In-Office Lab Approval List

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 CodeTest Description
81000Routine urinalysis
81001Urinalysis, automated, w/microscopy
81002Urinalysis, non-automated w/o microscopy
81003Urinalysis, automated, w/o microscopy
81025Urine Pregnancy test
82043Urine, microalbumin, quantitative
82044Urine, microalbumin, semiquantitative
82247Bilirubin, total
82270Fecal occult blood testing
82271Fecal occult blood testing
82272Fecal occult blood testing
82947Glucose; quantitative
82948Glucose, blood, reagent strip
82962Blood glucose by FDA approved glucose monitoring devices
83014Helicobacter pylori, breath test analysis; drug administration
83036Hemoglobin; glycosylated (A1C)
83037Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use
83655Lead (finger stick lead testing only)
84703hCG, qualitative
85018Hemoglobin
85025CBC with differential
85027CBC without differential
85610prothrombin/INR
85651Sedimentation rate, erythrocyte; non-automated
86140C-reactive protein;
86308Mononucleosis test/heterophil antibody test
86580Tuberculosis, intradermal
86701Antibody HIV-1 test (with modifier 92)
86702Antibody; HIV-2
86703Antibody HIV-1 and HIV-2 single assay (with modifier 92)
87210Wet mount w/simple stain
87220KOH prep
87804Rapid Influenza test
87880Infectious agent detection by immunoassay-streptococcus group A
88738Hemoglobin (Hgb), quantitative, transcutaneous
87635Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
G2023Specimen 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.

 

last updated: June 3, 2022

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