Draft Schedule- Pathology contract_Sources Sought.xlsx
XLSX spreadsheet 214 KB Posted
- Solicitation number
- 36C26326Q0726
About this file
This file is a draft pricing schedule for pathology contract services to be provided to the Nebraska-Western Iowa Health Care System (NWIHCS). The schedule requires offerors to identify up to 26 subcontracting laboratories and provide their CLIA numbers, physical addresses, and laboratory director information, with self-performed tests designated as lab "0." Offerors must populate unit pricing for 280+ line items spanning 2027 CMS physician fee schedule and clinical diagnostic laboratory services, including molecular pathology procedures (CPT codes 81120-81450), chemistry and clinical laboratory tests (CPT codes 80012-89240), surgical pathology (CPT codes 88300-88381), cytopathology (CPT codes 88104-88173), hematology (CPT codes 85014-85732), immunology and microbiology tests (CPT codes 86022-87906), and ancillary services. Pricing is based on 100% of CMS amounts with offerors required to specify discount rates as percentages of CMS pricing for both send-out and in-house procedures. The contract is an Indefinite Delivery/Indefinite Quantity (IDIQ), fixed-price vehicle spanning five years (April 1, 2027 through March 30, 2032), with the anticipated volume ranging from single units to 972 units annually for specific tests such as HPV high-risk pooled results. The Department of Veterans Affairs Veterans Health Administration will distribute orders across three participating facilities: Omaha VA Medical Center, Lincoln Community Based Outreach Clinic, and Grand Island Community Based Outreach Clinic in Nebraska and Iowa.
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| File | Type | Posted |
|---|---|---|
| Draft PWS for NWI Pathology_Sources Sought.docx | DOCX document |
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Text version
Summary of Lab Information Instructions to Offerors: In order to comply with DC 02.03.01, the laboratory information is required below. Populate the information for any laboratories that will be performing tests under Subcontract. On the subsequent sheets, indicate in column "E" the lab that will be utilized for the test, by the Performing Lab number. If self-performed, please utilize the number "0".
| Performing Lab | Laboratory Name | Laboratory Address (Physical Address not Business Office) | Laboratory CLIA Number | Laboratory Director Name, Email and Phone number |
| 1 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 2 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 3 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 4 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 5 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 6 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 7 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 8 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 9 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 10 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 11 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 12 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 13 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 14 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 15 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 16 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 17 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 18 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 19 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 20 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 21 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 22 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 23 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 24 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 25 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
| 26 | To Be Provided by Offeror | To Be Provided by Offeror | To Be Provided | To Be Provided |
Profee_CMS OP1
| 2027 National Physician Fee Schedule Relative Value |
| CPT codes and descriptions only are copyright 2024 American Medical Association. All Rights Reserved. Applicable FARS Apply. |
| Dental codes (D codes) are copyright 2025/26 American Dental Association. All Rights Reserved. |
| Laboratory Performing Test (Populate corresponding number from Summary of Lab Information, For Self-performed tests, utilize the number '0') | Quantity | UNIT PRICING FOR CONTRACT | CMS Discount Rate (Enter Discount of CMS Amount) | TOTAL CONTRACT PRICING | ||||||
| *KEY | ||||||||||
| 100% of CMS Pricing | ||||||||||
| * | Send Outs | |||||||||
| ** | In-House Special Pricing | |||||||||
| Year | HCPCS / CPT | Send Outs | MOD | DESCRIPTION | ||||||
| Example | 2027 | 12345 | Example: Random Test | 1 | $100.00 | 100.00% | $100.00 | |||
| 0001 | 2027 | 81403 | Mopath procedure level 4 | 8 | $0.00 | |||||
| 0002 | 2027 | 81403 | X2 | Mopath procedure level 4 | 16 | $0.00 | ||||
| 0003 | 2027 | 81479 | Unlisted molecular pathology | 4 | $0.00 | |||||
| 0004 | 2027 | 81479 | Unlisted molecular pathology | 8 | $0.00 | |||||
| 0005 | 2027 | 81479 | Unlisted molecular pathology | 4 | $0.00 | |||||
| 0006 | 2027 | 81479 | Unlisted molecular pathology | 12 | $0.00 | |||||
| 0007 | 2027 | 82010 | Ketone bodys quan | 4 | $0.00 | |||||
| 0008 | 2027 | 84220 | Assay of pyruvate kinase | 12 | $0.00 | |||||
| 0009 | 2027 | 85060 | Blood smear interpretation | 4 | $0.00 | |||||
| 0010 | 2027 | 85060 | Blood smear interpretation | 1 | $0.00 | |||||
| 0011 | 2027 | 85097 | Bone marrow interpretation | 12 | $0.00 | |||||
| 0012 | 2027 | 85097 | Bone marrow interpretation | 20 | $0.00 | |||||
| 0013 | 2027 | 86849 | Immunology procedure | 1 | $0.00 | |||||
| 0014 | 2027 | 86849 | Immunology procedure | 1 | $0.00 | |||||
| 0015 | 2027 | 88040 | Forensic autopsy (necropsy) | 6 | $0.00 | |||||
| 0016 | 2027 | 88040 | Forensic autopsy (necropsy) | 7 | $0.00 | |||||
| 0017 | 2027 | 88040 | Forensic autopsy (necropsy) | 4 | $0.00 | |||||
