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Laboratory Services

PW_002132
 
Subsections:
 
Laboratory Procedures
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 or contracted pathologists. 

Lab Work Provided in the Provider’s Office
HCPCS
Description
HCPCS
Description
81000 
Urinalysis, nonauto w/scope 
86403 
Particle agglutination test (Rapid Strep) 
81001 
Urinalysis, auto w/scope 
86403 
Particle agglutination test (Rapid Strep) 
81002 
Urinalysis nonauto w/o scope 
86580 
TB intradermal test 
81003 
Urinalysis, auto, w/o scope 
83585 
Skin Test: tuberculosis, tine test 
81005 
Urinalysis 
87070 
Culture, bacteria, other 
81007 
Urine screen for bacteria 
87081 
Culture screen only (Rapid Strep) 
81015 
Microscopic exam of urine 
87205 
Smear, gram stain 
81025 
Urine pregnancy test 
87210 
Smear, wet mount, saline/ink 
82120 
Amines, vaginal fluid, qualitative 
87220 
Tissue exam for fungi 
82270 
Occult blood, feces 
87430 
Strep a ag, eia (Rapid Strep) 
82271 
Occult blood, other sources 
87802 
Infectious agent antigen detection by immunoassay with direct optical observation; Stretococcus, group B 
82465 
Assay, bld/serum cholesterol 
87804 
Influenza assay w/optic 
82803 
Gases, blood, any combination of pH, pC02, p02, C02, HC03 (including calculated 02 saturation). This procedure approved for Pulmonologists ONLY. 
87807 
Rsv assay w/optic 
82947 
Glucose; quantitative (except reagent strip) 
87880 
Strep a assay w/optic 
82948 
Glucose; blood reagent strip 
89260 
Sperm isolation; simple prep (e.g., sperm wash and swim-up) for insemination or diagnosis with semen analysis. 
82962 
Glucose; blood by glucose monitoring device(s) cleared by the FDA specifically for home use. 
89261 
Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis 
85002 
Bleeding time 
89300 
Semen analysis w/huhner 
85007 
Blood count; blood smear, microscopic examination with manual differential WBC count 
89310 
Semen analysis w/count 
85013 
Spun microhematocrit 
89320 
Semen analysis, complete 
85014 
Hematocrit 
89321 
Semen analysis & motility 
85018 
Hemoglobin 
89330 
Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test 
85610 
Prothrombin time 
G0027 
Semen analysis 
86308 
Heterophile antibodies (momo spot) 
   
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 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 when any other service is performed on the same date. 
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 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. 
 
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Lab Services Covered as Part of Preventive Care 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 below requires a medical diagnosis when billing Anthem.  

