Laboratory Services
PW_000572
Subsections:
Anthem is contracted with Laboratory Corporation of America® (LabCorp®). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures listed below:
Note: This relationship with LabCorp is specific to national reference lab services and does not affect network hospital-based lab service providers, contracted pathologists, or Frontline and Tricore Laboratories.
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Lab Work Provided in the Provider’s Office
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81000
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Urinalysis, nonauto w/scope
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86403
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Particle agglutination test (Rapid Strep)
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81001
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Urinalysis, auto w/scope
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86403
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Particle agglutination test (Rapid Strep)
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81002
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Urinalysis nonauto w/o scope
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86580
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TB intradermal test
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81003
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Urinalysis, auto, w/o scope
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83585
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Skin Test: tuberculosis, tine test
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81005
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Urinalysis
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87070
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Culture, bacteria, other
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81007
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Urine screen for bacteria
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87081
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Culture screen only (Rapid Strep)
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81015
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Microscopic exam of urine
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87205
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Smear, gram stain
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81025
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Urine pregnancy test
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87210
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Smear, wet mount, saline/ink
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82120
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Amines, vaginal fluid, qualitative
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87220
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Tissue exam for fungi
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82270
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Occult blood, feces
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87430
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Strep a ag, eia (Rapid Strep)
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82271
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Occult blood, other sources
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87802
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Infectious agent antigen detection by immunoassay with direct optical observation; Stretococcus, group B
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82465
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Assay, bld/serum cholesterol
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87804
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Influenza assay w/optic
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82803
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Gases, blood, any combination of pH, pC02, p02, 002,HC03, (including calculated 02 saturation). This procedure approved for Pulmonologists ONLY
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87807
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Rsv assay w/optic
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82947
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Glucose; quantitative (except reagent strip)
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87880
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Strep a assay w/optic
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82948
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Glucose; blood reagent strip
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89260
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Sperm isolation; simple prep (e.g., sperm wash and swim-up) for insemination or diagnosis with semen analysis.
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82962
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Glucose; blood by glucose monitoring device(s) cleared by the FDA specifically for home use.
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89261
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Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis
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85002
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Bleeding time
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89300
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Semen analysis w/huhner
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85007
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Blood count; blood smear, microscopic examination with manual differential WBC count
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89310
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Semen analysis w/count
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85013
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Spun microhematocrit
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89320
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Semen analysis, complete
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85014
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Hematocrit
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89321
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Semen analysis & motility
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85018
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Hemoglobin
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89330
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Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test
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85610
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Prothrombin time
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G0027
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Semen analysis
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86308
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Heterophile antibodies (momo spot)
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Lab procedure codes for procedures that can be performed at the physician’s office can be billed as fee-for-service. Anthem will pay for the lab procedure only. The drawing fee is incorporated into the lab procedure; therefore, the physician will not be reimbursed for an additional drawing fee. Anthem will pay a drawing fee to a physician who sends ALL lab work to LabCorp. (Please bill with procedure code 36415–routine venipuncture.) Codes on this list are not a guarantee of payment. Coverage may be restricted by member benefits
If the physician performs blood tests in his/her office and also sends additional blood to LabCorp for testing, the physician will NOT be reimbursed for the drawing fee. The handling fee, code 99000, is not allowed in addition to the 36415 venipuncture code or the E&M code. Codes 99000 and 36416, collection of capillary blood specimen (eg. Finger, heel, or ear stick) are on the Always Bundle policy and are considered part of the overall medical management of the patient and are not allowed separately.
Reviewing results of laboratory tests, phoning results to patients, filing such results, etc., are included in Anthem’s allowance for the E&M code, even if the E&M code is not on the same day.
A charge related to drawing of blood performed by an OB/GYN is payable as a separate charge and isn’t included in the total obstetrical allowance if the blood is sent to the lab.
An appropriate diagnosis to justify the procedure must accompany all lab procedures.
Specimen collections: For specimen requirements for various lab tests, collection procedures, specimen preparations and submission protocols, please call LabCorp at 303-792-2600 or toll free at 800-795-3699. Instructions for certain labile specimens are as follows:
 | Routine pediatric specimen collections can be performed at the drawing stations of the independent laboratories contracted with Anthem. |
| Stat: If an emergency situation exists and you can’t wait for LabCorp’s stat turnaround (three to four hours from the time the lab is called), you can mark “STAT” on your claim form for that lab procedure. However, Anthem will pay the lab charge only and will not pay for “STAT” fee charges. |
| If the original claim doesn’t denote “STAT” and is denied for payment because it should have been sent to LabCorp, Anthem will not pay at a later date even if the claim is resubmitted with “STAT” marked on it. |
| Cerebrospinal fluid/bone marrow aspirate: Due to the labile nature of these specimens, Anthem recommends that they be transported to the nearest hospital for analysis. Please call LabCorp for information or instructions. This also helps with reporting results properly and obtaining written copies of the results. |
| Non-gynecologic cytology: Place specimens such as urine, bladder washing, body fluids (peritoneal, gastric), cyst fluids and cerebrospinal fluids in a clean, leak-proof container with an equal volume of 50 percent alcohol. |
| Histology: Place tissue in leak-proof biopsy bottles containing 10 percent formalin in a volume five times that of the specimen. Do not use a preservative if microbiological cultures are required. |
LabCorp will contact Providers if it receives inadequate, inappropriate, or improperly prepared or stored specimens.
Lab Services Covered as Part of a Preventive Benefit
When a member’s health plan includes preventive care benefits, the following lab tests are covered when billed with a preventive diagnosis code. Any code not listed requires a medical diagnosis when billing Anthem. Lab Services Covered as Part of a Preventive Benefit (PDF)
A physician or other health care Provider may not bill for services sent to an outside lab. This includes cytopathology services for cervical cancer screening (Pap codes 88141-88175 and P3000-P3001). Obtaining the specimen for cervical cancer screening is included in the allowance for the evaluation and management (E&M) or the preventive care visit service. Codes 88141-88175 and P3000-P3001 are to be used by the laboratory performing the test, not by the physician obtaining the specimen. If obtaining the Pap smear is the only service provided, the appropriate code is Q0091. Code Q0091 is incidental to preventive care and medical E&M codes.
Specialized Anatomic Pathology
LabCorp is a leader in innovative diagnostic testing, with active research and development groups. Some of its specialized services include the following:
| A.P. triple screens |
| AIDS-related testing, including genotype and phenotype analysis |
| Allergy (RAST and Imunocap) testing |
| Genetic/cytogenetic testing with board-certified cytogeneticists and genetic counselors available for consultation |
| Tumor marker testing |
| DNA probe testing |
For information about specialized assays or about requirements for special collection kits and specimen handling, call LabCorp at 303-792-2600 or toll free at 888-LABCORP (888-522-2677)
LabCorp Patient Service Centers
To Find the LabCorp location near you, go to www.LabCorp.com or call one of the phone numbers above. |
