Download LABORATORY SERVICES

SCHEDULE OF
BENEFITS
For
LABORATORY SERVICES
April 1, 1999
LABORATORY MEDICINE
PREAMBLE:
SPECIFIC ELEMENTS
In addition to the common elements, (see General Preamble to the Schedule of Benefits,
Physician Services under the Health Insurance Act), all services listed under Laboratory
Medicine from L001 to L699 (including L900 codes), L701 to L799 and under the "Laboratory
Medicine in Private Office" listings in the Diagnostic and Therapeutic Procedures Section of the
Schedule, when performed by a physician for his/her own patients, include the following specific
elements:
A. Carrying out the laboratory procedure, including collecting specimens where not
separately billable, and processing of specimens.
B. Interpreting and/or providing the results of the procedure, where not interpreted by a
physician under an L800 code, even where the interpreting physician is another
physician.
C. Discussion with and providing advice and information to the patient or patient's
representative(s),
whether by telephone or otherwise, on matters related to the service.
D. Providing premises, equipment, supplies and personnel for the specific elements and for
any
aspect(s) of the specific elements, of any service(s) covered by a corresponding L800
code
that is (are) performed at the place in which the laboratory procedure is performed.
OTHER TERMS AND DEFINITIONS
1. The patient documentation and specimen handling benefit (see code L700 below) is
applicable to all insured procedures, except for those listed under anatomical pathology,
histology and cytology, the fees for which cover any administrative cost. This benefit is
not applicable to referred-in samples, since the collecting laboratory will already have
claimed the patient documentation and specimen collection benefit.
2. The biochemistry section has been condensed so that one listing refers to a procedure
for any of amniotic fluid (A), blood (B), CSF (C), faeces (F), gastrointestinal fluid (G),
urine (U). Exceptions are indicated by B, U, etc., following the test name. Other
specimens will be considered on an `IC’ (independent consideration) basis.
3. A number of tests are listed in different sections of Laboratory Medicine, i.e., where more
than one method of performing the test is available.
April 1, 1999
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LABORATORY MEDICINE
4. Blood glucose by the dipstick method may be claimed only when assessed by an
appropriate instrument such as a reflectance meter. It should not be claimed when used
only as a check on the fasting blood sample of a glucose tolerance test. The blood
glucose of the fasting sample in a glucose tolerance test is allowable only once even if
assessed by two methods.
Note:
A standard glucose tolerance test for the diagnosis of diabetes mellitus is performed over
2 hours and includes 5 blood glucose (L104) and one urine glucose determination (L253).
If the patient is pregnant, only 4 blood glucose specimens (L103) should be taken at
hourly intervals (see CMAJ 126, 473 (1982)). When 5 hour glucose tolerance test is
specifically ordered the blood glucose measurements are to be claimed individually
(L111). Only one L253 may be claimed with a glucose tolerance test.
5. Code L417 or L418 may not be claimed by a physician in addition to claim(s) for any
treatment or assessment. However, Code G481 in the Diagnostic and Therapeutic
Procedures Section may be claimed by a physician if a hemoglobin screen (any method
or instrument is carried out in the course of an office or home visit. Urinalysis may be
claimed with or without an associated visit to a physician's office (except for screening
and urinalyses which are not medically necessary).
6. When a screening culture method (e.g., Agar spoon) is used on a urine sample, L641
refers to a culture technique and does not apply to those kits using the nitrite test only.
Where a significant growth is obtained and followed up by definitive identification
methods, L633 or L634 only should be claimed. The benefits for L633 or L634 include
any necessary microscopic examination of the urine. However, urine examination by
microscopy may be claimed in addition to L633 or L634 if the authorized practitioner has
specifically ordered the former and receives a report from the laboratory.
7. Only those tests which are requested are to be claimed for with the following exceptions.
It is intended that if the requested test yields abnormal findings or information which
would be incomplete, insufficient or meaningless to the authorized practitioner, the
medical director of a laboratory may add further appropriate tests and claim for them with
the knowledge he/she may have to substantiate their justification.
8. A test must be completed in accordance with the pertinent schedule listing in order to
claim for it. The verbatim listing is intended as the definitive benefit for that test alone,
unless otherwise specified, e.g., isoenzymes do not include total enzyme estimation;
creatine does not include creatinine (as specified). Notwithstanding the foregoing and
recognizing that it is impossible to list all variations in techniques of all listed tests, when
there is a modification of the usual technique, the listing most closely approximating it
should be used.
April 1, 1999
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LABORATORY MEDICINE
9. This schedule, with the exception of L036, lists actual procedures performed. No claim
shall be made for calculated values made and reported, or for control tests or repeat tests
on same patient sample.
10. Creatinine is a justifiable addition in the case of tests on 24-hour urine samples, where it
is necessary to assess the sample as a complete 24-hour collection. However, if several
tests (e.g., steroids) are done on a single such sample, only one creatinine would be
claimed for that sample. In those estimations where the test result is expressed in terms
of creatinine excretion the performance of a creatinine is mandatory and should be
claimed.
11. It is recognized that in requests for a serologic titre, if a screening test is used and would
suffice, the lesser benefit for the screening test should be claimed. If positive and
followed by serial titration, both the screening and titre fees should be claimed. If the
titration is a micro technique using plates, it is the equivalent of a tube titre, the wells
being miniature tubes.
12. When a test for trichomonas identification (any method) is carried out in association with
L625 or L627, wet preparation (L653) may be claimed in addition. L653 may be claimed
when a wet preparation is used for direct examination of a fresh specimen for amoebae
or similar parasites. However, the wet preparation used in the faeces concentration
technique for parasites and ova is included in L650. The conditions set down in
paragraph 7 of this preamble must be adhered to.
13. It is recognized that in all laboratory tests there is a professional component.
14. Complete Blood Count includes WBC Differential (L372), Platelet Count (L396), RBC
Count (L397), WBC Count (L399), Hematocrit (L417), and Hemoglobin (L418). When one
or more of these tests are ordered, claim L393, not the individual codes. Perform and
report results for all six tests. The maximum number of LMS units which can be claimed
per patient per day is 16. L700 is not included in this total and should be claimed
separately, if appropriate.
15. The maximum number of units which may be claimed for any combination of chemical
analyses performed on a single sample by means of an automated chemical analyzer
with simultaneously functioning channels is 5 LMS units (L225).
April 1, 1999
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LABORATORY MEDICINE
16. The following preamble applies to the immunohematology section:
(a) L471 Antibody identification fee is per specimen regardless of method used.
Preparation of eluate and/or antibody absorption is included.
(b) L473 Parallel Titration - to be used when two sequential patient serum specimens are
tested to detect a change in antibody titre. Includes a repeat antibody identification
on the current sample.
(c) L490 Blood Group - ABO and RhD. The subgroups of A and weak RhD phenotype
are included where indicated. A direct AHGT is also included in L490, therefore L495
may not be claimed on the same patient when this code is claimed.
(d) L492 Crossmatch. When an initial crossmatch is requested, the appropriate claim is
for L490 x 1, L482 x 1 plus L492 for each unit ordered. L490 and L482 may not be
claimed more than once on the same day of service. L490 and L493 may not be
claimed when these procedures are carried out as a confirmatory test on the units of
blood to be transfused.
(e) L493. This code includes L490 [see Preamble, paragraph 16(c)] and Rh phenotype
as well as antigens C, D, E, c, e, and weak RhD phenotype when indicated. Any
other antigen is to be claimed under L494.
(f) L494 Blood Group per antigen. Antigens stated in L490 and L493 are excluded from
this code.
(g) L495 Direct AHGT - can be used when ordered as a single procedure, or in addition
to L482 when the latter is requested as a single procedure. L495 may not be claimed
when L490 or L493 is claimed with L482 on the same patient, on the same visit.
