40 331.00 202.40 381.70 337.73 213.30 641.85 308.00 238.00 348.56 527.87 120.00End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RSHORT DESCRIPTIONMecp2 gene dup/delet variantMyd88 gene p.leu265pro vrntNudt15 gene common variantsPalb2 gene full gene seqPalb2 gene known famil vrntPik3ca gene trgt seq alysNpm1 geneNras gene variants exon 2&3Pabpn1 gene detc abnor allelPca3/klk3 antigenPdgfra genePml/raralpha com breakpointsPml/raralpha 1 breakpointPms2 gene full seq analysisPms2 known familial variantsPms2 gene dup/delet variantsPlcg2 gene common variantsPten gene full sequencePten gene known fam variantPten gene dup/delet variantPmp22 gene dup/deletPmp22 gene full sequencePmp22 gene known fam variantSept9 gen prmtr mthyltn alysSlco1b1 gene com variantsSmn1 gene dos/deletion alysSmpd1 gene common variantsSnrpn/ube3a geneSerpina1 geneTgfbi gene common variantsRunx1 gene targeted seq alysTpmt gene com variantsSmn1 gene full gene sequenceSmn1 gen nown famil seq vrntTrb@ gene rearrange amplifyTrb@ gene rearrange dirprobeRATE 2020 150.00 175.40 291.36 282.88 301.35 274.83 246.52 295.79 137.00 255.05 329.51 207.31 207.31 676.50 331.00 203.50 291.36 600.00 46.60 300.00 758.36 769.58 46.60 192.00 174.81 137.00 47.00 51.07 43.65 137.00 329.51 174.81 301.35 185.20 208.92 49.59End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RSHORT DESCRIPTIONTrg gene rearrangement analPpp2r2b gen detc abnor allelTbp gene detc abnor allelesTert gene targeted seq alysTyms gene com variantsUgt1a1 gene common variantsVkorc1 geneHbb gene com variantsHbb gene known fam variantHbb gene dup/del variantsHbb full gene sequenceHla i & ii typing lrHla i & ii type verify lrHla i typing complete lrHla i typing 1 locus lrHla i typing 1 antigen lrHla ii typing ag equiv lrHla ii typing 1 locus lrHla ii type 1 ag equiv lrHla i & ii typing hrHla i typing complete hrHla i typing 1 locus hrHla i typing 1 allele hrHla ii typing 1 loc hrHla ii typing 1 allele hrMopath procedure level 1Mopath procedure level 2Mopath procedure level 3Mopath procedure level 4Mopath procedure level 5Mopath procedure level 6Mopath procedure level 7Mopath procedure level 8Mopath procedure level 9Aortic dysfunction/dilationAortic dysfunction/dilationRATE 2020 201.50 137.00 137.00 185.20 174.81 234.00 88.20 174.81 375.25 202.40 324.58 402.12 404.52 403.59 127.43 74.33 220.74 122.22 94.74 345.57 335.38 177.25 169.90 123.68 109.13 63.96 137.00 150.33 185.20 274.83 301.35 282.88 846.27 2,000.00 504.00 1,350.19End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RSHORT DESCRIPTIONAshkenazi jewish assoc disCar ion chnnlpath inc 10 gnsCar ion chnnlpath inc 2 gnsExome sequence analysisExome sequence analysisExome re-evaluationFetal chrmoml aneuploidyFetal chrmoml microdeltjGenome sequence analysisGenome sequence analysisGenome re-evaluationHearing loss sequence analysHearing loss dup/del analysHrdtry brst ca-rlatd dsordrsHrdtry brst ca-rlatd dsordrsHereditary retinal disordersHereditary colon ca dsordrsHereditary colon ca dsordrsHeredtry nurondcrn tum dsrdrHeredtry nurondcrn tum dsrdrHrdtry cardmypy gene panelMitochondrial geneNoonan spectrum disordersGenetic tstg severe inh condTargeted genomic seq analysHrdtry perph neurphy panelTargeted genomic seq analysTargeted genomic seq analysWhole mitochondrial genomeWhole mitochondrial genomeX-linked intellectual dbltX-linked intellectual dbltAutoimmune rheumatoid arthrCor artery disease mrnaOnco (ovar) two proteinsOnco (ovar) five proteinsRATE 2020 2,448.56 584.90 584.90 4,780.00 12,000.00 320.00 759.05 759.05 5,031.20 2,709.95 2,337.65 1,625.00 679.57 679.05 438.93 597.91 584.90 584.90 438.93 438.93 584.90 3,324.00 2,143.60 2,448.56 597.91 584.90 759.53 2,919.60 1,287.00 936.00 914.00 914.00 840.65 1,050.00 260.50 897.00End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RQWQWSHORT DESCRIPTIONOncology tissue of originEndo