2018 Clinical Diagnostic Laboratory Fee Schedule-Preliminary Determinations																																																														
"CPT codes, descriptions and other data only are copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA)."																																																														
HCPCS	"New National
Limit"		CA1	CA2	HI	NV	AK	ID	OR	WA	AZ	MT	ND	SD	UT	WY	CO	NM	OK	TX	IA	KS	KS	MO2	MO1	NE	IL	MN	WI	AR	LA	MS	IN	MI	FL	PR	AL	GA	TN	SC	VA	WV	NC	DE	DC	MD	NJ	PA	CT	NY2	NY1	NY3	ME	MA	NH	RI	VT	KY	OH	Short Descriptor		
			01112	01182	01212	01312	02102	02202	02302	02402	03102	03202	03302	03402	03502	03602	04112	04212	04312	04412	05102	05202	05202	05302	05302	05402	06102	06202	06302	07102	07202	07302	08102	08202	09102	09202	10102	10202	10302	11202	11302	11402	11502	12102	12202	12302	12402	12502	13102	13202	13282	13292	14112	14212	14312	14412	14512	15102	15202			
			LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 01	LOC 02	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 12	LOC 15	LOC 07	LOC 15	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 20	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00			
0004M	$79.00 		$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00	$79.00	$79.00	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	$79.00 	 Scoliosis dna alys 		
0006M	$150.00 		$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00	$150.00	$150.00	$150.00	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00	$150.00	$150.00	$150.00 	$150.00 	$150.00	$150.00	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00	$150.00	$150.00	$150.00	$150.00	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	$150.00 	 Onc hep gene risk classifier 		
0007M	$375.00 		$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00	$375.00	$375.00	$375.00	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00	$375.00	$375.00	$375.00 	$375.00 	$375.00	$375.00	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00	$375.00	$375.00	$375.00	$375.00	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	$375.00 	 Onc gastro 51 gene nomogram 		
0009M	$132.86 		$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$174.50	$174.50	$174.50	$174.50	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$174.50 	$174.50 	$174.50 	$174.50	$174.50	$174.50	$132.86 	$132.86 	$174.50	$174.50	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$132.86 	$174.50	$174.50	$174.50	$174.50	$174.50	$174.50 	$174.50 	$174.50 	$174.50 	$174.50 	$174.50 	$174.50 	$174.50 	$174.50 	$132.86 	$132.86 	 Fetal aneuploidy trisom risk 		
81327	$192.00 		$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$158.48	$158.48	$158.48	$158.48	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$158.48 	$158.48 	$158.48 	$158.48	$158.48	$158.48	$192.00 	$192.00 	$158.48	$158.48	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$192.00 	$158.48	$158.48	$158.48	$158.48	$158.48	$158.48 	$158.48 	$158.48 	$158.48 	$158.48 	$158.48 	$158.48 	$158.48 	$158.48 	$24.50 	$24.50 	 SEPT9 (Septin9) methylation analysis 		
81427	$24.50 		$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50	$24.50	$24.50	$24.50	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50	$24.50	$24.50	$24.50 	$24.50 	$24.50	$24.50	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50	$24.50	$24.50	$24.50	$24.50	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	$24.50 	 Genome re-evaluation 		
81425	$349.00 		$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00	$349.00	$349.00	$349.00	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00	$349.00	$349.00	$349.00 	$349.00 	$349.00	$349.00	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00	$349.00	$349.00	$349.00	$349.00	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	 Genome sequence analysis 		
81426	$349.00 		$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00	$349.00	$349.00	$349.00	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00	$349.00	$349.00	$349.00 	$349.00 	$349.00	$349.00	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00	$349.00	$349.00	$349.00	$349.00	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	" Genome sequence analysis, each comparator genome "		
81471	$914.00 		$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$495.95	$495.95	$495.95	$495.95	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$495.95 	$495.95 	$495.95 	$495.95	$495.95	$495.95	$914.00 	$914.00 	$495.95	$495.95	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$495.95	$495.95	$495.95	$495.95	$495.95	$495.95 	$495.95 	$495.95 	$495.95 	$495.95 	$495.95 	$495.95 	$495.95 	$495.95 	$914.00 	$914.00 	" X-linked intellectual disability dup/del, 60 Genes "		