17. Code L623 refers to a specific request for the minimal inhibitory concentration (MIC) of an
antimicrobial agent required to inhibit or kill a micro-organism, expressed in units or
µg/ml, using multiple/serial dilutions of the antimicrobial agent. L623 must not be used as
a routine antibiotic sensitivity test and does not include breakpoint susceptibility testing
using manual kit or automated methodologies.
18. The use of Nickersons Medium as a screening test for yeast is not a benefit.
April 1, 1999
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LABORATORY MEDICINE
19. The carcinoembryonic antigen test (CEA) L690 is an insured service only when carried
out in accordance with Cancer Care Ontario guidelines for following established
malignancies, and not as a general cancer screen.
20. The benefit for seminal fluid examination (complete) is to include sperm count, volume
estimation, motility, morphology and viscosity.
21. Fees for laboratory medicine testing are not to be paid (in whole or in part) to the referring
practitioner by the laboratory performing the tests.
22. The benefits for patient documentation and specimen collection and each test are
calculated by multiplying the individual LMS Unit values by 51.7 cents effective October
1, 1989.
23. Laboratory tests on specimens sent outside Ontario are not an insured benefit unless
prior approval is obtained from the Ministry of Health.
24. Secondary laboratories receiving specimens for additional (secondary) tests from another
laboratory that normally would be claimed as L303, L319, L500 or L544 should be
claimed as L903, L919, L900 or L944 respectively.
25. When a pregnancy test is requested, L655 should be performed. L318 should only be
performed, when H.C.G. or Beta sub-units are specifically requested by the authorized
practitioner.
26. The maximum number of units which can be claimed for the combination of L055, L153
and L243 is 30 units per patient per day. The maximum of 30 units applies on a per
patient basis, regardless of the number of specimens submitted and regardless of the
number of laboratories involved performing the test. Code L700 is not included in this
maximum and should be claimed separately if appropriate.
27. The following codes cannot be claimed when the tests are done, either individually or in
any combination, for fetal assessment: L311, L318, L691.
28. Codes L319 and/or L919 cannot be claimed when done for prenatal assessment.
29. The fee for L575 must include a gammopathy screen using antisera to the individual
immunoglobulins (IgG, IgA, IgM) as well as both Kappa and Lambda Light Chains. In the
event that further antisera are required to type the paraprotein, the fees for these extra
antisera are included in the 120 units for L575. L080/L085/L086 are not justifiable addons to code L575. Code L575 should not be used for qualitative determinations of acute
phase proteins. Requests of this type should utilize code L085 - Protein Electrophoresis
or specific protein determinants as requested, e.g., Transferrin (L554), Ceruloplasmin
(L553), Alpha 1 antitrypsin (L555). In appropriate cases when clinically indicated based
on the results of the immunoelectrophoresis test, and with written approval of the medical
director of the laboratory, code L550 Immunoglobulin quantitation may be a justifiable
add-on to L575.
April 1, 1999
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LABORATORY MEDICINE
30. L720 surgical pathology billable per block of tissue processed to a maximum of 8 per
patient per day, regardless of the number of specimens received. The laboratory must
meet the standard of practice that the number of blocks processed is the minimum
required. Normally additional blocks would be required only if the amount of tissue
exceeds the available space in the cassette or the pieces of tissue must be separately
identified. Additional work required is not billable, e.g.,
Special Stains,
Deeper Sections,
Block Rotation,
Block Retrieval,
Decalcification.
NOTE:
Claims for laboratory services, when referred by a Dentist, Osteopath, Chiropodist or
Chiropractor are not insured services.
April 1, 1999
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LABORATORY MEDICINE
LMS
Units
Code
L700
PATIENT DOCUMENTATION AND SPECIMEN COLLECTION FEE
(see Preamble, paragraphs 1, 14 & 26) ..................................................................................... 15
1.
2.
3.
4.
5.
Limited to 1 per patient, per day.
Not allowed to the recipient of a referred sample from another laboratory.
Not allowed to the attending physician.
Not applicable to a patient visit solely to receive instructions or collection containers.
When multiple tests are ordered for the same patient, for the same day, only one L700
may be claimed even though all specimens may not be available on any one day.
6. Not applicable to items under anatomical pathology, histology and cytology sections (Fee
Codes L701 to L731 inclusive, L800 - L848 or L900 - L944 inclusive).
BIOCHEMISTRY
(Applicable to all specimens except as denoted by B-blood, U-urine, F-faeces, C-CSF,
A-amniotic fluid).
L059
L001
L002
L003
L004
L005
L006
L008
L009
L010
L011
L012
L013
L014
L044
Acetaminophen ..................................................................................................................
Acetone, qualitative.............................................................................................................
Acetone, quantitative .........................................................................................................
Addis count -U ....................................................................................................................
Albumin, qualitative .............................................................................................................
Albumin, quantitative (excluded if globulin and/or protein electrophoresis done) ..............
Alcohol, ethyl - quantitative ................................................................................................
Alcohols, fractionation and quantification ...........................................................................
Aldolase ..............................................................................................................................
Aldosterone .........................................................................................................................
Amino acids - one way chromatography - B.U. ..................................................................
Amino acids - two way chromatography – U ......................................................................
Amino acids, fractionation and quantitation .......................................................................
Amino acid nitrogen ............................................................................................................
Acid profile - organic (by GC-MS) .......................................................................................
April 1, 1999
25
3
35
32
3
5
25
45
30
120
15
30
200
33
200
7
LABORATORY MEDICINE
LMS
Units
Code
BIOCHEMISTRY (Cont’d)
(Applicable to all specimens except as denoted by B-blood, U-urine, F-faeces, C-CSF,
A-amniotic fluid).
L071
L015
L016
L017
L018
L021
L019
L225
L026
L027
L028
L029
L030
L031
L037
L038
L039
L045
L046
L047
L048
L040
L049
L050
L051
L052
L041
L053
L054
L055
L056
L057
Aminoglycosides (e.g., gentamicin, tobramycin) ................................................................
Ammonia .............................................................................................................................
Amniotic fluid scan ..............................................................................................................
Amniotic fluid L/S ratio ........................................................................................................
Amylase .............................................................................................................................
Androstenedione ................................................................................................................
Ascorbic acid (ascorbate) ...................................................................................................
Automated chemical analyzers with simultaneously functioning channels, single Sample
(see Preamble, paragraph 15)
Barbiturates, quantitative ....................................................................................................
Barbiturates, fractionation and quantification (serum) - includes other drugs requiring
similar methodology, e.g. tricyclic antidepressants.............................................................
Bile microscopy ...................................................................................................................
Bilirubin, qualitative – F.......................................................................................................
Bilirubin, total.......................................................................................................................
Bilirubin, conjugated
Blood gases (see listings on pages 11-12).........................................................................
Blood volume - excluding injection of dye...........................................................................
Bromides .............................................................................................................................
Bromosulphthalein (BSP) excluding injection of dye ..........................................................
Calcium ...............................................................................................................................
Calcium ionized...................................................................................................................
Calculus analysis - chemical, qualitative ............................................................................
Calculus analysis, qualitative and quantitative ...................................................................
Carbamazepine, quantitative (Tegretol) .............................................................................
Carotene ............................................................................................................................
Catecholamines, total .........................................................................................................
Catecholamines, fractionated .............................................................................................
Ceruloplasmin .....................................................................................................................
Chlordiazepoxide, quantitative (Librium) ............................................................................
Chloride...............................................................................................................................
Chloride (sweat) ..................................................................................................................
Cholesterol, total - not to be claimed with L156 (see Preamble, paragraph 26) ................
Cholesterol, ester - not to be claimed with L156.................................................................
Cholinesterase - pseudo or true..........................................................................................