| 0018 | 2027 | 88040 | Forensic autopsy (necropsy) | 5 | $0.00 | |||||
| 0019 | 2027 | 88040 | Forensic autopsy (necropsy) | 3 | $0.00 | |||||
| 0020 | 2027 | 88040 | Forensic autopsy (necropsy) | 5 | $0.00 | |||||
| 0021 | 2027 | 88099 | Unlisted necropsy (autopsy) | 84 | $0.00 | |||||
| 0022 | 2027 | 88104 | Cytopath fl nongyn smears | 1 | $0.00 | |||||
| 0023 | 2027 | 88104 | TC | Cytopath fl nongyn smears | 4 | $0.00 | ||||
| 0024 | 2027 | 88104 | 26 | Cytopath fl nongyn smears | 24 | $0.00 | ||||
| 0025 | 2027 | 88106 | Cytopath fl nongyn filter | 1 | $0.00 | |||||
| 0026 | 2027 | 88106 | TC | Cytopath fl nongyn filter | 2 | $0.00 | ||||
| 0027 | 2027 | 88108 | Cytopath concentrate tech | 5 | $0.00 | |||||
| 0028 | 2027 | 88108 | TC | Cytopath concentrate tech | 3 | $0.00 | ||||
| 0029 | 2027 | 88112 | Cytopath cell enhance tech | 1 | $0.00 | |||||
| 0030 | 2027 | 88112 | TC | Cytopath cell enhance tech | 571 | $0.00 | ||||
| 0031 | 2027 | 88120 | Cytp urne 3-5 probes ea spec | 7 | $0.00 | |||||
| 0032 | 2027 | 88120 | TC | Cytp urne 3-5 probes ea spec | 1 | $0.00 | ||||
| 0033 | 2027 | 88121 | Cytp urine 3-5 probes cmptr | 5 | $0.00 | |||||
| 0034 | 2027 | 88121 | TC | Cytp urine 3-5 probes cmptr | 3 | $0.00 | ||||
| 0035 | 2027 | 88141 | Cytopath c/v interpret | 13 | $0.00 | |||||
| 0036 | 2027 | 88160 | Cytopath smear other source | 1 | $0.00 | |||||
| 0037 | 2027 | 88160 | TC | Cytopath smear other source | 6 | $0.00 | ||||
| 0038 | 2027 | 88160 | 26 | Cytopath smear other source | 3 | $0.00 | ||||
| 0039 | 2027 | 88161 | Cytopath smear other source | 1 | $0.00 | |||||
| 0040 | 2027 | 88161 | TC | Cytopath smear other source | 2 | $0.00 | ||||
| 0041 | 2027 | 88161 | 26 | Cytopath smear other source | 3 | $0.00 | ||||
| 0042 | 2027 | 88162 | Cytopath smear other source | 1 | $0.00 | |||||
| 0043 | 2027 | 88162 | TC | Cytopath smear other source | 1 | $0.00 | ||||
| 0044 | 2027 | 88162 | 26 | Cytopath smear other source | 4 | $0.00 | ||||
| 0045 | 2027 | 88172 | Cytp dx eval fna 1st ea site | 1 | $0.00 | |||||
| 0046 | 2027 | 88172 | TC | Cytp dx eval fna 1st ea site | 5 | $0.00 | ||||
| 0047 | 2027 | 88173 | Cytopath eval fna report | 45 | $0.00 | |||||
| 0048 | 2027 | 88173 | TC | Cytopath eval fna report | 4 | $0.00 | ||||
| 0049 | 2027 | 88177 | Cytp fna eval ea addl | 1 | $0.00 | |||||
| 0050 | 2027 | 88177 | TC | Cytp fna eval ea addl | 7 | $0.00 | ||||
| 0051 | 2027 | 88177 | 26 | Cytp fna eval ea addl | 1 | $0.00 | ||||
| 0052 | 2027 | 88182 | Cell marker study | 1 | $0.00 | |||||
| 0053 | 2027 | 88182 | TC | Cell marker study | 1 | $0.00 | ||||
| 0054 | 2027 | 88184 | Flowcytometry/ tc 1 marker | 184 | $0.00 | |||||
| 0055 | 2027 | 88185 | Flowcytometry/tc add-on | 31 | $0.00 | |||||
| 0056 | 2027 | 88187 | Flowcytometry/read 2-8 | 33 | $0.00 | |||||
| 0057 | 2027 | 88188 | Flowcytometry/read 9-15 | 35 | $0.00 | |||||
| 0058 | 2027 | 88189 | Flowcytometry/read 16 & > | 60 | $0.00 | |||||
| 0059 | 2027 | 88291 | Cyto/molecular report | 1 | $0.00 | |||||
| 0060 | 2027 | 88300 | Surgical path gross | 97 | $0.00 | |||||
| 0061 | 2027 | 88300 | TC | Surgical path gross | 59 | $0.00 | ||||
| 0062 | 2027 | 88302 | Tissue exam by pathologist | 3 | $0.00 | |||||
| 0063 | 2027 | 88302 | TC | Tissue exam by pathologist | 40 | $0.00 | ||||
| 0064 | 2027 | 88302 | 26 | Tissue exam by pathologist | 4 | $0.00 | ||||
| 0065 | 2027 | 88304 | Tissue exam by pathologist | 29 | $0.00 | |||||
| 0066 | 2027 | 88304 | TC | Tissue exam by pathologist | 192 | $0.00 | ||||
| 0067 | 2027 | 88304 | 26 | Tissue exam by pathologist | 45 | $0.00 | ||||
| 0068 | 2027 | 88305 | Tissue exam by pathologist | 328 | $0.00 | |||||
| 0069 | 2027 | 88305 | TC | Tissue exam by pathologist | 592 | $0.00 | ||||
| 0070 | 2027 | 88305 | Tissue exam by pathologist | 124 | $0.00 | |||||
| 0071 | 2027 | 88305 | TC | Tissue exam by pathologist | 3 | $0.00 | ||||
| 0072 | 2027 | 88305 | 26 | Tissue exam by pathologist | 27 | $0.00 | ||||
| 0073 | 2027 | 88307 | Tissue exam by pathologist | 46 | $0.00 | |||||
| 0074 | 2027 | 88307 | Tissue exam by pathologist | 13 | $0.00 | |||||
| 0075 | 2027 | 88307 | TC | Tissue exam by pathologist | 403 | $0.00 | ||||
| 0076 | 2027 | 88307 | 26 | Tissue exam by pathologist | 32 | $0.00 | ||||
| 0077 | 2027 | 88309 | Tissue exam by pathologist | 39 | $0.00 | |||||
| 0078 | 2027 | 88309 | TC | Tissue exam by pathologist | 49 | $0.00 | ||||
| 0079 | 2027 | 88309 | 26 | Tissue exam by pathologist | 53 | $0.00 | ||||
| 0080 | 2027 | 88311 | Decalcify tissue | 44 | $0.00 | |||||
| 0081 | 2027 | 88311 | Decalcify tissue | 9 | $0.00 | |||||
| 0082 | 2027 | 88311 | TC | Decalcify tissue | 5 | $0.00 | ||||
| 0083 | 2027 | 88312 | TC | Special stains group 1 | 244 | $0.00 | ||||
| 0084 | 2027 | 88312 | Special stains group 1 | 7 | $0.00 | |||||
| 0085 | 2027 | 88312 | TC | Special stains group 1 | 25 | $0.00 | ||||
| 0086 | 2027 | 88312 | TC | Special stains group 1 | 20 | $0.00 | ||||
| 0087 | 2027 | 88312 | Special stains group 1 | 12 | $0.00 | |||||
| 0088 | 2027 | 88313 | Special stains group 2 | 8 | $0.00 | |||||
| 0089 | 2027 | 88313 | TC | Special stains group 2 | 21 | $0.00 | ||||
| 0090 | 2027 | 88313 | Special stains group 2 | 1 | $0.00 | |||||
| 0091 | 2027 | 88313 | TC | Special stains group 2 | 136 | $0.00 | ||||
| 0092 | 2027 | 88313 | Special stains group 2 | 49 | $0.00 | |||||
| 0093 | 2027 | 88313 | 26 | Special stains group 2 | 7 | $0.00 | ||||
| 0094 | 2027 | 88314 | Histochemical stains add-on | 13 | $0.00 | |||||
| 0095 | 2027 | 88314 | TC | Histochemical stains add-on | 24 | $0.00 | ||||
| 0096 | 2027 | 88319 | Enzyme histochemistry | 9 | $0.00 | |||||
| 0097 | 2027 | 88319 | TC | Enzyme histochemistry | 5 | $0.00 | ||||
| 0098 | 2027 | 88321 | Consltj&reprt sld prep elswr | 32 | $0.00 | |||||
| 0099 | 2027 | 88321 | Consltj&reprt sld prep elswr | 1 | $0.00 | |||||
| 0100 | 2027 | 88321 | Consltj&reprt sld prep elswr | 23 | $0.00 | |||||
