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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 1 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 2 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 3 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 4 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 5 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 6 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