For HMO, PPO, POS and Optima Family Care Products
Effective October 1, 2007
To determine how the in-office lab list applies to self-funded products, refer to the Employer Choices Manual.
Only the following lab tests will be allowed to be performed in the physician's office.
All other testing must be performed by a participating reference lab.
Regardless of whether the test is performed in-office1 or collected and sent through a participating reference laboratory, the office may bill one draw fee per patient (CPT Code 36415 or 36416).
Charges from a physician for lab tests other than the ones listed below will be denied non-allowed lab charge; member not responsible.
CPT Description
81000 Routine urinalysis
81001 Urinalysis, automated, w/ microscopy
81002 Urinalysis, non-automated w/o microscopy
81003 Urinalysis, automated, w/o microscopy
81025 Urine pregnancy test
82247 Bilirubin; total
82270 Blood, occult; feces screening
82272 Blood, occult; feces screening
82274 Blood, occult; feces screening
G0107 Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations
82947 Glucose; quantitative
82948 Glucose, blood, reagent strip
82962 Blood glucose by FDA approved glucose monitoring devices
83655 Lead (finger stick lead testing only)
84703 Gonadotropin, qualitative
85007 Blood count; blood smear, microscopic exam with manual diff WBC count
85013 Blood count, spun microhematocrit
85014 Blood count, other than spun hematocrit
85018 Hemoglobin
85025 CBC
85027 CBC
85610 Prothrombin time
85651 Sedimentation rate;erythrocyte; non-automated
86308 Heterophile antibodies; screening (added effective 10/1/2007)
86580 Tuberculosis, intradermal
87086 Culture, bacterial; quantitative colony count, urine
87210 Wet mount w/ simple stain
87220 Tissue examination for fungi (KOH)
87430 Streptococcus, group A
87804 Influenza
87880 Streptococcus, group A
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Download Optima Health's In-Office Lab List
1 Lab procedures performed in-office must be performed according to your CLIA certification level.