In-Office Lab Approval List Effective January 15, 2021
The Primary Care Physician (PCP) In-Office Laboratory Testing and Procedures List is a list of testing/laboratory procedure codes that MetroPlusHealth will consider for reimbursement to our Network PCPs (Family Practice, Internal Medicine, Pediatrics, Geriatrics and Adolescent Medicine) when performed in their office. This listing went into effect on January 15, 2021.
MetroPlusHealth has contracts in place with several reference laboratories to ensure that our members receive the highest quality diagnostic testing available. MetroPlusHealth also understands that there are certain times when it is clinically appropriate and more efficient to administer tests while the member is in the provider’s office. The services below are allowed by Primary Care Physicians (PCP) for all MetroPlusHealth lines of business. All other lab testing must be referred to an In-Network Laboratory Provider that is a certified, full-service laboratory, offering a comprehensive test menu that includes routine, complex, drug, genetic testing and pathology. Note that for providers contracted under capitated arrangements, these testing services are included in your monthly capitation payment.
Claims for tests performed in the physician office, but not listed below will be denied.
|CPT Code||Test Description|
|81001||Urinalysis, automated, w/microscopy|
|81002||Urinalysis, non-automated w/o microscopy|
|81003||Urinalysis, automated, w/o microscopy|
|81025||Urine Pregnancy test|
|82043||Urine, microalbumin, quantitative|
|82044||Urine, microalbumin, semiquantitative|
|82270||Fecal occult blood testing|
|82271||Fecal occult blood testing|
|82272||Fecal occult blood testing|
|82948||Glucose, blood, reagent strip|
|82962||Blood glucose by FDA approved glucose monitoring devices|
|83014||Helicobacter pylori, breath test analysis; drug administration|
|83036||Hemoglobin; glycosylated (A1C)|
|83037||Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use|
|83655||Lead (finger stick lead testing only)|
|85025||CBC with differential|
|85027||CBC without differential|
|85651||Sedimentation rate, erythrocyte; non-automated|
|86308||Mononucleosis test/heterophil antibody test|
|86701||Antibody HIV-1 test (with modifier 92)|
|86703||Antibody HIV-1 and HIV-2 single assay (with modifier 92)|
|87210||Wet mount w/simple stain|
|87804||Rapid Influenza test|
|87880||Infectious agent detection by immunoassay-streptococcus group A|
|88738||Hemoglobin (Hgb), quantitative, transcutaneous|
|87635||Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique|
|G2023||Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source|
For more information about In-Network Laboratory Providers, please consult the MetroPlusHealth Provider Directory.