April 1, 1999
40
39
20
50
5
75
25
5
35
60
4
3
5
10
20
15
14
5
20
15
25
35
16
60
80
19
40
5
33
5
14
30
8
LABORATORY MEDICINE
LMS
Units
Code
BIOCHEMISTRY (Cont’d)
(Applicable to all specimens except as denoted by B-blood, U-urine, F-faeces, C-CSF,
A-amniotic fluid).
L058
L060
L061
L062
L063
L064
L065
L066
L070
L067
L068
L075
L069
L199
L074
L072
L077
L076
L078
L079
L085
L086
L080
L092
L095
L096
L097
L098
L099
L094
L105
L106
L113
L107
L109
Cholinesterase genotyping (includes pseudo, dibucaine and fluoride) ..............................
Carboxyhemoglobin ............................................................................................................
CO2 content, CO2 combining power, bicarbonate (measured, not calculated)...................
Chymotrypsin ......................................................................................................................
Copper ................................................................................................................................
Cortisol ................................................................................................................................
Creatine (see Preamble, paragraph 8) ...............................................................................
Creatine phosphokinase .....................................................................................................
Creatine phosphokinase, fractionation ...............................................................................
Creatinine - not with L068 (see Preamble, paragraph 10)..................................................
Creatinine clearance ...........................................................................................................
Crystal identification (x-ray powder diffraction analysis).....................................................
Cystine screening – U.........................................................................................................
Delta-aminolevulinic acid (ALA), quantitative – U...............................................................
Diazepam, quantitative (Valium, Vivol) ...............................................................................
Digoxin ................................................................................................................................
Diphenylhydantoin, quantitative (Phenytoin, Dilantin) ........................................................
Disopyramide ......................................................................................................................
Drugs of abuse screen, urine..............................................................................................
Broad spectrum toxicology screen, urine - includes confirmatory testing...........................
Electrophoresis, serum - including total protein..................................................................
Electrophoresis, other than serum - including total protein ................................................
Electrophoresis, serum – alone ..........................................................................................
Ethosuximide, quantitative (Zarontin) .................................................................................
Fat, total- F..........................................................................................................................
Fat, differential – F ..............................................................................................................
Fat and/or meat fibres (microscopic) – F ............................................................................
Fat (microscopic) – U ..........................................................................................................
Fatty acids, free...................................................................................................................
Flurazepam, quantitative (Dalmane)...................................................................................
Galactose (per sample) ......................................................................................................
Galactose-l-phosphate uridyl transferase (quantitative) .....................................................
Galactose-l-phosphate uridyl transferase (screening) ........................................................
Gamma glutamyl transpeptidase ........................................................................................
Gastric analysis titration (per sample).................................................................................
April 1, 1999
50
15
5
22
40
35
26
5
34
5
15
30
8
25
40
45
35
35
68
72
36
50
26
35
72
92
6
6
25
40
16
65
10
5
7
9
LABORATORY MEDICINE
LMS
Units
Code
BIOCHEMISTRY (Cont’d)
(Applicable to all specimens except as denoted by B-blood, U-urine, F-faeces, C-CSF,
A-amniotic fluid).
L110
L111
L112
L104
L103
L114
L115
L093
L116
L119
L132
L121
L122
L117
L118
L123
L101
L124
L125
L126
L127
L128
L129
L130
L131
L135
L136
L142
L143
L137
L139
L141
L145
L146
Globulin (excluded if albumin and/or protein electrophoresis done)...................................
Glucose, quantitative - not by dipstick (see Preamble, paragraph 4) .................................
Glucose, semi-quantitative (dipstick if read with reflectance meter)...................................
Glucose tolerance test (see Preamble, paragraph 4) .........................................................
Glucose tolerance test in pregnancy (see Preamble, paragraph 4) ...................................
Glutathione..........................................................................................................................
Glycoproteins ......................................................................................................................
Glycosylated hemoglobin - HgbAl ......................................................................................
Gold.....................................................................................................................................
Hexosaminidase A ..............................................................................................................
Hemoglobin A2 by chromatography ....................................................................................
5HIAA screening – U ..........................................................................................................
5HIAA quantitation – U .......................................................................................................
High density lipoprotein cholesterol ....................................................................................
Histamine ............................................................................................................................
Homogentisic acid (homogentisate) - qualitative ...............................................................
Homovanillic acid (homovanillate), HVA.............................................................................
Hydroxybutyrate dehydrogenase .......................................................................................
17-Hydroxycorticosteroids – U............................................................................................
17-Ketogenic steroids – U...................................................................................................
17-Ketosteroids, total – U ...................................................................................................
17-Ketosteroids, fractionated – U .......................................................................................
Hydroxyproline – B..............................................................................................................
Hydroxyproline, total – U.....................................................................................................
Hydroxyproline, total and free – U ......................................................................................
Inulin clearance test ............................................................................................................
Inulin....................................................................................................................................
Intestinal enzymes – qualitative ..........................................................................................
Intestinal enzymes – quantitative........................................................................................
Iodine protein bound ...........................................................................................................
Iron, total -with iron binding capacity and per cent saturation - not to be claimed with
L329 ....................................................................................................................................
Iso-citric dehydrogenase.....................................................................................................
Lactic acid (lactate) .............................................................................................................
Lactic dehydrogenase (L.D.H.), total ..................................................................................
April 1, 1999
10
5
3
30
24
20
60
22
40
15
25
9
50
18
90
9
60
10
34
40
34
80
25
90
150
40
40
6
22
21
34
15
27
10
10
LABORATORY MEDICINE
LMS
Units
Code
BIOCHEMISTRY (Cont’d)
(Applicable to all specimens except as denoted by B-blood, U-urine, F-faeces, C-CSF,
A-amniotic fluid).
L147
L148
L149
L153
L154
L155
L156
L157
L165
L166
L167
L168
L169
L170
L171
L172
L160
L175
L173
L174
L161
L180
L181
L182
L183
L184
L185
L032
Lactic dehydrogenase fractionation ....................................................................................
29
Lead ....................................................................................................................................
40
Leucine aminopeptidase .....................................................................................................
15
Lipoprotein, electrophoresis - not to be claimed with L156 .............................................
20
(see Preamble, paragraph 26) ............................................................................................
Lipoprotein, ultracentrifugation............................................................................................
50
Lipoprotein lipase ................................................................................................................ 100
Lipoprotein phenotyping (includes sample appearance, cholesterol, triglycerides, Lipoprot 40
Lithium.................................................................................................................................
10
Magnesium..........................................................................................................................
5
Malic acid (malate) dehydrogenase ....................................................................................
15
Melanin – U .........................................................................................................................
10
Mercury ...............................................................................................................................
30
Metanephrines, total – U.....................................................................................................
75
Metanephrines, fractionated – U.........................................................................................
90
Methemalbumin...................................................................................................................
21
Methemoglobin....................................................................................................................
21
Methotrexate (amethopterin)...............................................................................................
35
Methylphenidate, quantitative (Ritalin)................................................................................
40
Mucopolysaccharides – U...................................................................................................
25
Myoglobin, qualitative – U...................................................................................................
30
N-acetylprocainamide .........................................................................................................
35
5' – Nucleotidase.................................................................................................................
25
Occult blood ........................................................................................................................
3
Ornithine carbamoyl transferase.........................................................................................
15
Osmolality (osmolarity) .......................................................................................................
10
Oxalic acid (oxalate) – U.....................................................................................................
40
P.A.H. clearance .................................................................................................................
40
pCO2 ...........................................................................................................................................................................................................
8
April 1, 1999
11
LABORATORY MEDICINE
LMS
Units
Code
BIOCHEMISTRY (Cont’d)
(Applicable to all specimens except as denoted by B-blood, U-urine, F-faeces, C-CSF,
A-amniotic fluid).
