| CPT CODE |
MEDICARE FEE CAP |
TEST NAME (SELECTED PRODUCTS/MANUFACTURERS) |
| 87809QW | $16.88 | Adenovirus Test Kit (Rapid Pathogen Screening [RPS]) |
| 82055QW | $15.21 | Alcohol Saliva Test (STC Diagnostics, Q.E.D Diagnostics) |
| 85576QW | $30.23 | Aspirin resistance test(VerifyNow Accumetrics) |
| 87905QW | $17.2 | Bacterial Vaginosis Test(Sekisui) |
| 83518QW | $11.93 | Bladder Cancer Antigen (BTA Stat Test, Polymedco) |
| 83880QW | $47.77 | BNP test (Triage BNP Test, Biosite Corp) |
| Varies | $Varies | Chemistry tests: Albumin, Alkaline Phospha-tase, Amylase, Basic metabolic panel, Comprehensive metabolic panel, GGT, Total Bilirubin, Total Protein (Abaxis Piccolo, i-STAT, Polymedco Spotchem EZ) |
| 82465QW | $6.13 | Cholesterol (Roche, Actimed Labs, Lifestream Technologies) |
| 82044QW | $6.44 | Dipstick Albumin (Roche, Sekisui Diagnostics) |
| 81002 | $3.6 | Dipstick/Tablet Urinalysis |
| 81002 | $3.6 | Dipstick Urinalysis+Creatinine (Bayer) |
| 81003QW+82570QW | $3.16+$7.28 | Dipstick Urine Analyzer (Bayer, Roche)+Creatinine (Bayer Status Analyzer) |
| G0434 | $20.47 | Drugs of Abuse tests |
| 82272 | $4.58 | FOB, Diagnostic (Hemoccult, Beckman Coulter, Seracult Propper) |
| 82270 | $4.58 | FOB, Screening |
| 82274QW or G0328 | $22.38 | FOB, Immunoassay (Alfa Scientific, Hemoccult ICT Beckman Coulter, Immunostics, Quidel) |
| 83001QW | $26.15 | FSH (BTNX Rapid Response Urine Menopause FSH Test) |
| 82272QW | $4.58 | Gastric Occult Blood (Beckman Coulter) |
| 82962 | $3.29 | Glucose Meters |
| 82951QW | $18.12 | Glucose Tolerance Test, 3 Specimens |
| 82947QW | $5.52 | Glucose (HemoCue Glucose 201 Analyzer) |
| 83036QW | $13.66 | Hemoglobin A1c (Siemens Vantage, Cholestech GDX, Bayer A1c Now) |
| 85014QW | $3.33 | Hematocrit (StatSpin) |
| 85018QW | $3.33 | Hemoglobin (HemoCue) |
| 86318QW+86318 | $18.22 | H.pylori test whole blood+H. pylori serum/plasma (Quidel, BD, Sekisui ) |
| 87338QW | $20.24 | H. pylori test, stool(Meridian Bioscience, Immunocard) |
| 86677 | $20.42 | H. pylori, antibody (Sekisui) |
| 86703QW | $19.3 | HIV Rapid Test (OraSure) |
| 87804QW+87804 | $16.88 | Influenza Rapid Test Kits (Quidel, Sekisui Diagnostics ) |
| 83655QW | $17.03 | LeadCare II Blood Lead Test System (ESA Biosciences, Chelmsford, MA) |
| 80061QW | $18.65 | Lipid Panel (Cholestech, Abaxis) |
| 84460QW | $7.44 | ALT (SGPT) |
| 84450QW | $7.28 | AST (SGOT) |
| 83721QW | $13.42 | LDL (Polymer Technology; Cardiocheck PA) |
| 86618QW | $23.97 | Lyme Disease Rapid Test Kit (Alere) |
| 82043QW | $8.14 | Microalbumin, Urine Quantitative (HemoCue) |
| 82044QW | $6.44 | Microalbumin Immunoassay (Sekisui Diagnostics) |
| 86308QW+86308 | $7.28 | Mononucleosis Test Kits (Alere, Quidel, Sekisui Diagnostics) |
| 80101QW | $19.72 | Nicotine Test (NicCheck, Dynagen) |
| 84830 | $14.12 | Ovulation Test Kits |
| 81025 | $8.9 | Pregnancy Test Kits Urine, Qualitative (Beckman Coulter, Sekisui, Quidel) |
| 84703QW+84703 | $10.57 | Pregnancy Test (Quidel, Sekisui Diagnostics) |
| 85610QW | $5.53 | Prothrombin Time (Protime ITC Corp, CoaguChek Roche, Hemosense) |
| 87807QW | $16.88 | RSV Rapid Test Kit (Binax, Integrated Biotechnology, Quidel) |
| 85651 | $5 | Sedimentation Rate, Non-Automated |
| 87880QW | $16.88 | Strep Rapid Test Kits (Alere, Beckman Coulter, BD, Quidel, Sekisui Diagnostics) |
| 87808QW+87808 | $16.88 | Trichomonas Rapid Test Kit (Sekisui Diagnostics) |
| 84443QW | $23.64 | TSH, qualitative |
| 83518QW | $11.93 | Urinary Albumin (Sekisui Diagnostics) |
| 81007QW | $3.61 | Urinary Tract Infections (Jant Pharmacal) |