| 0101 | 2027 | 88323 | Consltj&reprt matrl prep sld | 4 | $0.00 | |||||
| 0102 | 2027 | 88323 | Consltj&reprt matrl prep sld | 25 | $0.00 | |||||
| 0103 | 2027 | 88341 | Imhchem/imcytchm ea add antb | 21 | $0.00 | |||||
| 0104 | 2027 | 88341 | TC | Imhchem/imcytchm ea add antb | 48 | $0.00 | ||||
| 0105 | 2027 | 88341 | Imhchem/imcytchm ea add antb | 81 | $0.00 | |||||
| 0106 | 2027 | 88341 | TC | Imhchem/imcytchm ea add antb | 16 | $0.00 | ||||
| 0107 | 2027 | 88341 | Imhchem/imcytchm ea add antb | 31 | $0.00 | |||||
| 0108 | 2027 | 88341 | TC | Imhchem/imcytchm ea add antb | 60 | $0.00 | ||||
| 0109 | 2027 | 88341 | 26 | Imhchem/imcytchm ea add antb | 5 | $0.00 | ||||
| 0110 | 2027 | 88341 | Imhchem/imcytchm ea add antb | 4 | $0.00 | |||||
| 0111 | 2027 | 88342 | Imhchem/imcytchm 1st antb | 33 | $0.00 | |||||
| 0112 | 2027 | 88342 | TC | Imhchem/imcytchm 1st antb | 13 | $0.00 | ||||
| 0113 | 2027 | 88342 | TC | Imhchem/imcytchm 1st antb | 8 | $0.00 | ||||
| 0114 | 2027 | 88342 | Imhchem/imcytchm 1st antb | 20 | $0.00 | |||||
| 0115 | 2027 | 88342 | TC | Imhchem/imcytchm 1st antb | 87 | $0.00 | ||||
| 0116 | 2027 | 88342 | Imhchem/imcytchm 1st antb | 4 | $0.00 | |||||
| 0117 | 2027 | 88342 | 26 | Imhchem/imcytchm 1st antb | 12 | $0.00 | ||||
| 0118 | 2027 | 88342 | Imhchem/imcytchm 1st antb | 25 | $0.00 | |||||
| 0119 | 2027 | 88344 | Imhchem/imcytchm ea mlt antb | 2 | $0.00 | |||||
| 0120 | 2027 | 88344 | TC | Imhchem/imcytchm ea mlt antb | 100 | $0.00 | ||||
| 0121 | 2027 | 88344 | Imhchem/imcytchm ea mlt antb | 9 | $0.00 | |||||
| 0122 | 2027 | 88344 | TC | Imhchem/imcytchm ea mlt antb | 8 | $0.00 | ||||
| 0123 | 2027 | 88346 | Imfluor 1st 1antb stain px | 32 | $0.00 | |||||
| 0124 | 2027 | 88346 | Imfluor 1st 1antb stain px | 39 | $0.00 | |||||
| 0125 | 2027 | 88346 | TC | Imfluor 1st 1antb stain px | 8 | $0.00 | ||||
| 0126 | 2027 | 88348 | Electron microscopy dx | 12 | $0.00 | |||||
| 0127 | 2027 | 88348 | TC | Electron microscopy dx | 9 | $0.00 | ||||
| 0128 | 2027 | 88350 | Imfluor ea addl 1antb stn px | 24 | $0.00 | |||||
| 0129 | 2027 | 88350 | Imfluor ea addl 1antb stn px | 23 | $0.00 | |||||
| 0130 | 2027 | 88350 | Imfluor ea addl 1antb stn px | 8 | $0.00 | |||||
| 0131 | 2027 | 88350 | TC | Imfluor ea addl 1antb stn px | 21 | $0.00 | ||||
| 0132 | 2027 | 88360 | Tumor immunohistochem/manual | 9 | $0.00 | |||||
| 0133 | 2027 | 88360 | Tumor immunohistochem/manual | 15 | $0.00 | |||||
| 0134 | 2027 | 88360 | TC | Tumor immunohistochem/manual | 32 | $0.00 | ||||
| 0135 | 2027 | 88361 | TC | Tumor immunohistochem/comput | 1 | $0.00 | ||||
| 0136 | 2027 | 88364 | Insitu hybridization (fish) | 8 | $0.00 | |||||
| 0137 | 2027 | 88364 | Insitu hybridization (fish) | 9 | $0.00 | |||||
| 0138 | 2027 | 88364 | TC | Insitu hybridization (fish) | 23 | $0.00 | ||||
| 0139 | 2027 | 88365 | Insitu hybridization (fish) | 21 | $0.00 | |||||
| 0140 | 2027 | 88365 | Insitu hybridization (fish) | 8 | $0.00 | |||||
| 0141 | 2027 | 88365 | TC | Insitu hybridization (fish) | 32 | $0.00 | ||||
| 0142 | 2027 | 88367 | TC | Insitu hybridization auto | 1 | $0.00 | ||||
| 0143 | 2027 | 88368 | TC | Insitu hybridization manual | 9 | $0.00 | ||||
| 0144 | 2027 | 88374 | X4 | M/phmtrc alys ishquant/semiq | 28 | $0.00 | ||||
| 0145 | 2027 | 88377 | M/phmtrc alys ishquant/semiq | 8 | $0.00 | |||||
| 0146 | 2027 | 88377 | M/phmtrc alys ishquant/semiq | 9 | $0.00 | |||||
| 0147 | 2027 | 88377 | M/phmtrc alys ishquant/semiq | 12 | $0.00 | |||||
| 0148 | 2027 | 88377 | TC | M/phmtrc alys ishquant/semiq | 7 | $0.00 | ||||
| 0149 | 2027 | 88377 | M/phmtrc alys ishquant/semiq | 5 | $0.00 | |||||
| 0150 | 2027 | 88381 | Microdissection manual | 13 | $0.00 | |||||
| 0151 | 2027 | 88381 | TC | Microdissection manual | 8 | $0.00 | ||||
| 0152 | 2027 | 88381 | Microdissection manual | 3 | $0.00 | |||||
| 0153 | 2027 | 88381 | TC | Microdissection manual | 1 | $0.00 | ||||
| 0154 | 2027 | 88399 | Unlisted surgical path px | 3 | $0.00 | |||||
| 0155 | 2027 | 89240 | Unlisted misc path test | 20 | $0.00 | |||||
| 0156 | 2027 | 89240 | Unlisted misc path test | 1 | $0.00 | |||||
| 0157 | 2027 | 89240 | Unlisted misc path test | 4 | $0.00 | |||||
| 0158 | 2027 | 89240 | Unlisted misc path test | 4 | $0.00 | |||||
| 0159 | 2027 | 89240 | Unlisted misc path test | 4 | $0.00 | |||||
| 0160 | 2027 | 99001 | Specimen handling pt-lab | 2 | $0.00 | |||||
| 0161 | 2027 | TBD | Miscellaneous test varies depending on methodology/pathways | 0 | TBD | ERROR:#VALUE! | ||||
| $0.00 |
$0.00
CLIA OP1
| 2027 Clinical Diagnostic Laboratory Fee Schedule | ||||||||||||
| CPT codes, descriptions and other data only are copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. | ||||||||||||
| *KEY | ||||||||||||
| 100% of CMS Pricing | ||||||||||||
| * | Send Outs | |||||||||||
| ** | In-House Special Pricing | |||||||||||
| LIN | YEAR | HCSPCS / CPT | Send Outs | MOD | Short Description | Extended Description | CMS INDICATOR | Quantity | UNIT PRICING FOR CONTRACT | CMS Discount Rate (Enter Discount of CMS Amount) | TOTAL - CONTRACT PRICING | |
| Example | 2027 | 12345 | Example: Random Test | 5 | $100.00 | 100.00% | $500.00 | 100.00% | ||||
| 0162 | 2027 | 0012M | Onc mrna 5 gen rsk urthl ca | Oncology (urothelial), mrna, gene expression profiling by real-time quantitative pcr of five genes (mdk, hoxa13, cdc2 [cdk1], igfbp5, and cxcr2), utilizing urine, algorithm reported as a risk score for having urothelial carcinoma | N | 1 | $0.00 | |||||
| 0163 | 2027 | 0013M | Onc mrna 5 gen recr urthl ca | Oncology (urothelial), mrna, gene expression profiling by real-time quantitative pcr of five genes (mdk, hoxa13, cdc2 [cdk1], igfbp5, and cxcr2), utilizing urine, algorithm reported as a risk score for having recurrent urothelial carcinoma | N | 1 | $0.00 | |||||
| 0164 | 2027 | 0035U | Neuro csf prion prtn qual | Neurology (prion disease), cerebrospinal fluid, detection of prion protein by quaking-induced conformational conversion, qualitative | N | 1 | $0.00 | |||||
