HMO Blue® Texas Outpatient Clinical Lab Services

HMO Blue®Texas Outpatient Clinical Reference Lab Services
Effective 01/01/2008

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 01/01/2008

Austin
Jefferson
Bell
Johnson
Bexar
Kaufman
Brazoria
Lavaca
Brazos
Leon
Calhoun
Liberty
Chambers
Madison
Collin
Matagorda
Comal
McLennan
Cooke
Montague
Dallas
Montgomery
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
Wise

Note: Physicians/professional providers who are contracted/affiliated with a capitated IPA/Medical Group, and physicians/professional providers who are not part of a capitated IPA/Medical Group but who provide services to a member whose PCP is a member of a capitated IPA/Medical Group, must contact the applicable IPA/Medical Group for instructions regarding outpatient laboratory services.

Reimbursable Lab Services - Effective 01/01/2008

 

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 (Hemoccult single)

82272

Stool for occult blood (Immunologic)
82274

Glucose, blood, quantitative

82947

Glucose, blood, reagent strip

82948

Glucose, blood, monitoring device

82962

H. pylori; breath test analysis for urease activity, drug administration

83014

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

Wet mount for infectious agents

87210

Tissue exam by KOH slide

87220

Influenza

87400

Strep screening, qualitative

87430

Influenza, rapid

87804

RSV, rapid

87807

Strep screening, rapid

87880

Sperm evaluation, cervical mucus penetration test

89330

All other outpatient clinical reference lab services not listed above must be referred to HMO Blue Texas' exclusive provider - Laboratory Corporation of America (LabCorp).