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TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 1 of nversionFactor/GAAFCategoryCPT/HCPCS Code DescriptionCOLLECTION VENOUS BLOOD VENIPUNCTUREUREA BREATH TEST C-14 ISOTOPIC ACQUISJ ANALYSISUREA BREATH TEST C-14 ISOTOPIC ANALYSISBASIC METABOLIC PANEL CALCIUM IONIZEDBASIC METABOLIC PANEL CALCIUM TOTALGENERAL HEALTH PANELELECTROLYTE PANELCOMPREHENSIVE METABOLIC PANELOBSTETRIC PANELLIPID PANELRENAL FUNCTION PANELACUTE HEPATITIS PANELHEPATIC FUNCTION PANELDRUG SCREEN QUANTITATIVE AMIKACINDRUG SCREEN QUANTITATIVE CAFFEINEDRUG SCREEN QUANTITATIVE CARBAMAZEPINE TOTALDRUG SCREEN QUANTITATIVE CARBAMAZEPINE FREEDRUG SCREEN QUANTITATIVE CYCLOSPORINEDRUG SCREEN ONE/MULT CLASSDRUG SCREEN QUANTITATIVE DIGOXIN TOTALDRUG SCREEN QUANTITATIVE DIGOXIN FREEDRUG SCREEN QUANT DIPROPYLACETIC ACID TOTALDRUG SCREEN QUANT DIPROPYLACETIC ACID FREEDRUG SCREEN QUANTITATIVE ETHOSUXIMIDEDRUG SCREEN QUANTITATIVE EVEROLIMUSDRUG SCREEN QUANTITATIVE GENTAMICINDRUG SCREEN QUANTITATIVE GABAPENTINDRUG SCREEN QUANTITATIVE HALOPRIDOLDRUG SCREEN QUANTITATIVE LAMOTRIGINEDRUG SCREEN QUANTITATIVE LIDOCAINEDRUG SCREEN QUANTITATIVE LEVETIRACETAMDRUG SCREEN QUANTITATIVE LITHIUMDRUG SCREEN QUANTITATIVE MYCOPHENOLATEDRUG SCREEN QUANTITATIVE OXCARBAZEPINEDRUG SCREEN QUANTITATIVE PHENOBARBITALDRUG SCREEN QUANTITATIVE PHENYTOIN TOTALDRUG SCREEN QUANTITATIVE PHENYTOIN FREEDRUG SCREEN QUANTITATIVE PRIMIDONEDRUG SCREEN QUANTITATIVE PROCAINAMIDEDRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITEDRUG SCREEN QUANTITATIVE QUINIDINEDRUG SCREEN QUANTITATIVE SIROLIMUSDRUG SCREEN QUANTITATIVE TACROLIMUSDRUG SCREEN QUANTITATIVE THEOPHYLLINEDRUG SCREEN QUANTITATIVE TIAGABINEDRUG SCREEN QUANTITATIVE TOBRAMYCINDRUG SCREEN QUANTITATIVE TOPIRAMATEDRUG SCREEN QUANTITATIVE VANCOMYCINDRUG SCREEN QUANTITATIVE ZONISAMIDEQUANTITATION DRUG NOT ELSEWHERE SPECIFIEDACTH STIMULATION PANEL ADRENAL INSUFFICIENCYACTH STIMULATION PANEL 21 HYDROXYLASE DEFICIENCYACTH STIMJ PANEL 3 BETA-HYDROXYDEHYD DEFNCYALDOSTERONE SUPPRESSION EVALUATION PANELCALCITONIN STIMULATION NOTES: CPT codes and descriptions only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.1 - See end of the table for note regarding Charge Methodology.TotalRVUsChargeMethodology 21.243.312.984.783.06CLABCLABCLABCLABCLABFAIR HealthCLABCLABFAIR ABCLABCLABCLABCLABCLABCLABCLABCLABCLABCLAB
TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 2 of nversionFactor/GAAFCategoryCPT/HCPCS Code DescriptionCORTICOTROPIC RELEASING HORM STIMJ PANELCHORNC GONAD STIMJ PANEL TSTOSTERONE RESPONSECHORNC GONAD STIMJ PANEL ESTRADIOL RESPONSERENAL VEIN RENIN STIMULATION PANELPERIPHERAL VEIN RENIN STIMULATION PANELCOMBINED RAPID ANT PITUITARY EVALUATION PANELDEXMETHASONE SUPPRESSION PANEL 48 HRGLUCOSE TOLERANCE PANEL INSULINOMAGLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMAGONADOTROPIN RELEASING HORMONE STIMJ PANELGROWTH HORMONE STIMULATION PANELGROWTH HORMONE SUPRJ PANEL GLUCOSE ADMNINSULIN-INDUCED C-PEPTIDE SUPRESSION PANELINSULIN TOLERANCE PANEL ACTH INSUFFICIENCYINSULIN TOLERANCE PANEL GROWTH HORM DEFNCYMETYRAPONE PANELTHYROTROPIN RELEASING HORMONE STMLJ PANEL 1 HRTHYROTROPIN RELEASING HORMONE STMLJ PANEL 2 HRTRH STIMULATION PANELURINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPYURNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPYURNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCPURNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPYURINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYSURINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICKURINALYSIS MICROSCOPIC ONLYURINALYSIS 2/3 GLASS TESTURINE PREGNANCY TEST VISUAL COLOR CMPRSN METHSVOLUME MEASUREMENT TIMED COLLECTION EACHUNLISTED URINALYSIS PROCEDUREAPC GENE ANALYSIS FULL GENE SEQUENCEAPC GENE ANALYSIS KNOWN FAMILIAL VARIANTSAPC GENE ANALYSIS DUPLICATION/DELETION VARIANTSBCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVEBCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVEBCR/ABL1 OTHER BREAKPNT QUALITATIVE/QUANTITATIVEBRAF GENE ANALYSIS V600E VARIANTBRCA1&BRCA2 FULL SEQ ANALYS/COMM DUP/DEL BRCABRCA1&BRCA2 ANAL 185DELAG5385INSC/6174DELTBRCA1&BRCA2 ANAL UNCOMMON DUP/DEL VARIANTSBRCA1 FULL SEQ ANAL&COMMON DUP/DEL VARIANTSBRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANTBRCA2 GENE ANALYSIS KNOWN FAMILIAL VARIANTCFTR GENE ANALYSIS COMMON VARIANTSCYP2C19 GENE ANALYSIS COMMON VARIANTSCYP2D6 GENE ANALYSIS COMMON VARIANTSCYP2C9 GENE ANALYSIS COMMON VARIANTSEGFR GENE ANALYSIS COMMON VARIANTSF2 GENE ANALYSIS 20210G A VARIANTF5 COAGULATION FACTOR V ANAL LEIDEN VARIANTFLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTSGJB2 GENE ANALYSIS FULL GENE SEQUENCEGJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTSGJB6 GENE ANALYSIS COMMON VARIANTSHFE HEMOCHROMATOSIS GENE ANAL COMMON ogyNOTES: CPT codes and descriptions only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.1 - See end of the table for note regarding Charge Methodology.TotalRVUsChargeMethodology edFAIR HealthFAIR HealthFAIR 4CLABCLABCLABCLABCLABCLABCLABFAIR HealthFAIR HealthFAIR HealthCLAB
TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 3 of nversionFactor/GAAFCategoryCPT/HCPCS Code DescriptionIGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIEDIGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBEIGH@ VARIABLE REGION SOMATIC MUTATION ANALYSISIGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POPCOMPARATIVE ANAL STR MARKERS PATIENT&COMP SPECCOMPARATIVE ANAL STR MARKERS EA ADDL SPECIMENCHIMERISM W/COMP TO BASELINE W/O CELL SELECTIONCHIMERISM W/COMP TO BASELINE W/CELL SELECTION EAJAK2 GENE ANALYSIS P.VAL617PHE VARIANTKRAS GENE ANALYSIS VARIANTS IN CODONS 12 AND 13MTHFR GENE ANALYSIS COMMON VARIANTSMLH1 GENE ANALYSIS FULL SEQUENCE ANALYSISMLH1 GENE ANALYSIS KNOWN FAMILIAL VARIANTSMLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTSMSH2 GENE ANALYSIS FULL SEQUENCE ANALYSISMSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTSMSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTSMSH6 GENE ANALYSIS FULL SEQUENCE ANALYSISMSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTSMSH6 GENE ANALYSIS DUPLICATION/DELETION VARIAMICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEFNPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTSPML/RARALPHA COMMON BREAKPOINTS QUAL/QUANTPML/RARALPHA SINGLE BREAKPOINT QUAL/QUANPMS2 GENE ANALYSIS FULL SEQUENCEPMS2 GENE ANALYSIS KNOWN FAMILIAL VARIANTSPMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTSPTEN GENE ANALYSIS FULL SEQUENCE ANALYSISPTEN GENE ANALYSIS KNOWN FAMILIAL VARIANTPTEN GENE ANALYSIS DUPLICATION/DELETION