| 0165 | 2027 | 80047 | Metabolic panel ionized ca | Basic metabolic panel (calcium, ionized) this panel must include the following: calcium, ionized (82330) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) potassium (84132) sodium (84295) urea nitrogen (bun) (84520) | N | 1 | $0.00 | |||||
| 0166 | 2027 | 80048 | Metabolic panel total ca | Basic metabolic panel (calcium, total) this panel must include the following: calcium, total (82310) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) potassium (84132) sodium (84295) urea nitrogen (bun) (84520) | N | 4 | $0.00 | |||||
| 0167 | 2027 | 80053 | Comprehen metabolic panel | Comprehensive metabolic panel this panel must include the following: albumin (82040) bilirubin, total (82247) calcium, total (82310) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) phosphatase, alkaline (84075) potassium (84132) protein, total (84155) sodium (84295) transferase, alanine amino (alt) (sgpt) (84460) transferase, aspartate amino (ast) (sgot) (84450) urea nitrogen (bun) (84520) | N | 13 | $0.00 | |||||
| 0168 | 2027 | 80061 | Lipid panel | Lipid panel this panel must include the following: cholesterol, serum, total (82465) lipoprotein, direct measurement, high density cholesterol (hdl cholesterol) (83718) triglycerides (84478) | N | 1 | $0.00 | |||||
| 0169 | 2027 | 80150 | Assay of amikacin | Amikacin | N | 1 | $0.00 | |||||
| 0170 | 2027 | 80156 | Assay carbamazepine total | Carbamazepine; total | N | 1 | $0.00 | |||||
| 0171 | 2027 | 80170 | Assay of gentamicin | Gentamicin | N | 1 | $0.00 | |||||
| 0172 | 2027 | 80185 | Assay of phenytoin total | Phenytoin; total | N | 1 | $0.00 | |||||
| 0173 | 2027 | 80186 | Assay of phenytoin free | Phenytoin; free | N | 1 | $0.00 | |||||
| 0174 | 2027 | 80194 | Assay of quinidine | Quinidine | N | 1 | $0.00 | |||||
| 0175 | 2027 | 80197 | Assay of tacrolimus | Tacrolimus | N | 1 | $0.00 | |||||
| 0176 | 2027 | 80202 | Assay of vancomycin | Vancomycin | N | 5 | $0.00 | |||||
| 0177 | 2027 | 80204 | Drug assay methotrexate | Methotrexate | N | 3 | $0.00 | |||||
| 0178 | 2027 | 80299 | Quantitative assay drug | Quantitation of therapeutic drug, not elsewhere specified | N | 68 | $0.00 | |||||
| 0179 | 2027 | 80299 | Quantitative assay drug | Quantitation of therapeutic drug, not elsewhere specified | N | 5 | $0.00 | |||||
| 0180 | 2027 | 80305 | Drug test prsmv dir opt obs | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service | N | 1 | $0.00 | |||||
| 0181 | 2027 | 80306 | Drug test prsmv instrmnt | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; read by instrument assisted direct optical observation (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service | N | 1 | $0.00 | |||||
| 0182 | 2027 | 80307 | Drug test prsmv chem anlyzr | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, eia, elisa, emit, fpia, ia, kims, ria]), chromatography (eg, gc, hplc), and mass spectrometry either with or without chromatography, (eg, dart, desi, gc-ms, gc-ms/ms, lc-ms, lc-ms/ms, ldtd, maldi, tof) includes sample validation when performed, per date of service | N | 1 | $0.00 | |||||
| 0183 | 2027 | 80307 | Drug test prsmv chem anlyzr | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, eia, elisa, emit, fpia, ia, kims, ria]), chromatography (eg, gc, hplc), and mass spectrometry either with or without chromatography, (eg, dart, desi, gc-ms, gc-ms/ms, lc-ms, lc-ms/ms, ldtd, maldi, tof) includes sample validation when performed, per date of service | N | 1 | $0.00 | |||||
| 0184 | 2027 | 81120 | Idh1 common variants | Idh1 (isocitrate dehydrogenase 1 [nadp+], soluble) (eg, glioma), common variants (eg, r132h, r132c) | N | 16 | $0.00 | |||||
| 0185 | 2027 | 81121 | Idh2 common variants | Idh2 (isocitrate dehydrogenase 2 [nadp+], mitochondrial) (eg, glioma), common variants (eg, r140w, r172m) | N | 15 | $0.00 | |||||
| 0186 | 2027 | 81170 | Abl1 gene | Abl1 (abl proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain | N | 5 | $0.00 | |||||
| 0187 | 2027 | 81206 | Bcr/abl1 gene major bp | Bcr/abl1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative | N | 40 | $0.00 | |||||
| 0188 | 2027 | 81207 | Bcr/abl1 gene minor bp | Bcr/abl1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative | N | 9 | $0.00 | |||||
| 0189 | 2027 | 81210 | Braf gene | Braf (b-raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, v600 variant(s) | N | 1 | $0.00 | |||||
| 0190 | 2027 | 81210 | Braf gene | Braf (b-raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, v600 variant(s) | N | 1 | $0.00 | |||||
| 0191 | 2027 | 81210 | Braf gene | Braf (b-raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, v600 variant(s) | N | 3 | $0.00 | |||||
| 0192 | 2027 | 81219 | Calr gene com variants | Calr (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon 9 | N | 11 | $0.00 | |||||
| 0193 | 2027 | 81245 | Flt3 gene | Flt3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; internal tandem duplication (itd) variants (ie, exons 14, 15) | N | 61 | $0.00 | |||||
| 0194 | 2027 | 81245 | Flt3 gene | Flt3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; internal tandem duplication (itd) variants (ie, exons 14, 15) | N | 7 | $0.00 | |||||
| 0195 | 2027 | 81246 | Flt3 gene analysis | Flt3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; tyrosine kinase domain (tkd) variants (eg, d835, i836) | N | 7 | $0.00 | |||||
| 0196 | 2027 | 81261 | Igh gene rearrange amp meth | Igh@ (immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, b-cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (eg, polymerase chain reaction) | N | 11 | $0.00 | |||||
| 0197 | 2027 | 81261 | Igh gene rearrange amp meth | Igh@ (immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, b-cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (eg, polymerase chain reaction) | N | 1 | $0.00 | |||||
| 0198 | 2027 | 81270 | Jak2 gene | Jak2 (janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.val617phe (v617f) variant | N | 5 | $0.00 | |||||