Lab Work Provided in the Provider’s Office
HCPCS
Description
HCPCS
Description
80048 
Basic metabolic panel (Calcium, total) 
83721 
Assay of blood lipoprotein 
80050 
General health panel 
84030 
Phenylaline (PKU) 
80051 
Electrolyte panel 
84075 
Assay alkaline phosphatase 
80053 
Comprehensive metabolic panel 
84132 
Assay of serum potassium 
80061 
Lipid panel 
84152 
Assay of psa, complexed 
80076 
Hepatic Function Panel 
84153 
Assay of psa, total 
81000 
Urinalysis, nonauto w/scope 
84154 
Assay of psa, free 
81001 
Urinalysis, auto w/scope 
84155 
Assay of protein, serum 
81002 
Urinalysis nonauto w/o scope 
84295 
Assay of serum sodium 
81003 
Urinalysis, auto, w/o scope 
84443 
Assay thyroid stim hormone 
81005 
Urinalysis 
84450 
Transferase (AST) (SGOT) 
82040 
Assay of serum albumin 
84460 
Alanine amino (ALT) (SGPT) 
82247 
Bilirubin, total 
84478 
Assay of triglycerides 
82270 
Blood, occult feces 
84520 
Assay of urea nitrogen 
82274 
Blood, occult feces 
85004 
Automated diff wbc count 
82310 
Assay of calcium 
85007 
Bl smear w/diff wbc count 
82374 
Assay, blood carbon dioxide 
85009 
Manual diff wbc count b-coat 
82435 
Assay of blood chloride 
85013 
Spun hematocrit 
82465 
Assay, bld/serum cholest 
85014 
Hematocrit 
82565 
Assay of creatinine 
85018 
Hemoglobin 
82776 
Galactose transferase test 
85025 
Complete cbc w/auto diff wbc 
82947 
Assay, glucose, blood quant 
85027 
Complete cbc, automated 
82951 
Glucose tolerance test (GTT) 
86255 
Fluorescent antibody, screen 
83020 
Hemoglobin electrophoresis 
86316 
Immunoassay, tumor other 
83700 
Lipopro bld, electrophoretic 
86355 
Immunfix e-phorsis/urine/csf 
83718 
Assay of lipoprotein 
86480 
Tb test, cell immun measure 
83719 
Assay of blood lipoprotein 
86580 
TB intradermal test 
86592 
Syphilis test, qualitative 
88150 
Cytopath, c/v, manual 
86593 
Syphilis test, quantitative 
88152 
Cytopath, c/v, auto redo 
86631 
Chlamydia antibody 
88153 
Cytopath, c/v, redo 
86632 
Chlamydia igm antibody 
88154 
Cytopath, c/v, select 
86689 
HTLV/HIV confirmatory test 
88155 
Cytopath, c/v, index add-on 
86701 
HIV-1 
88160 
Cytopath smear, other source 
86702 
HIV-2 
88161 
Cytopath smear, other source 
86703 
HIV-1/HIV-2, single assay 
88162 
Cytopath smear, other source 
86762 
Rubella antibody 
88164 
Cytopath tbs, c/v, manual 
87110 
Chlamydia culture 
88165 
Cytopath tbs, c/v, redo 
87272 
Cryptosporidium ag, if 
88166 
Cytopath tbs, c/v, auto redo 
87320 
Chylmd trach ag, eia 
88167 
Cytopath tbs, c/v, select 
87390 
Hiv-1 ag, eia 
88172 
Cytopathology eval of fna 
87391 
Hiv-2 ag, eia 
88173 
Cytopath eval, fna, report 
87485 
Chylmd pneum, dna, dir probe 
88174 
Cytopath, c/v auto, in fluid 
87486 
Chylmd pneum, dna, amp prob 
88175 
Cytopath c/v auto fluid redo 
87490 
Chylmd trach, dna, dir probe 
88271 
Cytogenetics, dna probe 
87491 
Chylmd trach, dna, amp probe 
88291 
Cyto/molecular report 
87590 
N.gonorrhoeae, dna, dir prob 
G0103 
Psa, total screening 
87591 
N.gonorrhoeae, dna, amp prob 
G0123 
Screen cerv/vag thin layer 
87592 
N.gonorrhoeae, dna, quant 
G0124 
Screen c/v thin layer by MD 
87620 
Hpv, dna, dir probe 
G0141 
Scr c/v cyto,autosys and md 
87621 
Hpv, dna, amp probe 
G0143 
Scr c/v cyto,thinlayer,rescr 
87622 
Hpv, dna, quant 
G0144 
Scr c/v cyto,thinlayer,rescr 
87850 
N. gonorrhoeae assay w/optic 
G0145 
Scr c/v cyto,thinlayer,rescr 
88141 
Cytopath, c/v, interpret 
G0147 
Scr c/v cyto, automated sys 
88142 
Cytopath, c/v, thin layer 
G0148 
Scr c/v cyto, autosys, rescr 
88143 
Cytopath c/v thin layer redo 
P3000 
Screen pap by tech w md supv 
88147 
Cytopath, c/v, automated 
P3001 
Screening pap smear by phys 
88148 
Cytopath, c/v, auto rescreen 
   
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Other Considerations
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. 
 
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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 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  
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use