assay seven analFetal aneuploidy trisom riskFtl cgen abnor two proteinsFtl cgen abnor 3 proteinsFtl cgen abnor three analFtl cgen abnor four analFtl cgen abnor five analOnc brst mrna 11 genesOncology breast mrnaOnc breast mrna 58 genesOnc breast mrna 70 genesOnc breast mrna 12 genesOncology colon mrnaOncology colorectal scrOncology gynecologicOncology gynecologicOncology lungOncology prostate prob scoreOncology tum unknown originOnc prostate mrna 46 genesOnc prostate mrna 22 cnt genOncology thyroidOnc prostate 3 genesCardiology hrt trnspl mrnaNfct ds chrnc hcv 6 assaysTest for acetone/ketonesAcetone assayAcetone assayAcetylcholinesterase assayAcylcarnitines qualAcylcarnitines quantAssay of acthAssay of adp & ampAssay of serum albuminAssay of serum albuminRATE 2020 520.00 68.92 795.00 54.30 1,487.37 55.54 153.50 69.52 3,873.00 3,873.00 2,510.21 3,873.00 3,873.00 3,116.00 508.87 579.46 177.56 2,871.00 760.00 3,750.00 3,873.00 0.00 3,600.00 2,030.00 3,240.00 72.19 4.52 8.17 8.17 12.29 16.49 16.87 38.62 25.80 4.95 4.95End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RQWQWQWQWQWSHORT DESCRIPTIONOther source albumin quan eaOther source albumin quan eaUr albumin quantitativeUr albumin quantitativeUr albumin semiquantitativeUr albumin semiquantitativeAlbumin ischemia modifiedAssay of breath ethanolAssay of aldolaseAssay of aldosteroneAlpha-1-antitrypsin totalAlpha-1-antitrypsin phenoAlpha-fetoprotein serumAlpha-fetoprotein amnioticAlpha-fetoprotein l3Assay of aluminumAmines vaginal fluid qualAmines vaginal fluid qualAmino acid single qualAmino acids mult qualAmino acids single quantAssay aminolevulinic acidAmino acids quant 2-5Amino acids quan 6 or moreAssay of ammoniaAmniotic fluid scanAssay of amylaseAssay of amylaseAndrostanediol glucuronideAssay of androstenedioneAssay of androsteroneAssay of angiotensin iiAngiotensin i enzyme testAssay of apolipoproteinAssay of arsenicAssay of ascorbic acidRATE 2020 7.78 7.78 5.78 5.78 6.23 6.23 33.94 30.00 9.71 40.75 13.44 14.46 16.77 17.00 64.41 25.48 5.99 5.99 14.18 13.87 22.98 16.45 19.61 16.87 14.57 9.35 6.48 6.48 28.83 29.28 25.55 20.52 14.60 21.09 18.97 9.89End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleCPT codes, descriptions and other data only are copyright 2018 American Medical Association.All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).Codes in green are enddated.NOTE: Zero pay (0.00) codes will be reimbursed at 65% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage, nor a guarantee of RQWQWQWQWQWQWSHORT DESCRIPTIONAtomic absorptionAssay of beta-2 proteinBile acids totalBile acids cholylglycineBilirubin totalBilirubin totalBilirubin directFecal bilirubin testAssay of biotinidaseOccult blood fecesOccult blood other sourcesOccult blood other sourcesOccult bld feces 1-3 testsAssay test for blood fecalAssay test for blood fecalAssay of bradykininAssay of cadmiumVitamin d 25 hydroxyAssay of calcitoninAssay of calciumAssay of calciumAssay of calciumAssay of calciumCalcium infusion testAssay of calcium in urineCalculus analysis qualCalculus assay quantCalculus spectroscopyX-ray assay calculusAssay c-d transfer measureAssay blood carbon dioxideAssay blood carbon dioxideAssay carboxyhb quantAssay carboxyhb qualCarcinoembryonic antigenAssay of carnitineRATE 2020 15.90 16.18 17.12 26.58 5.02 5.02 5.02 4.56 16.87 4.38 5.32 5.32 4.23 15.92 15.92 5.16 23.64 29.60 26.79 5.16 5.16 13.68 13.68 13.34 6.03 11.58 12.87 12.90 12.52 18.06 4.88 4.88 12.32 14.07 18.96 16.87End Date

2020 Clinical Diagnostic Laboratory Fee ScheduleC

0009U Onc brst ca erbb2 amp/nonamp 107.00 0010U Nfct ds strn typ whl gen seq 427.26 0011M Onc prst8 ca mrna 12 gen alg 760.00 0011U Rx mntr lc-ms/ms oral fluid 114.43 0012M Onc mrna 5 gen rsk urthl ca 760.00 0013M Onc mrna 5 gen recr urthl ca 760.00 0016U Onc hmtlmf neo rna bcr/abl1 163.96 0017U Onc hmtlmf neo jak2 mut dna 91.66