| 0199 | 2027 | 81270 | Jak2 gene | Jak2 (janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.val617phe (v617f) variant | N | 239 | $0.00 | |||||
| 0200 | 2027 | 81272 | Kit gene targeted seq analys | Kit (v-kit hardy-zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [gist], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons 8, 11, 13, 17, 18) | N | 8 | $0.00 | |||||
| 0201 | 2027 | 81275 | Kras gene variants exon 2 | Kras (kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and 13) | N | 15 | $0.00 | |||||
| 0202 | 2027 | 81275 | Kras gene variants exon 2 | Kras (kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and 13) | N | 3 | $0.00 | |||||
| 0203 | 2027 | 81275 | Kras gene variants exon 2 | Kras (kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and 13) | N | 4 | $0.00 | |||||
| 0204 | 2027 | 81276 | Kras gene addl variants | Kras (kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146) | N | 5 | $0.00 | |||||
| 0205 | 2027 | 81301 | Microsatellite instability | Microsatellite instability analysis (eg, hereditary non-polyposis colorectal cancer, lynch syndrome) of markers for mismatch repair deficiency (eg, bat25, bat26), includes comparison of neoplastic and normal tissue, if performed | N | 4 | $0.00 | |||||
| 0206 | 2027 | 81301 | Microsatellite instability | Microsatellite instability analysis (eg, hereditary non-polyposis colorectal cancer, lynch syndrome) of markers for mismatch repair deficiency (eg, bat25, bat26), includes comparison of neoplastic and normal tissue, if performed | N | 1 | $0.00 | |||||
| 0207 | 2027 | 81305 | Myd88 gene p.leu265pro vrnt | Myd88 (myeloid differentiation primary response 88) (eg, waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.leu265pro (l265p) variant | N | 10 | $0.00 | |||||
| 0208 | 2027 | 81310 | Npm1 gene | Npm1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, exon 12 variants | N | 40 | $0.00 | |||||
| 0209 | 2027 | 81311 | Nras gene variants exon 2&3 | Nras (neuroblastoma ras viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61) | N | 2 | $0.00 | |||||
| 0210 | 2027 | 81311 | Nras gene variants exon 2&3 | Nras (neuroblastoma ras viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61) | N | 3 | $0.00 | |||||
| 0211 | 2027 | 81314 | Pdgfra gene | Pdgfra (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [gist]), gene analysis, targeted sequence analysis (eg, exons 12, 18) | N | 12 | $0.00 | |||||
| 0212 | 2027 | 81315 | Pml/raralpha com breakpoints | Pml/raralpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; common breakpoints (eg, intron 3 and intron 6), qualitative or quantitative | N | 4 | $0.00 | |||||
| 0213 | 2027 | 81342 | Trg gene rearrangement anal | Trg@ (t cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population(s) | N | 70 | $0.00 | |||||
| 0214 | 2027 | 81342 | Trg gene rearrangement anal | Trg@ (t cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population(s) | N | 6 | $0.00 | |||||
| 0215 | 2027 | 81345 | Tert gene targeted seq alys | Tert (telomerase reverse transcriptase) (eg, thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (eg, promoter region) | N | 1 | $0.00 | |||||
| 0216 | 2027 | 81401 | Mopath procedure level 2 | Molecular pathology procedure, level 2 (eg, 2-10 snps, 1 methylated variant, or 1 somatic variant [typically using nonsequencing target variant analysis], or detection of a dynamic mutation disorder/triplet repeat) abcc8 (atp-binding cassette, sub-family c [cftr/mrp], member 8) (eg, familial hyperinsulinism), common variants (eg, c.3898-9g>a [c.3992-9g>a], f1388del) abl1 (abl proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib resistance), t315i variant acadm (acyl-coa dehydrogenase, c-4 to c-12 straight chain, mcad) (eg, medium chain acyl dehydrogenase deficiency), commons variants (eg, k304e, y42h) adrb2 (adrenergic beta-2 receptor surface) (eg, drug metabolism), common variants (eg, g16r, q27e) apob (apolipoprotein b) (eg, familial hypercholesterolemia type b), common variants (eg, r3500q, r3500w) apoe (apolipoprotein e) (eg, hyperlipoproteinemia type iii, cardiovascular disease, alzheimer disease), common variants (eg, *2, *3, *4) cbfb/myh11 (inv(16)) (eg, acute myeloid leukemia), qualitative, and quantitative, if performed cbs (cystathionine-beta-synthase) (eg, homocystinuria, cystathionine beta-synthase deficiency), common variants (eg, i278t, g307s) cfh/arms2 (complement factor h/age-related maculopathy susceptibility 2) (eg, macular degeneration), common variants (eg, y402h [cfh], a69s [arms2]) dek/nup214 (t(6;9)) (eg, acute myeloid leukemia), translocation analysis, qualitative, and quantitative, if performed e2a/pbx1 (t(1;19)) (eg, acute lymphocytic leukemia), translocation analysis, qualitative, and quantitative, if performed eml4/alk (inv(2)) (eg, non-small cell lung cancer), translocation or inversion analysis etv6/runx1 (t(12;21)) (eg, acute lymphocytic leukemia), translocation analysis, qualitative, and quantitative, if performed ewsr1/atf1 (t(12;22)) (eg, clear cell sarcoma), translocation analysis, qualitative, and quantitative, if performed ewsr1/erg (t(21;22)) (eg, ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed ewsr1/fli1 (t(11;22)) (eg, ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed ewsr1/wt1 (t(11;22)) (eg, desmoplastic small round cell tumor), translocation analysis, qualitative, and quantitative, if performed f11 (coagulation factor xi) (eg, coagulation disorder), common variants (eg, e117x [type ii], f283l [type iii], ivs14del14, and ivs14+1g>a [type i]) fgfr3 (fibroblast growth factor receptor 3) (eg, achondroplasia, hypochondroplasia), common variants (eg, 1138g>a, 1138g>c, 1620c>a, 1620c>g) fip1l1/pdgfra (del[4q12]) (eg, imatinib-sensitive chronic eosinophilic leukemia), qualitative, and quantitative, if performed flg (filaggrin) (eg, ichthyosis vulgaris), common variants (eg, r501x, 2282del4, r2447x, s3247x, 3702delg) foxo1/pax3 (t(2;13)) (eg, alveolar rhabdomyosarcoma), translocation analysis, qualitative, and quantitative, if performed foxo1/pax7 (t(1;13)) (eg, alveolar rhabdomyosarcoma), translocation analysis, qualitative, and quantitative, if performed fus/ddit3 (t(12;16)) (eg, myxoid liposarcoma), translocation analysis, qualitative, and quantitative, if performed galc (galactosylceramidase) (eg, krabbe disease), common variants (eg, c.857g>a, 30-kb deletion) galt (galactose-1-phosphate uridylyltransferase) (eg, galactosemia), common variants (eg, q188r, s135l, k285n, t138m, l195p, y209c, ivs2-2a>g, p171s, del5kb, n314d, l218l/n314d) h19 (imprinted maternally expressed transcript [non-protein coding]) (eg, beckwith-wiedemann syndrome), methylation analysis igh@/bcl2 (t(14;18)) (eg, follicular lymphoma), translocation analysis; single breakpoint (eg, major breakpoint region [mbr] or minor cluster region [mcr]), qualitative or quantitative (when both mbr and mcr breakpoints are performed, use 81278) kcnq1ot1 (kcnq1 overlapping transcript 1 [non-protein coding]) (eg, beckwith-wiedemann syndrome), methylation analysis linc00518 (long intergenic non-protein coding rna 518) (eg, melanoma), expression analysis lrrk2 (leucine-rich repeat kinase 2) (eg, parkinson disease), common variants (eg, r1441g, g2019s, i2020t) med12 (mediator complex subunit 12) (eg, fg syndrome type 1, lujan syndrome), common variants (eg, r961w, n1007s) meg3/dlk1 (maternally expressed 3 [non-protein coding]/delta-like 1 homolog [drosophila]) (eg, intrauterine growth retardation), methylation analysis mll/aff1 (t(4;11)) (eg, acute lymphoblastic leukemia), translocation analysis, qualitative, and quantitative, if performed mll/mllt3 (t(9;11)) (eg, acute myeloid leukemia), translocation analysis, qualitative, and quantitative, if performed mt-atp6 (mitochondrially encoded atp synthase 6) (eg, neuropathy with ataxia and retinitis pigmentosa [narp], coli]) (eg, myh-associated polyposis), common variants (eg, y165c, g382d) nod2 (nucleotide-binding oligomerization domain containing 2) (eg, crohn's disease, blau syndrome), common variants (eg, snp 8, snp 12, snp 13) npm1/alk (t(2;5)) (eg, anaplastic large cell lymphoma), translocation analysis pax8/pparg (t(2;3) (q13;p25)) (eg, follicular thyroid carcinoma), translocation analysis prame (preferentially expressed antigen in melanoma) (eg, melanoma), expression analysis prss1 (protease, serine, 1 [trypsin 1]) (eg, hereditary pancreatitis), common variants (eg, n29i, a16v, r122h) pygm (phosphorylase, glycogen, muscle) (eg, glycogen storage disease type v, mcardle disease), common variants (eg, r50x, g205s) runx1/runx1t1 (t(8;21)) (eg, acute myeloid leukemia) translocation analysis, qualitative, and quantitative, if performed ss18/ssx1 (t(x;18)) (eg, synovial sarcoma), translocation analysis, qualitative, and quantitative, if performed ss18/ssx2 (t(x;18)) (eg, synovial sarcoma), translocation analysis, qualitative, and quantitative, if performed vwf (von willebrand factor) (eg, von willebrand disease type 2n), common variants (eg, t791m, r816w, r854q) | N | 7 | $0.00 | |||||
| 0217 | 2027 | 81403 | Mopath procedure level 4 | Molecular pathology procedure, level 4 (eg, analysis of single exon by dna sequence analysis, analysis of >10 amplicons using multiplex pcr in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons) ang (angiogenin, ribonuclease, rnase a family, 5) (eg, amyotrophic lateral sclerosis), full gene sequence arx (aristaless related homeobox) (eg, x-linked lissencephaly with ambiguous genitalia, x-linked intellectual disability), duplication/deletion analysis cel (carboxyl ester lipase [bile salt-stimulated lipase]) (eg, maturity-onset diabetes of the young [mody]), targeted sequence analysis of exon 11 (eg, c.1785delc, c.1686delt) ctnnb1 (catenin [cadherin-associated protein], beta 1, 88kda) (eg, desmoid tumors), targeted sequence analysis (eg, exon 3) daz/sry (deleted in azoospermia and sex determining region y) (eg, male infertility), common deletions (eg, azfa, azfb, azfc, azfd) dnmt3a (dna [cytosine-5-]-methyltransferase 3 alpha) (eg, acute myeloid leukemia), targeted sequence analysis (eg, exon 23) epcam (epithelial cell adhesion molecule) (eg, lynch syndrome), duplication/deletion analysis f8 (coagulation factor viii) (eg, hemophilia a), inversion analysis, intron 1 and intron 22a f12 (coagulation factor xii [hageman factor]) (eg, angioedema, hereditary, type iii; factor xii deficiency), targeted sequence analysis of exon 9 fgfr3 (fibroblast growth factor receptor 3) (eg, isolated craniosynostosis), targeted sequence analysis (eg, exon 7) (for targeted sequence analysis of multiple fgfr3 exons, use 81404) gjb1 (gap junction protein, beta 1) (eg, charcot-marie-tooth x-linked), full gene sequence gnaq (guanine nucleotide-binding protein g[q] subunit alpha) (eg, uveal melanoma), common variants (eg, r183, q209) human erythrocyte antigen gene analyses (eg, slc14a1 [kidd blood group], bcam [lutheran blood group], icam4 [landsteiner-wiener blood group], slc4a1 [diego blood group], aqp1 [colton blood group], ermap [scianna blood group], rhce [rh blood group, ccee antigens], kel [kell blood group], darc [duffy blood group], gypa, gypb, gype [mns blood group], art4 [dombrock blood group]) (eg, sickle-cell disease, thalassemia, hemolytic transfusion reactions, hemolytic disease of the fetus or newborn), common variants hras (v-ha-ras harvey rat sarcoma viral oncogene homolog) (eg, costello syndrome), exon 2 sequence kcnc3 (potassium voltage-gated channel, shaw-related subfamily, member 3) (eg, spinocerebellar ataxia), targeted sequence analysis (eg, exon 2) kcnj2 (potassium inwardly-rectifying channel, subfamily j, member 2) (eg, andersen-tawil syndrome), full gene sequence kcnj11 (potassium inwardly-rectifying channel, subfamily j, member 11) (eg, familial hyperinsulinism), full gene sequence killer cell immunoglobulin-like receptor (kir) gene family (eg, hematopoietic stem cell transplantation), genotyping of kir family genes known familial variant not otherwise specified, for gene listed in tier 1 or tier 2, or identified