L033
L034
L035
L036
L187
L188
L189
L190
NOTE:
L191
L192
L193
L194
L195
L196
L197
L198
L200
L201
L202
L203
L204
L205
L206
L211
L212
L213
L208
L209
pO2 arterial ..........................................................................................................................
pH........................................................................................................................................
pCO2 , pO2 and pH in combination ......................................................................................
pCO2 , pO2 pH- calculation of one or more of standard bicarbonate, base.........................
excess, etc (see Preamble, paragraph 9)...........................................................................
Phenothiazines, qualitative – U...........................................................................................
Phenothiazines, quantitative – U ........................................................................................
Phenylalanine......................................................................................................................
Phosphatase, acid...............................................................................................................
8
7
17
3
6
30
15
15
L190 - no additional claim may be made for a repeat test using an Inhibitor (such as for
prostatic acid phosphatase determination).
Phosphatase, alkaline.........................................................................................................
Phosphatase, alkaline fractionation ....................................................................................
Phospholipids......................................................................................................................
Phosphorus (inorganic phosphate) .....................................................................................
Plasma clearing factor (Baker)............................................................................................
Plasma hemoglobin ............................................................................................................
Porphobilinogen (PBG), screen – U....................................................................................
Porphobilinogen (PBG), quantitative – U............................................................................
Porphyrins, screen ..............................................................................................................
Porphyrins, quantitation (copro, proto, uro) – U..................................................................
Porphyrins, quantitation (copro, proto, uro) – B..................................................................
Porphyrins, quantitation (copro, proto, uro) – F ..................................................................
Potassium ...........................................................................................................................
Pregnanediol – U ................................................................................................................
Pregnanetriol – U ................................................................................................................
Primidone, quantitative (Mysoline)......................................................................................
Procainamide ......................................................................................................................
Propranolol..........................................................................................................................
Protein, total - not to be claimed with L085 or L086........................................................
PSP (Phenosulphonphthalein)............................................................................................
April 1, 1999
5
29
30
5
35
15
10
25
10
60
75
90
5
70
80
35
35
35
5
15
12
LABORATORY MEDICINE
LMS
Units
Code
BIOCHEMISTRY (Cont’d)
(Applicable to all specimens except as denoted by B-blood, U-urine, F-faeces, C-CSF,
A-amniotic fluid).
L210
L215
L216
L220
L221
L222
L223
L226
L227
L228
L229
L073
L240
L243
L244
L250
L251
L252
L253
L254
L267
L256
L257
L260
L261
L265
L266
L299
NOTE:
Pyruvic acid (pyruvate) .......................................................................................................
Quinidine .............................................................................................................................
Reducing substances, identified by chromatography .........................................................
Salicylate, qualitative ..........................................................................................................
Salicylate, quantitative ........................................................................................................
SGOT (AST)........................................................................................................................
SGPT (ALT) ........................................................................................................................
Sodium ................................................................................................................................
Spectroscopic examination (any)........................................................................................
Sulfhemoglobin ...................................................................................................................
Sulfonamides ......................................................................................................................
Target drug testing, urine, qualitative or quantitative..........................................................
Thiocyanates.......................................................................................................................
Triglycerides - not to be claimed with L156 (see Preamble, paragraph 26) ....................
Trypsin ................................................................................................................................
Urea clearance....................................................................................................................
Urea nitrogen (B.U.N.) ........................................................................................................
Uric acid (urate) ..................................................................................................................
Urinal Urinalysis, routine chemical (any of S.G., pH, protein, sugar, hemoglobin,
ketones, urobilinogen, bilirubin, leukocyte esterase, nitrate) see Preamble, paragraph 4
Urinalysis, microscopic examination of centrifuged specimen ...........................................
Urobilin, qualitative – U .......................................................................................................
Urobilinogen, quantitative – U.............................................................................................
Valproic acid (valproate) ....................................................................................................
Vitamin A.............................................................................................................................
VMA, vanillylmandelic acid (vanillylmandelate) .................................................................
Xylose absorption test (per specimen)................................................................................
Zinc .....................................................................................................................................
Biochemical assays not included above .............................................................................
27
18
30
5
12
5
5
5
20
21
27
17
15
5
22
15
5
5
5
2
7
15
35
30
60
6
25
IC
Biochemical assays other than specifically listed are not a benefit as such until
approved by the Ministry of Health.
April 1, 1999
13
LABORATORY MEDICINE
LMS
Units
Code
IMMUNOASSAYS
The following listings are to be used if the assay involves the use of a radioisotope,
enzyme or fluorescent label.
L307
L300
L691
L304
L321
L305
L322
L323
L301
L302
L346
L690
L303
L903
L347
L306
L324
L310
L311
L312
L313
L329
L309
L315
L316
L317
L318
L693
L320
L334
L688
L689
L325
L326
L327
ACTH (adrenocorticotrophic hormone) ...............................................................................
Aldosterone .........................................................................................................................
Alphafetoprotein ..................................................................................................................
Aminoglycosides (e.g., gentamicin, tobramycin) ................................................................
Aminophylline (theophylline) ...............................................................................................
Androstenedione .................................................................................................................
Anti-DNA .............................................................................................................................
Anti-RNA .............................................................................................................................
Calcitonin ............................................................................................................................
C-AMP (cyclic adenosine monophosphate)........................................................................
C-peptide immunoreactivity ................................................................................................
Carcinoembryonic antigen (CEA) (see Preamble, paragraph 19) ......................................
Cortisol (see Preamble, paragraph 24)...............................................................................
Cortisol, secondary laboratory (see Preamble, paragraph 24)...........................................
Dehydroepiandrosterone sulphate (DHEAS)......................................................................
Digoxin ................................................................................................................................
Diphenylhydantoin (phenytoin), quantitative (Dilantin) .......................................................
Estradiol ..............................................................................................................................
Estriol .................................................................................................................................
Estrogens - total –U ............................................................................................................
Estrone ...............................................................................................................................
Ferritin ................................................................................................................................
Folate in red cells, to include hematocrit and if requested, serum folate............................
FSH (pituitary gonadotrophins) ...........................................................................................
Gastrin ................................................................................................................................
Growth hormone ................................................................................................................
HCG (human chorionic gonadotrophins) - (see also Preamble, paragraphs 25 & 27).......
Hormone receptors for carcinoma (to include estrogen and/or progesterone assays) ......
HPL (human placental lactogen).........................................................................................
IgE - not to be billed for RAST test .....................................................................................
Immune complexes by C1q binding ....................................................................................
Immune complexes by Raji cell assay ................................................................................
Insulin..................................................................................................................................
Insulin antibodies ................................................................................................................
Iron binding capacity - not to be claimed with L329.........................................................
April 1, 1999
120
120
45
40
28
75
45
45
120
60
60
IC
35
35
40
28
35
55
75
50
75
28
60
28
75
40
30
IC
50
28
60
100
40
80
24
14
LABORATORY MEDICINE
LMS
Units
Code
IMMUNOASSAYS (Cont’d)
L328
L330
L343
L348
L331
L333
L332
L335
L336
L337
L607
L338
L339
L340
L608
L341
L609
L342
L345
L605
L606
L585
LH (luteinizing hormone).....................................................................................................
Parathyroid hormone ..........................................................................................................
Phenobarbitone...................................................................................................................
Proinsulin immunoassay .....................................................................................................
Progesterone.......................................................................................................................
17-OH progesterone ...........................................................................................................
Prolactin ..............................................................................................................................
Renin ..................................................................................................................................
T-3, total (triiodothyronine)..................................................................................................
T-3 uptake ...........................................................................................................................
T-3, free...............................................................................................................................
T-4, total (thyroxine) ............................................................................................................
