| HMO Blue® Texas Outpatient Clinical Reference Lab Services |
|
Effective 7/01/2004 - 9/30/2005
For physicians and professional providers located in the following
counties, the lab services that will be reimbursed on a fee-for-service
basis if performed in the physician's office
for HMO Blue Texas members are included on the STAT Lab Services
list that follows below.
| Austin |
Johnson |
| Atascosa |
Kaufman |
| Bell |
Lavaca |
| Bexar |
Leon |
| Brazoria |
Liberty |
| Brazos |
Madison |
| Calhoun |
Matagorda |
| Chambers |
McLennan |
| Collin |
Medina |
| Comal |
Montague |
| Cooke |
Montgomery |
| Dallas |
Nueces |
| Denton |
Orange |
| Ellis |
Parker |
| Fannin |
Polk |
| Fort Bend |
Robertson |
| Galveston |
Rockwall |
| Gonzales |
San Jacinto |
| Grayson |
Somervell |
| Grimes |
Tarrant |
| Guadalupe |
Trinity |
| Hardin |
Victoria |
| Harris |
Walker |
| Hood |
Waller |
| Houston |
Washington |
| Hunt |
Wharton |
| Jackson |
Wilson |
| Jefferson |
Wise |
| Jim Wells |
|
Note: HMO Blue Texas physicians
and professional providers who are contracted/affiliated with
a capitated IPA/Medical Group must contact the IPA/Medical Group
regarding outpatient laboratory services.
|
STAT Lab Services - Effective 7/01/2004 to 9/30/2005
Test Description |
CPT Code |
Basic metabolic panel |
80048 |
Electrolyte panel |
80051 |
Urinalysis, dipstick |
81000 |
Urinalysis, with microscopy, automated |
81001 |
Urinalysis, without microscopy, non-automated |
81002 |
Urinalysis, without microscopy, automated |
81003 |
Urinalysis, bacteriuria screen, except by culture or dipstick |
81007 |
Pregnancy test, urine |
81025 |
Stool for occult blood (Hemoccult) |
82270 |
Glucose, blood, quantitative |
82947 |
Glucose, blood, reagent strip |
82948 |
Glucose, blood, monitoring device |
82962 |
Bleeding time |
85002 |
Blood count, differential WBC, automated |
85004 |
Blood count, smear, WBC differential, manual |
85007 |
Blood count, smear, no WBC differential |
85008 |
Blood count, spun microhematocrit |
85013 |
Blood count, hematocrit |
85014 |
Blood count, hemoglobin |
85018 |
Blood count, complete CBC & WBC differential, automated |
85025 |
Blood count, complete CBC, automated |
85027 |
Blood count, manual, each |
85032 |
Blood count, platelet, automated |
85049 |
Coagulation time, Lee and White |
85345 |
Coagulation time, Lee and White, activated |
85347 |
Coagulation time, Lee and White, other methods |
85348 |
Prothrombin time |
85610 |
Heterophile antibody screen for mononucleosis |
86308 |
Wet mount for infectious agents |
87210 |
Tissue exam by KOH slide |
87220 |
Influenza |
87400 |
Strep screening, qualitative |
87430 |
Strep screening, rapid |
87880 |
Note: Venipunctures will be reimbursed when performed in the physician’s office.
|
