HMO Blue® Texas Outpatient Clinical Lab Services Reference

HMO Blue®Texas Outpatient Clinical Reference Lab Services
Effective 02/01/2006

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 Reimbursable Lab Services list that follows below.

 

County Listing – Effective 10/01/2005

Austin
Johnson
Atascosa
Kaufman
Bell
Lavaca
Bexar
Leon
Brazoria
Liberty
Brazos
Madison
Calhoun
Matagorda
Chambers
McLennan
Collin
Medina
Comal
Montague
Cooke
Montgomery
Dallas
Orange
Denton
Parker
Ellis
Polk
Fannin
Robertson
Fort Bend
Rockwall
Galveston
San Jacinto
Gonzales
Somervell
Grayson
Tarrant
Grimes
Trinity
Guadalupe
Victoria
Hardin
Walker
Harris
Waller
Hood
Washington
Houston
Wharton
Hunt
Wilson
Jackson
Wise
Jefferson

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.

Reimbursable Lab Services - Effective 02/01/2006

 

Test Description

CPT Code

Collection of venous blood by venipuncture

36415

Collection of capillary blood specimen

36416

Venipuncture, cutdown; under age 1 year

36420

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

Stool for occult blood
82274

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

Skin test, coccidioidomycosis

86490

Skin test, histoplasmosis

86510

Skin test, tuberculosis, intradermal

86580

Skin test, tuberculosis, tine test

86585

Wet mount for infectious agents

87210

Tissue exam by KOH slide

87220

Influenza

87400

Strep screening, qualitative

87430

RSV, rapid

87807

Strep screening, rapid

87880