MVMA In-Office Lab List
Updated August 1, 2006
80048
80050
80051
80053
80061
80069
80076
80400
80428
81000
81001
81002
81015
81025
82043
82044
82247
82248
82270
82310
82378
82533
82550
82570
82607
82627
82670
82947
82948
82962
82985
83001
83002
83003
83036
83525
83540
83550
83615
83655
83735
83970
84100
84105
84146
84153
84403
84432
84436
84439
84443
84479
84480
Basic metabolic panel
General health panel
Electrolyte panel
Comprehensive metabolic panel
Lipid panel
Renal function panel
Hepatic function panel
ACTH Stimulation Panel (endocrinology only)
Growth Hormone Stimulation Panel (endocrinology only)
Urinalysis, dipstick or reagent tablet; non-automated, with microscopy
Urinalysis, automated, with microscopy
Urinalysis, without microscopy
Urinalysis, microscopic only
Urine pregnancy test
Urine microalbumin, quantitative
Urine microalbumin, reagent strip assay
Bilirubin, total
Bilirubin, direct
Blood, occult; feces(1-3 simultaneous determinations)
Calcium
CEA (hematology & oncology only)
Cortisol, total (endocrinology only)
CPK (CK), total (endocrinology only)
Creatinine, source other than blood (endocrinology only)
Vitamin B-12 (endocrinology only)
DHEA-S (endocrinology only)
Estradiol (endocrinology only)
Glucose, quantitative
Glucose, reagent strip
Glucose, blood by glucose monitoring device cleared by FDA for home use
Glycated protein
FSH (endocrinology only)
LH (reproductive endocrinology, endocrinology only)
Growth hormone, human (endocrinology only)
Glycated hemoglobin (Hemoglobin A1C)
Insulin, total (endocrinology only)
Iron (endocrinology only)
Iron binding capacity (endocrinology only)
Lactate dehydrogenase (LD), (LDH) (hematology, oncology only)
Lead level
Magnesium (endocrinology, hematology, oncology only)
Parathyroid hormone (endocrinology only)
Phosphorus inorganic, serum
Phosphorus inorganic, urine
Prolactin (endocrinology only)
Prostate specific antigen (PSA)
Testosterone (endocrinology only)
Thyroglobulin (endocrinology only)
Thyroxin; total (endocrinology only)
Free thyroxin
Thyroid stimulating hormone
Thyroid hormone uptake (T3 or T4) or THBR (endocrinology only)
Triiodothyronine T3; total (TT-3) (endocrinology only)
MVMA In-Office Lab List (continued)
84481
84550
84681
84702
85007
85013
85014
85018
85025
85027
85032
85044
85045
85048
85060
85097
85610
85651
86141
86376
86403
86580
86800
87070
87084
87086
87177
87184
87205
87207
87210
87220
87804
87880
88305
88313
89051
89060
89190
89300
89310
89320
89330
Free triiodothyronine T3 (endocrinology only)
Uric acid, serum (endocrinology only)
C-peptide (endocrinology only)
HCG, quantitative
Blood count; manual differential
Spun microhematocrit
Hematocrit
Hemoglobin
CBC, automated (Hgb, Hct, RBC, WBC & platelet count), and automated differential WBC count
CBC, automated (HGB, Hct, RBC, WBC, & platelet count)
Manual cell count (erythrocyte, leukocyte, or platelet), each (hematology, oncology, rheumatology,
pediatric & GYN oncology only)
Reticulocyte, manual (hematology, oncology, pediatric & GYN oncology only)
Reticulocyte, automated (hematology, oncology, pediatric & GYN oncology only)
Leukocyte (WBC), automated
Blood smear, peripheral, interpretation by physician with written report (hematology, oncology,
pediatric & GYN oncology only)
Bone marrow smear interpretation only (hematology, oncology, pediatric & GYN oncology only)
Prothrombin time
Sedimentation rate, erythrocyte, non-automated
CRP, high sensitivity (endocrinology only)
Microsomal antibodies; each (endocrinology only)
Particle agglutination; screen, each antibody
Intradermal TB
Thyroglobulin antibody (endocrinology only)
Culture, any other source except urine, blood or stool, aerobic, with isolation and presumptive
identification of isolates
Culture, presumptive, pathogenic organisms, with colony estimation from density chart
Culture, bacterial, urine; quantitative, colony count
Ova and parasites, direct smears, concentration and identification
Susceptibility studies, antimicrobial agent, disk method, per plate (12 or fewer agents)
Smear, primary source, with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types
Special stain for inclusion bodies or intracellular parasites (eg. malaria, coccidia, microsporidia,
trypanosomes, herpes viruses)
Wet mount for infectious agents (eg. saline, India ink, KOH preps)
Tissue exam by KOH slide of samples from skin, hair or nails for fungi or ectoparasite ova or mites
(eg, scabies)
Infectious agent, antigen detection by immunoassay with direct optical observation, influenza
(reimbursed 10/24/05 – 5/31/06 only)
Streptococcus, group A (infectious agent detection by immunoassay with direct optical observation)
Bone marrow biopsy interpretation ONLY (hematologists, oncologists, pediatric and GYN oncologists only)
Special stains – for iron stains on bone marrow ONLY, with physician evaluation (hematologists,
oncologists, pediatric & GYN oncologists
Cell count, miscellaneous body fluids, except blood, with differential count (rheumatology only)
Crystal identification by light microscopy, with or without polarizing lens analysis, any body fluid
except urine (rheumatology only)
Nasal smear for eosinophils (allergy specialty only)
Semen analysis; presence and/or motility of sperm including Huhner test (post-coital)
Semen analysis, motility and count, not including Huhner test (reproductive endocrinology only)
Semen analysis, complete – volume, count, motility, and differential (urology only)
Cervical mucus penetration test, with or without spinnbarkeit test (OBGYN only)
Changes noted:
 Removed the “dermatology only” designation from CPT code 87220 effective July 1, 2006
 Added CPT code 83655 (lead level) effective July 1, 2006
 Added CPT codes 83735 (Magnesium) and 83615 (LDH) for hematology/oncology effective August 15, 2006