VARIANTSERPINA1 GENE ANALYSIS COMMON VARIANTSTRB@ REARRANGEMENT ANAL AMPLIFICATION METHODTRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGYTRG@ GENE REARRANGEMENT ANALYSISVKORC1 GENE ANALYSIS COMMON VARIANTSHLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&DQBHLA I&LI LOW RESOLUTION HLA-A -B&-DRB1HLA CLASS I TYPING LOW RESOLUTION COMPLETEHLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACHHLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACHHLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EAHLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EAHLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1HLA CLASS I TYPING HIGH RESOLUTION COMPLETEHLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EAHLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRPHLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EAHLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUPMOLECULAR PATHOLOGY PROCEDURE LEVEL 4UNLISTED MOLELCULAR PATHOLOGY PROCEDUREASSAY OF BLOOD ACETALDEHYDEASSAY OF ACETAMINOPHENKETONE BODIES SERUM QUALITATIVEKETONE BODIES SERUM thologyNOTES: CPT codes and descriptions only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.1 - See end of the table for note regarding Charge Methodology.TotalRVUsChargeMethodology LAB5% CLABCLAB
TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 4 of nversionFactor/GAAFCategoryCPT/HCPCS Code DescriptionASSAY OF ACETYLCHOLINESTERASEACYLCARNITINES QUALITATIVE EACH SPECIMENACYLCARNITINES QUANTIATIVE EACH SPECIMENADRENOCORTICOTROPIC HORMONE ACTHADENOSINE 5-MONOPHOSPHATE CYCLICALBUMIN SERUM PLASMA/WHOLE BLOODALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMENALBUMIN URINE MICROALBUMIN QUANTIATIVEALBUMIN URINE MICROALBUMIN SEMIQUANTITATIVEALBUMIN ISCHEMIA MODIFIEDASSAY OF ETHANOLASSAY OF ALCOHOL BREATHASSAY OF ALDOLASEASSAY OF ALDOSTERONEASSAY OF URINE ALKALOIDSALPHA-1-ANTITRYPSIN TOTALALPHA-1-ANTITRYPSIN PHENOTYPEALPHA-FETOPROTEIN SERUMALPHA-FETOPROTEIN AMNIOTIC FLUIDAFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIOASSAY OF ALUMINUMAMINES VAGINAL FLUID QUALITATIVEAMINO ACIDS 1 QUALITATIVE EACH SPECIMENAMINO ACIDS MULTIPLE QUALITATIVE EACH SPECIMENAMINO ACIDS 1 QUANTITATIVE EACH SPECIMENAMINOLEVULINIC ACID DELTAAMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPECAMINO ACIDS 6/ AMINO ACIDS QUANTITATIVE EA SPEASSAY OF AMMONIAAMNIOTIC FLU SCANASSAY OF AMPHETAMINESASSAY OF AMYLASEANDROSTANEDIOL GLUCURONIDEANDROSTENEDIONEANDROSTERONEANGIOTENSIN IIANGIOTENSIN I-CONVERTING ENZYMEAPOLIPOPROTEIN EACHASSAY OF ARSENICASSAY OF ASCORBIC ACID BLOODATOMIC ABSRPJ SPECTROSCOPY EA ANALYTEASSAY OF BARBITURATESBETA-2 MICROGLOBULINBILE ACIDS TOTALBILE ACIDS CHOLYLGLYCINEBILIRUBIN TOTALBILIRUBIN DIRECTBILIRUBIN FECES QUALITATIVEBIOTINIDASE EACH SPECIMENBLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETERBLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCESBLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPECBLOOD OCCULT FECAL HGB DETER IA QUAL FECES hologyPathologyNOTES: CPT codes and descriptions only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.1 - See end of the table for note regarding Charge hodology BCLABCLABCLABCLABCLAB
TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 5 of nversionFactor/GAAFCategoryCPT/HCPCS Code Description25 HYDROXY INCLUDES FRACTIONS IF PERFORMEDCALCITONINCALCIUM TOTALCALCIUM IONIZEDCALCIUM AFTER CALCIUM INFUSION TESTCALCIUM URINE QUANTITATIVE TIMED SPECIMENCALCULUS QUALITATIVE ANALYSISCALCULUS QUANTITATIVE CHEMICALCALCULUS INFRARED SPECTROSCOPYCALCULUS XRAY DIFFRACTIONCARBOHYDRATE DEFICIENT TRANSFERRINCARBON DIOXIDE BICARBONATECARBOXYHEMOGLOBIN QUANTITATIVECARBOXYHEMOGLOBIN QUALITATIVECARCINOEMBRYONIC ANTIGEN CEACARNITINE QUANTITATIVE EACH SPECIMENCAROTENECATECHOLAMINES TOTAL URINECATECHOLAMINES BLOODCATECHOLAMINES NT ASSAYCHLORAMPHENICOLCHLORIDE BLDCHLORIDE URINECHLORIDE OTHER SOURCECHLORINATED HYDROCARBONS SCREENCHOLESTEROL SERUM/WHOLE BLOOD TOTALCHOLINESTERASE SERUMCHOLINESTERASE RBCCHONDROITIN B SULFATE QUANTITATIVECHROMATOGRAPHY QUAL COLUMN ANALYTE NESCHROMATOGRAPHY QUAL PAPR 1-DIMENSNL ANALYTE NESCHROMATOGRAPHY QUAL PAPR 2-DIMENSIONAL ANAL NESCHROMATOGRAPHY QUAL THIN LAYER ANALYTE NESCHROMATOGRAPHY QUAN COLUMN 1 ANALYTE NESCHROMATOGRAPHY QUAN COLUMN MULTIPLE ANALYTESASSAY OF CHROMIUMASSAY OF CITRATEASSAY OF COCAINECOLLAGEN CROSS LINKS ANY METHODASSAY OF COPPERCORTICOSTERONECORTISOL FREECORTISOL TOTALASSAY OF CREATINECOL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE NESCOL-CHR/MS QUAN 1 STATIONARY&MOBILE PHASE NESCOL-CHR/MS STABLE ISOTOPE DIL 1 ANALYTE NESCOL-CHR/MS STABLE ISOTOPE DIL MLT ANALYTES NESCREATINE KINASE TOTALCREATINE KINASE ISOENZYMESCREATINE KINASE MB FRACTION ONLYCREATINE KINASE ogyNOTES: CPT codes and descriptions only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.1 - See end of the table for note regarding Charge hodology BCLABCLABCLABCLABCLAB
TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 6 of nversionFactor/GAAFCategoryCPT/HCPCS Code DescriptionCREATININE BLOODCREATININE OTHER SOURCECREATININE CLEARANCEASSAY OF CRYOFIBRNCRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVEASSAY OF CYANIDECYANOCOBALAMIN VITAMIN B-12CYANOCOBALAMIN VIT B-12 UNSAT BINDING CAPACITYCYSTATIN CCSTINE&HOMOCSTINE URINE ERONE-SULFATEDESOXYCORTICOSTERONE 11DEOXYCORTISOL 11ASSAY OF DIBUCAINE NUMBER1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMEDELASTASE PANCREATIC FECAL QUAL/SEMI-QUANNZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EANZYM ACTV BLOOD CELLS/TISS RADACT SUBSTRATE EAELCTROPHORETIC TECHNIQUE NOT ELSEWHERE SPECIFIEDASSAY OF ERYTHROPOIETINASSAY OF ESTRADIOLASSAY OF ESTROGENS FRACTIONATEDASSAY OF ESTROGENS TOTALASSAY OF ESTRIOLASSAY OF ESTRONEASSAY OF ETHYLENE GLYCOLASSAY OF ETIOCHOLANOLONEFAT/LIPIDS FECES QUALITATIVEFAT/LIPIDS FECES QUANTITATIVEFAT DIFFIAL FECES QUANTITATIVEFATTY ACIDS NONESTERIFIEDVERY LONG CHAIN FATTY ACIDSASSAY OF FERRITINFTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUANASSAY OF FLUORIDEASSAY OF FOLIC ACID SERUMASSAY OF FOLIC ACID RBCASSAY OF FRUCTOSE SEMENASSAY OF GALACTOKINASE RBCASSAY OF GALACTOSEGALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE QUANGALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE SCREENGALECTIN-3ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACHASSAY OF GAMMAGLOBULIN IGEGAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSESGASES BLOOD PH ONLYBLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRYGASES BLOOD O2 SATURATION ONLY DIRECT MEASHGB-O2 AFFINITY PO2 50% SATURATION OXYGENGASTRIC ACID ANALYIS W/PH EACH SPECIMENGASTRIN AFTER SECRETIN STIMULATIONASSAY OF gyNOTES: CPT codes and descriptions only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.1 - See end of the table for note regarding Charge hodology BCLABCLABCLABCLABCLAB
TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 7 of nversionFactor/GAAFCategoryCPT/HCPCS Code DescriptionASSAY OF GLUCAGONGLUCOSE BODY FLUID OTHER THAN BLOODGLUCOSE TOLERANCE TESTGLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIPGLUCOSE BLOOD REAGENT STRIPGLUCOSE POST GLUCOSE DOSEGLUCOSE TOLERANCE TEST GTT 3 SPECIMENSGLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENSGLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVEGLUC-6-PHOSPHATE DEHYDROGENASE SCREENGLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USEASSAY OF GLUCOSIDASE BETAASSAY OF GLUTAMATE DEHYDROGENASEASSAY OF GLUTAMYLTRASE GAMMAASSAY OF GLUTATHIONEASSAY OF GLUTATHIONE REDUCTASE RBCASSAY OF GLYCATED PROTEINGONADOTROPIN FOLLICLE STIMULATING HORMONEGONADOTROPIN LUTEINIZING HORMONEASSAY OF GROWTH HORMONE HUMANGROWTH STIMULATION EXPRESSED GENE 2HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPEASSAY OF HAPTOGLOBIN QUANTITATIVEASSAY OF HAPTOGLOBIN PHENOTYPESHPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPEHPYLORI DRUG ADMINISTRATIONHEAVY METAL SCREENHEAVY METAL QUANTIATIVE EACHHEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESISHEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHYHEMOGLOBIN COPPER SULFATE METHOD NON-AUTOMATEDHEMOGLOBIN F FETAL CHEMICALHEMOGLOBIN F FETAL QUALITATIVEHEMOGLOBIN GLYCOSYLATED A1CHGB GLYCOSYLATED DEVICE CLEARED FDA HOME USEHEMOGLOBIN METHEMOGLOBIN QUALITATIVEHEMOGLOBIN METHEMOGLOBIN QUANTITATIVEASSAY OF HEMOGLOBIN PLASMAHEMOGLOBIN SULFHEMOGLOBIN QUANTITATIVEHEMOGLOBIN THERMOLABILEHEMOGLOBIN UNSTABLE SCREENASSAY OF HEMOGLOBIN URINEASSAY OF HEMOSIDERIN QUALITATIVEASSAY OF B-HEXOSAMINIDASE EACH ASSAYASSAY OF HISTAMINEASSAY OF HOMOCYSTEINEASSAY OF HOMOVANILLIC ACIDHYDROXYCORTICOSTEROIDS 17ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAAASSAY OF HYDROXYPROGESTERONE 17-DASSAY OF HYDROXYPROGESTERONE 20ASSAY OF HYDROXYPROLINE FREEASSAY OF HYDROXYPROLINE TOTALIMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEPIMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE OTES: CPT codes and descriptions only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.1 - See end of the table for note regarding Charge hodology ABCLABCLABCLABCLABCLAB
TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 8 of nversionFactor/GAAFCategoryCPT/HCPCS Code DescriptionIMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAYIMMUNOASSAY ANALYTE QUANTITATIVE NOSASSAY OF INSULIN TOTALASSAY OF INSULIN FREEASSAY OF INTRINSIC FACTORASSAY OF IRONIRON BINDING CAPACITYISOCITRIC DEHYDROGENASEASSAY OF KETOGENIC STEROIDS FRACTIONATIONASSAY OF KETOSTEROIDS 17- TOTALKETOSTEROIDS 17- FRACTIONATIONASSAY OF LACTATELACTATE DEHYDROGENASE LDHLACTATE DEHYDROGENASE ISOENZYMES SEP&QUANLACTOFERRIN FECAL QUALITATIVELACTOFERRIN FECAL QUANTITATIVELACTOGEN HPL HUMAN CHORIONIC SOMATOMAMMOTROPINLACTOSE URINE QUALITATIVEASSAY OF LEADFETAL LUNG MATURITY LECITHIN SPHINGOMYELIN RATIOFETAL LUNG MATURITY FOAM STABILITY TESTFETAL LUNG MATURITY FLUORESCENCE POLARIZATIONFETAL LUNG MATURITY LAMELLAR BODY DENSITYLEUCINE AMINOPEPTIDASE LAPASSAY OF LIPASELIPOPROTEIN (A)LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2LIPOPROTEIN BLOOD ELECTROPHORECTIC SEP&QUANLIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASSLIPOPROTEIN BLOOD QUAN NUMBERS&SUBCLASSESLIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROLLIPOPROTEIN DIRECT MEASUREMENT VLDL CHOLESTEROLLIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROLLUTEINIZING RELEASING FACTORASSAY OF MAGNESIUMASSAY OF MALATE DEHYDROGENASEASSAY OF MANGANESEMASS SPECT&TANDEM MASS SPECT ANAL QUAL EA SPECMASS SPECT&TANDEM MASS SPECT ANAL QUAN EA SPECASSAY OF MERCURY QUANTITATIVEMETANEPHRINESMETHEMALBUMINMICROFLUIDIC ANALYSIS TEAR OSMOLARITYMUCOPOLYSACCHARIDES ACID QUANTITATIVEMUCIN SYNOVIAL FLUID ROPES TESTMYELIN BASIC PROTEIN CEREBROSPINAL FLUIDMYOGLOBINMYELOPEROXIDASE MPONATRIURETIC PEPTIDEASSAY OF NEPHELOMETRY EACH ANALYTE NESASSAY OF NICKELASSAY OF NUCLEOTIDASE 5'OLIGOCLONAL IMMUNEORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMENORGANIC ACIDS QUALITATIVE EACH ogyNOTES: CPT codes and descriptions only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.1 - See end of the table for note regarding Charge hodology BCLABCLABCLABCLABCLAB
TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs)PAGE 9 of nversionFactor/GAAFCategoryCPT/HCPCS Code DescriptionORGANIC ACID 1 QUANTITATIVEASSAY OF OSMOLALITY BLOODASSAY OF OSMOLALITY URINEASSAY OF OSTEOCALCINASSAY OF OXALATEONCOPROTEIN HER-2/NEUONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCPASSAY OF PARATHORMONEPH BODY FLUID NOT ELSEWHERE SPECIFIEDPH EXHALED BREATH CONDENSATEASSAY OF PHENCYCLIDINEASSAY OF CALPROTECTIN FECALASSAY OF PHENYLALANINE BLOODASSAY OF PHENYLKETONES QUALITATIVEASSAY OF PHOSPHATASE ACID TOTALPHOSPHATASE ACID FORENSIC EXAMINATIONASSAY OF PHOSPHATASE ACID PROSTATICASSAY OF PHOSPHATASE ALKALINEASSAY OF PHOSPHATASE ALKALINE HEAT STABLEASSAY OF PHOSPHATASE ALKALINE ISOENZYMESPHOSPHATIDYLGLYCEROLPHOSPHOGLUCONATE 6-DEHYD RBCASSAY OF PHOSPHOHEXOSE ISOMERASEASSAY OF PHOSPHORUS INORGANICASSAY OF PHOSPHORUS INORGANIC URINEPORPHOBILINOGEN URINE QUALITATIVEASSAY OF PORPHOBILINOGEN URINE QUANTITATIVEEVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMENPORPHYRINS URINE QUALITATAIVEPORPHYRINS URINE QUANTITATION & FRACTIONATIONPORPHYRINS FECES QUANTITATIVEPOTASSIUM SERUM PLASMA/WHOLE BLOODPOTASSIUM NE17-HYDROXYPREGNENOLONEASSAY OF PROGESTERONEPROCALCITONIN (PCT)ASSAY OF PROLACTINASSAY OF PROSTAGLNDIN EACHASSAY OF PROSTATE SPECIFIC ANTIGEN COMPLEXEDASSAY OF PROSTATE SPECIFIC ANTIGEN TOTALASSAY OF PROSTATE SPECIFIC ANTIGEN FREEPROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLDPROTEIN TOTAL XCPT REFRACTOMETRY URINEPROTEIN TOTAL XCPT REFRACTOMETRY OTH SRCPROTEIN TOTAL REFRACTOMETRY ANY SRCPREGNANCY-ASSOCIATED PLASMA PROTEIN-APROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUMPROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATIPROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUIDPROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICALPROTOPORPHYRIN RBC og
36415 COLLECTION VENOUS BLOOD VENIPUNCTURE . Pathology : 0.08 : CLAB : . CPT/ HCPCS Code Modifier CPT/HCPCS Code Description : Conversion Factor/GAAF Category RVUs Charge . 80434 INSULIN TOLERANCE PANEL ACTH INSUFFICIENCY ; Pathology : 3.85 : CLAB : 80435 INSULIN TOLERANCE PANEL GROWTH HORM DEFNCY ; Pathology : 3.92 :
