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HMO Blue®Texas Outpatient Clinical Reference Lab Services
Effective 03/01/2007
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 |
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Austin
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Johnson
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Atascosa
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Kaufman
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Bell
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Lavaca
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Bexar
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Leon
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Brazoria
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Liberty
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Brazos
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Madison
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Calhoun
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Matagorda
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Chambers
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McLennan
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Collin
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Medina
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Comal
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Montague
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Cooke
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Montgomery
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Dallas
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Orange
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Denton
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Parker
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Ellis
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Polk
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Fannin
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Robertson
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Fort Bend
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Rockwall
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Galveston
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San Jacinto
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Gonzales
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Somervell
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Grayson
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Tarrant
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Grimes
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Trinity
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Guadalupe
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Victoria
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Hardin
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Walker
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Harris
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Waller
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Hood
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Washington
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Houston
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Wharton
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Hunt
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Wilson
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Jackson
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Wise
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Jefferson
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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.
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Reimbursable Lab Services - Effective 03/01/2007
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Test Description
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CPT Code
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Collection of venous blood by venipuncture
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36415
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Collection of capillary blood specimen
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36416
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Venipuncture, cutdown; under age 1 year
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36420
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Basic metabolic panel
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80048
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Electrolyte panel
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80051
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Urinalysis, dipstick
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81000
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Urinalysis, with microscopy, automated
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81001
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Urinalysis, without microscopy, non-automated
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81002
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Urinalysis, without microscopy, automated
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81003
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Urinalysis, bacteriuria screen, except by culture or dipstick
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81007
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Pregnancy test, urine
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81025
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Stool for occult blood (Hemoccult)
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82270
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Stool for occult blood (Hemoccult single)
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82272
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| Stool for occult blood (Immunologic) |
82274
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Glucose, blood, quantitative
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82947
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Glucose, blood, reagent strip
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82948
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Glucose, blood, monitoring device
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82962
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H. pylori; breath test analysis for urease activity, drug administration
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83014
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Bleeding time
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85002
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Blood count, differential WBC, automated
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85004
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Blood count, smear, WBC differential, manual
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85007
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Blood count, smear, no WBC differential
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85008
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Blood count, spun microhematocrit
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85013
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Blood count, hematocrit
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85014
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Blood count, hemoglobin
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85018
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Blood count, complete CBC & WBC differential, automated
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85025
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Blood count, complete CBC, automated
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85027
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Blood count, manual, each
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85032
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Blood count, platelet, automated
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85049
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Coagulation time, Lee and White
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85345
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Coagulation time, Lee and White, activated
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85347
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Coagulation time, Lee and White, other methods
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85348
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Prothrombin time
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85610
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Heterophile antibody screen for mononucleosis
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86308
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Skin test, coccidioidomycosis
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86490
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Skin test, histoplasmosis
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86510
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Skin test, tuberculosis, intradermal
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86580
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Wet mount for infectious agents
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87210
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Tissue exam by KOH slide
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87220
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Influenza
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87400
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Strep screening, qualitative
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87430
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Influenza, rapid
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87804
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RSV, rapid
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87807
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Strep screening, rapid
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87880
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All other outpatient clinical reference lab services not listed above must be referred to HMO Blue Texas' exclusive provider - Laboratory Corporation of America (LabCorp).
Posted 2/08/07
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