T-4, free-absolute (includes T-4 total).................................................................................
Testosterone .......................................................................................................................
Testosterone, free ...............................................................................................................
TSH (thyroid stimulating hormone) .....................................................................................
Thyroglobulin.......................................................................................................................
Thyroxine binding globulin (T.B.G.) ....................................................................................
Vitamin B12 .........................................................................................................................
1,25-dihydroxy Vitamin D....................................................................................................
25-hydroxy Vitamin D..........................................................................................................
Ligand assays - not included above....................................................................................
28
120
35
500
28
60
28
75
0
0
28
0
0
28
50
28
40
50
28
150
100
IC
HEMATOLOGY
The following listings include assays using clotting, chromogenic, radioisotopic or
immunologic labels or technique
L373
L370
L371
L374
L375
L376
L377
L378
Antithrombin III assay .........................................................................................................
Assay of Factors, II, V, VII, VIII, IX, X, XI and XII (each) ....................................................
Autohemolysis test ..............................................................................................................
Blood film - buffy coat preparation - not to be claimed with L430....................................
Blood film - special stain .....................................................................................................
Bleeding time - Duke method..............................................................................................
Bleeding time - Ivy method .................................................................................................
Bone marrow - film preparation...........................................................................................
April 1, 1999
55
55
24
18
11
8
15
15
15
LABORATORY MEDICINE
LMS
Units
Code
HEMATOLOGY (Cont’d)
L379
L385
L386
L387
L388
L389
L390
L393
L391
L395
L400
L403
L401
L402
L404
L405
L406
L410
L411
L415
L417
L418
L419
L420
L421
L422
L423
L424
L416
L425
L431
L430
L432
L450
L462
L435
L433
L434
Bone marrow - staining (Romanowski and iron).................................................................
Capillary fragility..................................................................................................................
Circulating anticoagulant (e.g., lupus anticoagulant) ..........................................................
Clot observation for lysis.....................................................................................................
Clot lysis, dilute whole blood...............................................................................................
Clot retraction......................................................................................................................
Clotting time (Lee and White) .............................................................................................
Complete Blood Count (any method, see Preamble paragraph 14)...................................
C.S.F. cell count (to include differential) .............................................................................
Eosinophil count..................................................................................................................
Euglobulin clot lysis.............................................................................................................
Factor XIII (urea solubility test) ...........................................................................................
Fibrinogen, semi-quantitative..............................................................................................
Fibrinogen, quantitative.......................................................................................................
Fibrinolysis (plate method)..................................................................................................
Fibrin split products, quantitative ........................................................................................
Fibrin split products, latex screening...................................................................................
G-6-PD screen ....................................................................................................................
G-6-PD quantitative assay ..................................................................................................
Haptoglobin .........................................................................................................................
Hematocrit (see Preamble paragraphs 5 & 14) ..................................................................
Hemoglobin (see Preamble paragraphs 5 & 14) ................................................................
Hemoglobin electrophoresis or chromatography to include Hb A2 fraction ........................
Hemoglobin, foetal ..............................................................................................................
Hemoglobins, unstable .......................................................................................................
Hemolysins - Ham's acid serum test...................................................................................
Hemolysins - cold (Donath-Lansteiner)...............................................................................
Hemosiderin in urine ...........................................................................................................
Heinz bodies .......................................................................................................................
Heparin assay .....................................................................................................................
Kleihauer stain ....................................................................................................................
L.E. cell prep - not to be claimed with L374.....................................................................
Malaria smear or other parasites ........................................................................................
Osmotic fragility...................................................................................................................
Partial thromboplastin time .................................................................................................
Plasmapheresis...................................................................................................................
Plasminogen assay.............................................................................................................
Plasmin assay .....................................................................................................................
April 1, 1999
23
7
10
7
10
6
8
16
18
8
20
5
6
28
16
30
5
10
65
15
0
0
34
20
6
18
18
11
15
55
18
18
15
45
14
50
55
55
16
LABORATORY MEDICINE
LMS
Units
Code
HEMATOLOGY (Cont’d)
L396
L436
L437
L438
L439
L440
L441
L442
L443
L444
L445
L446
L412
L397
L398
L447
L451
L452
L453
L455
L454
L456
L460
L461
L465
L372
L399
Platelet (thrombocyte) count (see Preamble paragraph 14)...............................................
Platelet (thrombocyte) function - aggregation, per additive ................................................
Platelet (thrombocyte) function - adhesiveness .................................................................
Platelet (thrombocyte) function - thromboplastic function (PF-3) .......................................
Preparation of cryoprecipitate (per treatment) ....................................................................
Preparation of platelet (thrombocyte) concentrates (per treatment)...................................
Preparation of washed red cells..........................................................................................
Preparation of leukocyte-poor blood ...................................................................................
Protamine titration ...............................................................................................................
Protamine sulphate test ......................................................................................................
Prothrombin time.................................................................................................................
Prothrombin consumption ...................................................................................................
Pyruvate kinase quantitative assay.....................................................................................
R.B.C. (erythrocyte) count, excluding manual method (see Preamble paragraph 14).......
Reticulocyte count...............................................................................................................
Reptilase time .....................................................................................................................
Sedimentation rate ..............................................................................................................
Sickle cell preparation.........................................................................................................
Sickle cell solubility test (screen) ........................................................................................
Special stains for acute leukemia .......................................................................................
Sucrose hemolysis ..............................................................................................................
Terminal transferase by immunofluorescence....................................................................
Thrombin time .....................................................................................................................
Thromboplastin generation test ..........................................................................................
Vitamin B12, microbiologic, not isotopic...............................................................................
W.B.C. differential count, any method(s) includes R.B.C. (Erc) morphology and
platelet (thrombocyte) estimate, where indicated (see Preamble, paragraph 14)..............
W.B.C. (leukocyte) count, excluding whole blood manual method (see Preamble,
paragraph 14)......................................................................................................................
0
12
25
28
17
25
35
20
15
10
12
10
65
0
13
10
3
14
5
75
18
75
10
71
45
0
0
IMMUNOHEMATOLOGY
L471
L481
L482
L473
Antibody identification, per specimen (see Preamble, paragraph 16(a))............................
Antibody titre per antibody, per specimen - to be claimed only if L471 yields a
positive identification .......................................................................................................
Antibody screening (see Preamble, paragraph 16) ............................................................
Parallel titration on two specimens to include confirmation of previously detected
antibody (see Preamble, paragraph 16b) ...........................................................................
April 1, 1999
45
15
20
75
17
LABORATORY MEDICINE
LMS
Units
Code
IMMUNOHEMATOLOGY (Cont’d)
L490
L493
L494
L492
L495
Blood Group - ABO and RhD (see Preamble, paragraph 16) ............................................
Blood Group - ABO and Rh phenotype (see Preamble, paragraph 16) .............................
Blood Group per antigen (see Preamble, paragraph 16)....................................................
Crossmatch per unit of blood (see Preamble, paragraph 16).............................................
Direct anti-human globulin test (see Preamble, paragraph 16) ..........................................
18
40
8
10
4
IMMUNOLOGY
L567
L665
L660
L661
L560
L551
L552
L557
L558
L561
L553
L554
L555
L556
L576
L568
L575
NOTE:
L655
L550
NOTE:
Cl esterase inactivator screen.............................................................................................
C-Reactive protein ..............................................................................................................
Cold agglutinins- screen ....................................................................................................
Cold agglutinins – titre ........................................................................................................
Complement proteins - C1q.................................................................................................
Complement proteins - C3 (B1C) .........................................................................................
Complement proteins - C4 (B1E) .........................................................................................
Complement proteins - C5 .........................................................................................................................................................
Complement proteins - C3 proactivator...............................................................................