during a genomic sequencing procedure, dna sequence analysis, each variant exon (for a known familial variant that is considered a common variant, use specific common variant tier 1 or tier 2 code) mc4r (melanocortin 4 receptor) (eg, obesity), full gene sequence mica (mhc class i polypeptide-related sequence a) (eg, solid organ transplantation), common variants (eg, *001, *002) mt-rnr1 (mitochondrially encoded 12s rna) (eg, nonsyndromic hearing loss), full gene sequence mt-ts1 (mitochondrially encoded trna serine 1) (eg, nonsyndromic hearing loss), full gene sequence ndp (norrie disease [pseudoglioma]) (eg, norrie disease), duplication/deletion analysis nhlrc1 (nhl repeat containing 1) (eg, progressive myoclonus epilepsy), full gene sequence phox2b (paired-like homeobox 2b) (eg, congenital central hypoventilation syndrome), duplication/deletion analysis pln (phospholamban) (eg, dilated cardiomyopathy, hypertrophic cardiomyopathy), full gene sequence rhd (rh blood group, d antigen) (eg, hemolytic disease of the fetus and newborn, rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene) rhd (rh blood group, d antigen) (eg, hemolytic disease of the fetus and newborn, rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene), performed on cell-free fetal dna in maternal blood (for human erythrocyte gene analysis of rhd, use a separate unit of 81403) sh2d1a (sh2 domain containing 1a) (eg, x-linked lymphoproliferative syndrome), duplication/deletion analysis twist1 (twist homolog 1 [drosophila]) (eg, saethre-chotzen syndrome), duplication/deletion analysis uba1 (ubiquitin-like modifier activating enzyme 1) (eg, spinal muscular atrophy, x-linked), targeted sequence analysis (eg, exon 15) vhl (von hippel-lindau tumor suppressor) (eg, von hippel-lindau familial cancer syndrome), deletion/duplication analysis vwf (von willebrand factor) (eg, von willebrand disease types 2a, 2b, 2m), targeted sequence analysis (eg, exon 28) | N | 38 | $0.00 | |||||
| 0218 | 2027 | 81403 | Mopath procedure level 4 | Molecular pathology procedure, level 4 (eg, analysis of single exon by dna sequence analysis, analysis of >10 amplicons using multiplex pcr in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons) ang (angiogenin, ribonuclease, rnase a family, 5) (eg, amyotrophic lateral sclerosis), full gene sequence arx (aristaless related homeobox) (eg, x-linked lissencephaly with ambiguous genitalia, x-linked intellectual disability), duplication/deletion analysis cel (carboxyl ester lipase [bile salt-stimulated lipase]) (eg, maturity-onset diabetes of the young [mody]), targeted sequence analysis of exon 11 (eg, c.1785delc, c.1686delt) ctnnb1 (catenin [cadherin-associated protein], beta 1, 88kda) (eg, desmoid tumors), targeted sequence analysis (eg, exon 3) daz/sry (deleted in azoospermia and sex determining region y) (eg, male infertility), common deletions (eg, azfa, azfb, azfc, azfd) dnmt3a (dna [cytosine-5-]-methyltransferase 3 alpha) (eg, acute myeloid leukemia), targeted sequence analysis (eg, exon 23) epcam (epithelial cell adhesion molecule) (eg, lynch syndrome), duplication/deletion analysis f8 (coagulation factor viii) (eg, hemophilia a), inversion analysis, intron 1 and intron 22a f12 (coagulation factor xii [hageman factor]) (eg, angioedema, hereditary, type iii; factor xii deficiency), targeted sequence analysis of exon 9 fgfr3 (fibroblast growth factor receptor 3) (eg, isolated craniosynostosis), targeted sequence analysis (eg, exon 7) (for targeted sequence analysis of multiple fgfr3 exons, use 81404) gjb1 (gap junction protein, beta 1) (eg, charcot-marie-tooth x-linked), full gene sequence gnaq (guanine nucleotide-binding protein g[q] subunit alpha) (eg, uveal melanoma), common variants (eg, r183, q209) human erythrocyte antigen gene analyses (eg, slc14a1 [kidd blood group], bcam [lutheran blood group], icam4 [landsteiner-wiener blood group], slc4a1 [diego blood group], aqp1 [colton blood group], ermap [scianna blood group], rhce [rh blood group, ccee antigens], kel [kell blood group], darc [duffy blood group], gypa, gypb, gype [mns blood group], art4 [dombrock blood group]) (eg, sickle-cell disease, thalassemia, hemolytic transfusion reactions, hemolytic disease of the fetus or newborn), common variants hras (v-ha-ras harvey rat sarcoma viral oncogene homolog) (eg, costello syndrome), exon 2 sequence kcnc3 (potassium voltage-gated channel, shaw-related subfamily, member 3) (eg, spinocerebellar ataxia), targeted sequence analysis (eg, exon 2) kcnj2 (potassium inwardly-rectifying channel, subfamily j, member 2) (eg, andersen-tawil syndrome), full gene sequence kcnj11 (potassium inwardly-rectifying channel, subfamily j, member 11) (eg, familial hyperinsulinism), full gene sequence killer cell immunoglobulin-like receptor (kir) gene family (eg, hematopoietic stem cell transplantation), genotyping of kir family genes known familial variant not otherwise specified, for gene listed in tier 1 or tier 2, or identified during a genomic sequencing procedure, dna sequence analysis, each variant exon (for a known familial variant that is considered a common variant, use specific common variant tier 1 or tier 2 code) mc4r (melanocortin 4 receptor) (eg, obesity), full gene sequence mica (mhc class i polypeptide-related sequence a) (eg, solid organ transplantation), common variants (eg, *001, *002) mt-rnr1 (mitochondrially encoded 12s rna) (eg, nonsyndromic hearing loss), full gene sequence mt-ts1 (mitochondrially encoded trna serine 1) (eg, nonsyndromic hearing loss), full gene sequence ndp (norrie disease [pseudoglioma]) (eg, norrie disease), duplication/deletion analysis nhlrc1 (nhl repeat containing 1) (eg, progressive myoclonus epilepsy), full gene sequence phox2b (paired-like homeobox 2b) (eg, congenital central hypoventilation syndrome), duplication/deletion analysis pln (phospholamban) (eg, dilated cardiomyopathy, hypertrophic cardiomyopathy), full gene sequence rhd (rh blood group, d antigen) (eg, hemolytic disease of the