81470	$914.00 		$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$755.96	$755.96	$755.96	$755.96	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$755.96 	$755.96 	$755.96 	$755.96	$755.96	$755.96	$914.00 	$914.00 	$755.96	$755.96	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$914.00 	$755.96	$755.96	$755.96	$755.96	$755.96	$755.96 	$755.96 	$755.96 	$755.96 	$755.96 	$755.96 	$755.96 	$755.96 	$755.96 	$914.00 	$914.00 	 X-linked intellectual disability (XLID) 60 Genes 		
81551	"$2,030.00 "		"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,102.42"	"$2,102.42"	"$2,102.42"	"$2,102.42"	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	2102.42	2102.42	2102.42	"$2,102.42"	"$2,102.42"	"$2,102.42"	"$2,030.00 "	"$2,030.00 "	"$2,102.42"	"$2,102.42"	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,030.00 "	"$2,102.42"	"$2,102.42"	"$2,102.42"	"$2,102.42"	"$2,102.42"	2102.42	2102.42	2102.42	2102.42	2102.42	2102.42	2102.42	2102.42	2102.42	"$2,030.00 "	"$2,030.00 "	" Oncology (prostate), profiling by real-time PCR of 3 genes "		
0001U	$720.00 		$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$452.60	$452.60	$452.60	$452.60	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$452.60 	$452.60 	$452.60 	$452.60	$452.60	$452.60	$720.00 	$720.00 	$452.60	$452.60	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$720.00 	$452.60	$452.60	$452.60	$452.60	$452.60	$452.60 	$452.60 	$452.60 	$452.60 	$452.60 	$452.60 	$452.60 	$452.60 	$452.60 	$720.00 	$720.00 	" Red blood cell antigen typing, DNA, "		
0002U	$25.00 		$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$200.00	$200.00	$200.00	$200.00	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$200.00 	$200.00 	$200.00 	$200.00	$200.00	$200.00	$25.00 	$25.00 	$200.00	$200.00	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$25.00 	$200.00	$200.00	$200.00	$200.00	$200.00	$200.00 	$200.00 	$200.00 	$200.00 	$200.00 	$200.00 	$200.00 	$200.00 	$200.00 	$25.00 	$25.00 	" Oncology (colorectal), quan assessment of 3 urine metabolites "		
0009U	$107.00 		$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$109.44	$109.44	$109.44	$109.44	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$109.44 	$109.44 	$109.44 	$109.44	$109.44	$109.44	$107.00 	$107.00 	$109.44	$109.44	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$107.00 	$109.44	$109.44	$109.44	$109.44	$109.44	$109.44 	$109.44 	$109.44 	$109.44 	$109.44 	$109.44 	$109.44 	$109.44 	$109.44 	$107.00 	$107.00 	" Oncology (breast cancer), ERBB2 (HER2) copy number by FISH "		
0010U	$142.00 		$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.42	$142.42	$142.42	$142.42	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.00 	$142.00 	$142.42	$142.42	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.00 	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.42	$142.00 	$142.00 	" Infectious disease (bacterial), strain typing by WGS "		
0012U	$349.00 		$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$597.91	$597.91	$597.91	$597.91	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$597.91	$597.91	$597.91	$349.00 	$349.00 	$597.91	$597.91	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$597.91	$597.91	$597.91	$597.91	$597.91	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	$349.00 	" Germline disorders, gene rearrangement detection by WGS "		
0013U	$600.18 		$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$597.91	$597.91	$597.91	$597.91	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$597.91 	$597.91 	$597.91 	$597.91	$597.91	$597.91	$600.18 	$600.18 	$597.91	$597.91	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$597.91	$597.91	$597.91	$597.91	$597.91	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$600.18 	$600.18 	" Oncology (SO neoplasia), gene rearrangement detection by WGS "		
0014U	$600.18 		$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$597.91	$597.91	$597.91	$597.91	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$597.91 	$597.91 	$597.91 	$597.91	$597.91	$597.91	$600.18 	$600.18 	$597.91	$597.91	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$600.18 	$597.91	$597.91	$597.91	$597.91	$597.91	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$600.18 	$600.18 	" Hematology (hematolymphoid neoplasia), gene rearrangement detection by WGS "		
																																																														