Complement proteins - C1 esterase inactivator ..................................................................
Miscellaneous proteins - Ceruloplasmin ............................................................................
Miscellaneous proteins – Transferrin ..................................................................................
Miscellaneous proteins - Alpha 1 antitrypsin .......................................................................
Miscellaneous proteins - Alpha 2 macroglobulin .................................................................
Cryoglobulin characterization..............................................................................................
Double gel diffusion, qualitative (Ouchterlony) per antigen: antibodies to food
antigens (milk, wheat proteins) or fungal antigens (allergic alveolitis screening
series) - maximum of 4 antisera per patient screen............................................................
Gammopathy Screen by immunoelectrophoresis or immunofixation
Serum..................................................................................................................................
Urine....................................................................................................................................
5
6
6
15
12
12
12
12
12
12
12
12
12
12
30
5
120
120
Maximum one serum and one urine per patient (see Preamble, paragraph 29)
Pregnancy test (see Preamble, paragraph 25)...................................................................
Single gel diffusion and nephelometric quantitative assays Immunoglobulin G, A, D, M
6
15
15 LMS units applies to each of the listed immunoglobulins
April 1, 1999
18
LABORATORY MEDICINE
LMS
Units
Code
IMMUNOLOGY (Cont’d)
L500
L900
L501
L502
L596
L597
Screen for miscellaneous agglutination reactions (see Preamble, paragraph 24),
e.g., Rheumatoid factor Antithyroid (thyroglobulin or microsomal
Streptolysin screen..............................................................................................................
Screen by secondary laboratory (see Preamble, paragraph 24)........................................
Titre - serial tube single antigen .........................................................................................
Serial tube 4 or more antigens............................................................................................
Sperm antibodies – screen .................................................................................................
Sperm antibodies – titre ......................................................................................................
L525
L526
L527
L529
L520
Cellular Assays
Antibody dependent cellular cytotoxicity.............................................................................
ATP depletion test...............................................................................................................
Caffeine - halothane contracture test..................................................................................
Intracellular leukocyte bacterial killing capacity ..................................................................
Leukocyte chemotactic activity ...........................................................................................
Leukocyte phagocytic capacity ...........................................................................................
Lymphocyte activation (transformation) by isotope incorporation (limited..........................
to 3 mitogens and/or antigens) ...........................................................................................
Lymphocyte surface immunoglobulins by immunofluorescence ........................................
Lymphocyte T and B cell rosettes.......................................................................................
Mixed lymphocyte reaction .................................................................................................
Naturally occurring cell cytotoxicity .....................................................................................
Nitroblue tetrazolium test - screen for enzyme deficiency ..................................................
L530
L531
Complement - kinetic (activity) assays
Total hemolytic complement (CH50 non-kit) ........................................................................
Complement components (activity assays) ........................................................................
L528
L533
L532
L521
L522
L523
L524
6
6
15
30
20
40
200
275
300
100
150
40
200
200
200
300
200
30
40
60
Fluorescent Antibody Tests (Immunofluorescent Studies)
Tests for serum antibodies to tissue and cell components (Codes L535 and L544)
should be claimed per type of tissue section examined and per serum dilution used,
irrespective of number of antibodies identified, maximum, four slides.
April 1, 1999
19
LABORATORY MEDICINE
LMS
Units
Code
Fluorescent Antibody Tests (Immunofluorescent Studies) (Cont’d)
L544
L944
L535
L545
L582
L581
L583
L580
L659
L662
L663
L664
L503
L668
L670
L667
L682
L683
L684
Antinuclear (see Preamble, paragraph 24).........................................................................
Antinuclear by secondary laboratory (see Preamble, paragraph 24) .................................
Other antibody tests ............................................................................................................
Antimitochondrial
Antithyroid
Antiadrenal
antismooth muscle
Antiparietal
Antiskin
Antisperm
Protein deposition in tissues (per tissue examined, any number of antisera, e.g.,
Immunoglobulin, complement component, fibrinogen and pathogens, etc.) ......................
Histocompatibility Testing
Antibody screening (per panel of 15 antigens) ...................................................................
Crossmatch .........................................................................................................................
HLA 27 typing......................................................................................................................
Tissue typing .......................................................................................................................
Microbial Immunology
Antistreptolysin O, or anti-DNaseB, titre or micro-technique ..............................................
Complement fixation, screen ..............................................................................................
Complement fixation, titre, single antigen ..........................................................................
Complement fixation, multiple antigens ..............................................................................
Febrile agglutinins, slide or tube agglutination ...................................................................
Heterophile antibodies-screen (slide or single tube) with or without absorption ...............
Heterophile antibodies - with absorption by guinea pig kidney or ox cells, multiple tube
titres (Paul Bunnell).............................................................................................................
Non-cultural direct bacterial antibody or antigen assays by fluorescence, agglutination or
ELISA techniques. Not to be claimed with any of the codes listed under cultures and not
to include Group A streptococcus or chlamydia .................................................................
For each additional antibody ........................................................................................ add
Non-cultural indirect antibody or antigen assays by fluorescence, agglutination or ELISA
techniques...........................................................................................................................
For each additional antibody ........................................................................................ add
April 1, 1999
35
35
50
75
150
50
50
200
25
20
30
50
25
5
30
12
4
15
5
20
LABORATORY MEDICINE
L319
L919
N.C.
L685
L686
L658
N.C.
L680
L681
L679
NOTE:
L599
L600
L601
L602
L604
L603
Hepatitis associated antigen or antibody immunoassay - per assay, e.g., hepatitis B
surface antigen or antibody, hepatitis B core antibody,hepatitis A antibody (see
Preamble, paragraphs 24 & 28)..........................................................................................
Hepatitis associated antigen or antibody immunoassay by secondary Laboratory per
assay (see Preamble, paragraphs 24 & 28) .......................................................................
Serology HIV Antibody........................................................................................................
Leukocyte phenotyping by monoclonal antibodies - first antibody .....................................
Leukocyte phenotyping by monoclonal antibodies - each additional antibody, to a
maximum of 20 antibodies ..................................................................................................
Trichinella antibody .............................................................................................................
VDRL (patient out of the Province) ....................................................................................
Virus antibodies - neutralization test ...................................................................................
Virus antibodies - sucrose gradient separation of IgM plus inhibition test..........................
Virus antibodies - hemagglutination inhibition or ELISA technique ....................................
28
28
NAB
200
15
6
5
40
90
30
not to be used for AIDS testing
Miscellaneous
Cryofibrinogen – qualitative ................................................................................................
Cryoglobulin – qualitative....................................................................................................
Cryoglobulin – quantitative..................................................................................................
Pyroglobulin – qualitative ....................................................................................................
Serum viscosity – relative ...................................................................................................
Serum viscosity – quantitative ............................................................................................
5
5
30
5
10
20
Radioimmunoassay - see listings under Immunoassays modifiers (units in addition to
units for the basic test where applicable - immunologic procedures)
L610
L611
NOTE:
N.C.
N.C.
Concentration of sample before testing (any method)........................................................
Radio-modification of standard technique utilizing isotope labelled reagents, e.g., antiinsulin, anti-diphtheria, anti-tetanus ....................................................................................
- immunoelectrophoresis
- double diffusion
- radial diffusion
2
50
Radio-modifications other than specifically listed under code L611 are not a benefit as
such until approved by the Ministry of Health
Preparation of special antigens or antisera ........................................................................
Special investigations .........................................................................................................
April 1, 1999
NAB
NAB
21
LABORATORY MEDICINE
L620
L623
L624
L625
L622
L640
L639
L626
L627
L628
L629
L630
L635
L631
L641
L633
L634
L637
NOTE:
L632
L642
L656
L636
L638
MICROBIOLOGY
Antibiotic level, serum .........................................................................................................