fetus and newborn, rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene) rhd (rh blood group, d antigen) (eg, hemolytic disease of the fetus and newborn, rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene), performed on cell-free fetal dna in maternal blood (for human erythrocyte gene analysis of rhd, use a separate unit of 81403) sh2d1a (sh2 domain containing 1a) (eg, x-linked lymphoproliferative syndrome), duplication/deletion analysis twist1 (twist homolog 1 [drosophila]) (eg, saethre-chotzen syndrome), duplication/deletion analysis uba1 (ubiquitin-like modifier activating enzyme 1) (eg, spinal muscular atrophy, x-linked), targeted sequence analysis (eg, exon 15) vhl (von hippel-lindau tumor suppressor) (eg, von hippel-lindau familial cancer syndrome), deletion/duplication analysis vwf (von willebrand factor) (eg, von willebrand disease types 2a, 2b, 2m), targeted sequence analysis (eg, exon 28) | N | 20 | $0.00 | |||||
| 0219 | 2027 | 81403 | Mopath procedure level 4 | Molecular pathology procedure, level 4 (eg, analysis of single exon by dna sequence analysis, analysis of >10 amplicons using multiplex pcr in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons) ang (angiogenin, ribonuclease, rnase a family, 5) (eg, amyotrophic lateral sclerosis), full gene sequence arx (aristaless related homeobox) (eg, x-linked lissencephaly with ambiguous genitalia, x-linked intellectual disability), duplication/deletion analysis cel (carboxyl ester lipase [bile salt-stimulated lipase]) (eg, maturity-onset diabetes of the young [mody]), targeted sequence analysis of exon 11 (eg, c.1785delc, c.1686delt) ctnnb1 (catenin [cadherin-associated protein], beta 1, 88kda) (eg, desmoid tumors), targeted sequence analysis (eg, exon 3) daz/sry (deleted in azoospermia and sex determining region y) (eg, male infertility), common deletions (eg, azfa, azfb, azfc, azfd) dnmt3a (dna [cytosine-5-]-methyltransferase 3 alpha) (eg, acute myeloid leukemia), targeted sequence analysis (eg, exon 23) epcam (epithelial cell adhesion molecule) (eg, lynch syndrome), duplication/deletion analysis f8 (coagulation factor viii) (eg, hemophilia a), inversion analysis, intron 1 and intron 22a f12 (coagulation factor xii [hageman factor]) (eg, angioedema, hereditary, type iii; factor xii deficiency), targeted sequence analysis of exon 9 fgfr3 (fibroblast growth factor receptor 3) (eg, isolated craniosynostosis), targeted sequence analysis (eg, exon 7) (for targeted sequence analysis of multiple fgfr3 exons, use 81404) gjb1 (gap junction protein, beta 1) (eg, charcot-marie-tooth x-linked), full gene sequence gnaq (guanine nucleotide-binding protein g[q] subunit alpha) (eg, uveal melanoma), common variants (eg, r183, q209) human erythrocyte antigen gene analyses (eg, slc14a1 [kidd blood group], bcam [lutheran blood group], icam4 [landsteiner-wiener blood group], slc4a1 [diego blood group], aqp1 [colton blood group], ermap [scianna blood group], rhce [rh blood group, ccee antigens], kel [kell blood group], darc [duffy blood group], gypa, gypb, gype [mns blood group], art4 [dombrock blood group]) (eg, sickle-cell disease, thalassemia, hemolytic transfusion reactions, hemolytic disease of the fetus or newborn), common variants hras (v-ha-ras harvey rat sarcoma viral oncogene homolog) (eg, costello syndrome), exon 2 sequence kcnc3 (potassium voltage-gated channel, shaw-related subfamily, member 3) (eg, spinocerebellar ataxia), targeted sequence analysis (eg, exon 2) kcnj2 (potassium inwardly-rectifying channel, subfamily j, member 2) (eg, andersen-tawil syndrome), full gene sequence kcnj11 (potassium inwardly-rectifying channel, subfamily j, member 11) (eg, familial hyperinsulinism), full gene sequence killer cell immunoglobulin-like receptor (kir) gene family (eg, hematopoietic stem cell transplantation), genotyping of kir family genes known familial variant not otherwise specified, for gene listed in tier 1 or tier 2, or identified during a genomic sequencing procedure, dna sequence analysis, each variant exon (for a known familial variant that is considered a common variant, use specific common variant tier 1 or tier 2 code) mc4r (melanocortin 4 receptor) (eg, obesity), full gene sequence mica (mhc class i polypeptide-related sequence a) (eg, solid organ transplantation), common variants (eg, *001, *002) mt-rnr1 (mitochondrially encoded 12s rna) (eg, nonsyndromic hearing loss), full gene sequence mt-ts1 (mitochondrially encoded trna serine 1) (eg, nonsyndromic hearing loss), full gene sequence ndp (norrie disease [pseudoglioma]) (eg, norrie disease), duplication/deletion analysis nhlrc1 (nhl repeat containing 1) (eg, progressive myoclonus epilepsy), full gene sequence phox2b (paired-like homeobox 2b) (eg, congenital central hypoventilation syndrome), duplication/deletion analysis pln (phospholamban) (eg, dilated cardiomyopathy, hypertrophic cardiomyopathy), full gene sequence rhd (rh blood group, d antigen) (eg, hemolytic disease of the fetus and newborn, rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene) rhd (rh blood group, d antigen) (eg, hemolytic disease of the fetus and newborn, rh maternal/fetal compatibility), deletion analysis (eg, exons 4, 5, and 7, pseudogene), performed on cell-free fetal dna in maternal blood (for human erythrocyte gene analysis of rhd, use a separate unit of 81403) sh2d1a (sh2 domain containing 1a) (eg, x-linked lymphoproliferative syndrome), duplication/deletion analysis twist1 (twist homolog 1 [drosophila]) (eg, saethre-chotzen syndrome), duplication/deletion analysis uba1 (ubiquitin-like modifier activating enzyme 1) (eg, spinal muscular atrophy, x-linked), targeted sequence analysis (eg, exon 15) vhl (von hippel-lindau tumor suppressor) (eg, von hippel-lindau familial cancer syndrome), deletion/duplication analysis vwf (von willebrand factor) (eg, von willebrand disease types 2a, 2b, 2m), targeted sequence analysis (eg, exon 28) | N | 24 | $0.00 |
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