Antibiotic sensitivity - M.I.C. - one antibiotic, tube or agar dilution (see Preamble,
paragraph 17)......................................................................................................................
Cultures
Blood (including ærobic, anærobic, subcultures, smears) per bottle..................................
Cervical, vaginal, including GC culture, Gram smear, yeast identification (e.g., Germ
tube) - not to be charged with L627 (see Preamble, paragraph 12)................................
Chlamydia culture isolation or non-cultural assays ............................................................
Culture - throat swab, for streptococcus screen only .........................................................
Fluids (CSF, joint, pleural etc., not exudates).....................................................................
Fungus, including KOH preparation and smear - not to be charged with L625 ..............
GC culture and smear - not to be charged with L625 (see Preamble, paragraph 12) ....
Other swabs or pus - culture and smear (includes screening) ...........................................
Sputum - culture and smear................................................................................................
Stool culture including the necessary agglutinations and culture for campylobacter .........
Pathogenic E. coli (as sole procedure in infants only, such as fluorescent staining, not
with L630)............................................................................................................................
Tuberculosis, including ZN or fluorescent smear................................................................
Urine, screening, actual culture without identification (see Preamble, paragraph 6) .........
Urine, pour plate or Miles-Misra quantitative (see Preamble, paragraph 6) .......................
Urine calibrated volume to include plate, turbidimetric or photometric techniques (See
Preamble, paragraph 6) ......................................................................................................
Virus isolation .....................................................................................................................
40
25
30
25
30
6
28
20
20
25
22
34
5
55
7
20
25
50
The above fee codes include cultures and antibiotic sensitivity testing when
indicated.
Animal inoculation ...............................................................................................................
Lysozyme inhibition test .....................................................................................................
Penicillinase production .....................................................................................................
Streptococcus grouping, Lancefield or equivalent with extractions ....................................
Streptococcus grouping, coagglutination method...............................................................
April 1, 1999
100
13
8
18
18
22
LABORATORY MEDICINE
L645
L646
L647
L648
L649
L650
L654
L651
L643
L652
L653
Microscopy
Darkfield (spirochetes) ........................................................................................................
Electron- direct, for viruses .................................................................................................
Electron- immunoelectron microscopy................................................................................
Electron- after ultracentrifugation........................................................................................
Electron- thin section, for virus............................................................................................
Parasites and ova - faeces concentration (see Preamble, paragraph 12) .........................
Parasites and ova, smear only, special stain(s) .................................................................
Pinworm (Scotch tape prep) ...............................................................................................
Smear only, Gram or Papanicolaou stain, as sole procedure (not with L624 to L634) ......
Smear only, special stain, e.g., ZN, inclusions, spores, diphtheria ....................................
Wet preparation - for fungus, trichomonas, parasites (see Preamble, paragraph 12) .......
10
40
60
65
130
25
25
5
5
14
3
ANATOMICAL PATHOLOGY, HISTOLOGY AND CYTOLOGY
NOTE:
L701
L702
L703
L704
L726
L705
L706
L707
L713
L710
L717
Do not claim L700 in addition to codes L701 to L731, or L800 - L848,or L900 - L944
inclusive. The items listed in this section include only the technical component of the
various items listed. The professional component for each item where applicable is
listed in the Schedule of Benefits for Physicians Services (refer to paragraph 30 in
Preamble)
Chromosome Analysis
Chromosome banding.........................................................................................................
Karyotype of blood or bone marrow....................................................................................
Karyotype of skin or amnion cells .......................................................................................
Cytology and Histology
Amniotic fluid for fetal maturation........................................................................................
Analytical electron microscopy - elemental detection, mapping or electron diffraction per
specimen.............................................................................................................................
Aspiration biopsy (lung, breast, thyroid, etc.) .....................................................................
Bronchial washings or brushings, per specimen ................................................................
Buccal or vaginal smear for Barr body................................................................................
Cervicovaginal specimen (including all types of cellular abnormality,
assessment of flora and/or cytohormonal evaluation) ........................................................
Direct smears - oral, larynx, nipple discharge, vulvar .........................................................
Electron microscopy............................................................................................................
April 1, 1999
70
300
475
8
40
32
14
8
20
13
225
23
LABORATORY MEDICINE
L708
L709
L711
L712
L728
L729
L731
L723
L724
L730
L727
L721
L722
L714
L715
L718
L719
L716
L720
L725
Esophageal, gastric or endometrial washings or brushings ...............................................
Esophageal and gastric washings (including collection) ....................................................
Fluids (pleural, ascitic, cystic, aspirate, pericardial, joint, CSF, and urine).........................
Fluorescent Y chromosome ...............................................................................................
Histochemistry of muscle- 1 to 3 enzymes ........................................................................
Histochemistry of muscle- each additional enzyme, per label ...........................................
Immunoperoxidase technique - per label (maximum of 3 per patient) ...............................
Metabolic bone study - morphologic and morphometric assessment.................................
Metabolic bone study - kinetic assessment including fluorescent label studies .................
Morphometry, e.g., muscle fibre, nerve fascicles, cells .....................................................
Nerve teasing for demyelination .........................................................................................
Operative consultation - with or without frozen section (up to three specimens) ..............
For each specimen over three ..................................................................................... add
Smear for inclusion bodies .................................................................................................
Smear for eosinophils (nasal, sputum, ocular, etc.)............................................................
Seminal fluid examination (complete) - (see Preamble, paragraph 20) .............................
Smear for spermatozoa only (post-operative) ....................................................................
Sputum per specimen for general and/or specified assessment,.......................................
Surgical pathology - (see Preamble, paragraph 30) ...........................................................
X-ray diffraction analysis of calculi......................................................................................
April 1, 1999
14
33
13
8
40
13
75
250
30
75
50
15
8
8
3
22
7
14
32
75
24
L-CODES
NUMERIC LISTING
LABORATORY MEDICINE
Code
L001
L002
L003
L004
L005
L006
L008
L009
L010
L011
L012
L013
L014
L015
L016
L017
L018
L019
L021
L026
L027
L028
L029
L030
L031
L032
L033
L034
L035
L036
L037
L038
L039
L040
L041
L044
L045
L046
April 1, 1999
LMS
3
35
32
3
5
25
45
30
120
15
30
200
33
39
20
50
5
25
75
35
60
4
3
5
10
8
8
7
17
3
20
15
14
35
40
200
5
20
Page(s)
1,7
7
7
7
7
7
7
7
7
7
7
7
7
8
8
8
8
8
8
8
8
8
8
8
8
11
12
12
12
3, 12
8
8
8
8
8
7
8
8
Code
L047
L048
L049
L050
L051
L052
L053
L054
L055
L056
L057
L058
L059
L060
L061
L062
L063
L064
L065
L066
L067
L068
L069
L070
L071
L072
L073
L074
L075
L076
L077
L078
L079
L080
L085
L086
L092
L093
LMS
15
25
16
60
80
19
5
33
5
14
30
50
25
15
5
22
40
35
26
5
5
15
8
34
40
45
17
40
30
35
35
68
72
26
36
50
35
22
Page(s)
8
8
8
8
8
8
8
8
5, 8, 11
8
8
9
7
9
9
9
9
9
9
9
9
9
9
9
8
9
13
9
9
9
9
9
9
6, 9
6, 9, 12
6, 9, 12
9
10
25
LABORATORY MEDICINE
Code
L094
L095
L096
L097
L098
L099
L101
L103
L104
L105
L106
L107
L109
L110
L111
L112
L113
L114
L115
L116
L117
L118
L119
L121
L122
L123
L124
L125
L126
L127
L128
L129
L130
L131
L132
L135
April 1, 1999
LMS
40
72
92
6
6
25
60
24
30
16
65
5
7
10
5
3
10
20
60
40
18
90
15
9
50
9
10
34
40
34
80
25
90
150
25
40
Page(s)
9
9
9
9
9
9
10
2, 10
2, 10
9
9
9
9
10
2, 10
10
9
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
Code
L136
L137
L139
L141
L142
L143
L145
L146
L147
L148
L149
L150
L151
L152
L153
L154
L155
L156
L157
L159
L160
L161
L165
L166
L167
L168
L169
L170
L171
L172
L173
L174
L175
L180
L181
L182
LMS
40
21
34
15
6
22
27
10
29
40
15
22
16
30
20
50
100
40
10
35
35
35
5
15
10
30
75
90
21
21
25
30
40
25
3
15
Page(s)
10
10
10
10
10
10
10
10
11
11
11
11
11
11
5, 11
11
11
8, 11, 13
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
26
LABORATORY MEDICINE
Code
L183
L184
L185
L187
L188
L189
L190
L191
L192
L193
L194
L195
L196
L197
L198
L199
L200
L201
L202
L203
L204
L205
L206
L208
L209
L210
L211
L212
L213
L215
L216
L220
L221
L222
L223
April 1, 1999
LMS
10
40
40
6
30
15
15
5
29
30
5
35
15
10
25
25
10
60
75
90
5
70
80
5
15
27
35
35
35
18
30
5
12
5
5
Page(s)
11
11
11
12
12
12
12
12
12
12
12
12
12
12
12
9
12
12
12
12
12
12
12
12
12
13
12
12
12
13
13
13
13
13
13
Code
L225
L226
L227
L228
L229
L240
L243
L244
L250
L251
L252
L253
L254
L256
L257
L260
L261
L265
L266
L267
L299
L300
L301
L302
L303
L304
L305
L306
L307
L309
L310
L311
L312
L313
L315
LMS
5
5
20
21
27
15
5
22
15
5
5
5
2
15
35
30
60
6
25
7
IC
120
120
60
35
40
75
28
120
60
55
75
50
75
28
Page(s)
3, 8
13
13
13
13
13
5, 11, 13
13
13
13
13
2, 13
13
13
13
13
13
13
13
13
13
14
14
14
5, 14
14
14
14
14
14
14
5, 14
14
14
14
27
LABORATORY MEDICINE
Code
L316
L317
L318
L319
L320
L321
L322
L323
L324
L325
L326
L327
L328
L329
L330
L331
L332
L333
L334
L335
L336
L337
L338
L339
L340
L341
L342
L343
L345
L346
L347
L348
L370
L371
L372
April 1, 1999
LMS
75
40
30
28
50
28
45
45
35
40
80
24
28
28
120
28
28
60
28
75
0
0
0
0
28
28
50
35
28
60
40
500
55
24
0
Page(s)
14
14
5, 14
5, 21
14
14
14
14
14
14
14
14
15
10, 14, 15
15
15
15
15
14
15
15
15
15
15
15
15
15
15
15
14
14
15
15
15
2,17
Code
L373
L374
L375
L376
L377
L378
L379
L385
L386
L387
L388
L389
L390
L391
L393
L395
L396
L397
L398
L399
L400
L401
L402
L403
L404
L405
L406
L410
L411
L412
L415
L416
L417
L418
L419
LMS
55
18
11
8
15
15
23
7
10
7
10
6
8
18
16
8
0
0
13
0
20
6
28
5
16
30
5
10
65
65
15
15
0
0
34
Page(s)
15
15, 16
15
15
15
15
16
16
16
16
16
16
16
16
3, 16
16
3, 17
3, 17
17
3, 17
16
16
16
16
16
16
16
16
16
17
16
16
2, 3,16
2, 3, 16
16
28
LABORATORY MEDICINE
Code
L420
L421
L422
L423
L424
L425
L430
L431
L432
L433
L434
L435
L436
L437
L438
L439
L440
L441
L442
L443
L444
L445
L446
L447
L450
L451
L452
L453
L454
L455
L456
L460
L461
L462
April 1, 1999
LMS
20
6
18
18
11
55
18
18
15
55
55
50
12
25
28
17
25
35
20
15
10
12
10
10
45
3
14
5
18
75
75
10
71
14
Page(s)
16
16
16
16
16
16
15, 16
16
16
16
16
16
17
17
17
17
17
17
17
17
17
17
17
17
16
17
17
17
17
17
17
17
17
16
Code
L465
L471
L473
L481
L482
L490
L492
L493
L494
L495
L500
L501
L502
L503
L520
L521
L522
L523
L524
L525
L526
L527
L528
L529
L530
L531
L532
L533
L535
L544
L545
L550
L551
L552
LMS
45
45
75
15
20
18
10
40
8
4
6
15
30
25
30
100
150
40
200
200
200
300
200
200
40
60
300
275
50
35
75
15
12
12
Page(s)
17
4, 17
4, 17
17
4, 17
4, 18
4, 18
4, 18
4, 18
4, 18
5, 19
19
19
20
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19, 20
5, 19, 20
20
6, 18
18
18
29
LABORATORY MEDICINE
Code
L553
L554
L555
L556
L557
L558
L560
L561
L567
L568
L575
L576
L580
L581
L582
L583
L585
L596
L597
L599
L600
L601
L602
L603
L604
L605
L606
L607
L608
L609
L610
L611
L620
L622
April 1, 1999
LMS
12
12
12
12
12
12
12
12
5
5
120
30
200
50
150
50
IC
20
40
5
5
30
5
20
10
150
100
28
50
40
2
50
40
30
Page(s)
6, 18
6, 18
6, 18
18
18
18
18
18
18
18
5, 6, 18
18
20
20
20
20
15
19
19
21
21
21
21
21
21
15
15
15
15
15
21
21
22
22
Code
L623
L624
L625
L626
L627
L628
L629
L630
L631
L632
L633
L634
L635
L636
L637
L638
L639
L640
L641
L642
L643
L645
L646
L647
L648
L649
L650
L651
L652
L653
L654
L655
L656
L658
LMS
25
30
25
20
20
25
22
34
55
100
20
25
5
18
50
18
28
6
7
13
5
10
40
60
65
130
25
5
14
3
25
6
8
6
Page(s)
4, 22
22, 23
3, 22
22
3, 22
22
22
22
22
22
2, 22
2, 22, 23
22
22
22
22
22
22
2, 22
22
23
23
23
23
23
23
3, 23
23
23
3, 23
23
5, 18
22
21
30
LABORATORY MEDICINE
Code
L659
L660
L661
L662
L663
L664
L665
L667
L668
L670
L679
L680
L681
L681
L682
L683
L684
L685
L686
L688
L689
L690
L691
L693
L700
L701
L702
L703
L704
L705
L706
April 1, 1999
LMS
25
6
15
20
30
50
6
12
5
5
30
40
90
90
4
15
5
200
15
60
100
IC
45
IC
15
70
300
475
8
32
14
Page(s)
20
18
18
20
20
20
18
20
20
20
21
21
21
21
20
20
20
21
21
14
14
5, 14
5, 14
14
1, 3, 5, 7
1,7,23
23
23
23
23
23
Code
L707
L708
L709
L710
L711
L712
L713
L714
L715
L716
L717
L718
L719
L719
L720
L721
L722
L723
L724
L725
L726
L727
L728
L729
L730
L731
L900
L903
L919
L944
NC(VDRL)
LMS
8
14
33
13
13
8
20
8
3
14
225
22
7
7
32
15
8
250
30
75
40
50
40
13
75
75
6
35
28
35
5
Page(s)
23
24
24
23
24
24
23
24
24
24
23
24
24
24
6, 24
24
24
24
24
24
23
24
24
24
24
7,24
5,7,19,23
5.14
5,21
5,7,20,24
21
31