Refer to the Clinical Payment and Coding Policies page for general information and disclaimers about these policies.
Lab Management Clinical Payment and Coding Policies apply only to Certain Administrative Services Only Groups.
A list of applicable groups will be available prior to Jan. 1, 2025.
| Policy Name | CPCP Number | Posted | Effective Date | Archived Documents |
|---|---|---|---|---|
| Allergen Testing | CPCPLAB013 | 09/30/2024 | 01/01/2025 | N/A |
| Biomarker Testing for Autoimmune Rheumatic Disease | CPCPLAB011 | 09/30/2024 | 01/01/2025 | N/A |
| Biomarkers for Myocardial Infarction and Chronic Heart Failure |
CPCPLAB046 | 09/30/2024 | 01/01/2025 | N/A |
| β-Hemolytic Streptococcus Testing | CPCPLAB053 | 09/30/2024 | 01/01/2025 | N/A |
| Cardiovascular Disease Risk Assessment | CPCPLAB020 | 09/30/2024 | 01/01/2025 | N/A |
| Celiac Disease Testing | CPCPLAB017 | 09/30/2024 | 01/01/2025 | N/A |
| Cervical Cancer Screening | CPCPLAB002 | 09/30/2024 | 01/01/2025 | N/A |
| Colorectal Cancer Screening | CPCPLAB071 | 09/30/2024 | 01/01/2025 | N/A |
| Coronavirus Testing in the Outpatient Setting | CPCPLAB057 | 09/30/2024 | 01/01/2025 | N/A |
| Diabetes Mellitus Testing | CPCPLAB004 | 09/30/2024 | 01/01/2025 | N/A |
| Diagnosis of Idiopathic Environmental Intolerance | CPCPLAB023 | 09/30/2024 | 01/01/2025 | N/A |
| Diagnostic Testing of Influenza | CPCPLAB033 | 09/30/2024 | 01/01/2025 | N/A |
| Diagnostic Testing of Iron Homeostasis & Metabolism | CPCPLAB008 | 09/30/2024 | 01/01/2025 | N/A |
| Epithelial Cell Cytology in Breast Cancer Risk Assessment | CPCPLAB024 | 09/30/2024 | 01/01/2025 | N/A |
| Evaluation of Dry Eyes | CPCPLAB043 | 09/30/2024 | 01/01/2025 | N/A |
| Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing | CPCPLAB025 | 09/30/2024 | 01/01/2025 | N/A |
| Fecal Calprotectin Testing in Adults | CPCPLAB026 | 09/30/2024 | 01/01/2025 | N/A |
| Flow Cytometry | CPCPLAB001 | 09/30/2024 | 01/01/2025 | N/A |
| Folate Testing | CPCPLAB048 | 09/30/2024 | 01/01/2025 | N/A |
| Gamma-glutamyl Transferase | CPCPLAB056 | 09/30/2024 | 01/01/2025 | N/A |
| General Inflammation Testing | CPCPLAB049 | 09/30/2024 | 01/01/2025 | N/A |
| Helicobacter Pylori Testing | CPCPLAB018 | 09/30/2024 | 01/01/2025 | N/A |
| Hepatitis Testing | CPCPLAB015 | 09/30/2024 | 01/01/2025 | N/A |
| Human Immunodeficiency Virus | CPCPLAB065 | 09/30/2024 | 01/01/2025 | N/A |
| Identification of Microorganisms Using Nucleic Acid Probes | CPCPLAB063 | 09/30/2024 | 01/01/2025 | N/A |
| Immune Cell Function Assay | CPCPLAB028 | 09/30/2024 | 01/01/2025 | N/A |
| Immunohistochemistry | CPCPLAB069 | 09/30/2024 | 01/01/2025 | N/A |
| In Vitro Chemoresistance and Chemosensitivities Assays | CPCPLAB030 | 09/30/2024 | 01/01/2025 | N/A |
| Intracellular Micronutrient Analysis | CPCPLAB029 | 09/30/2024 | 01/01/2025 | N/A |
| Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease | CPCPLAB035 | 09/30/2024 | 01/01/2025 | N/A |
| Lyme Disease Testing | CPCPLAB044 | 09/30/2024 | 01/01/2025 | N/A |
| Nerve Fiber Density Testing | CPCPLAB064 | 09/30/2024 | 01/01/2025 | N/A |
| Onychomycosis Testing | CPCPLAB068 | 09/30/2024 | 01/01/2025 | N/A |
| Oral Cancer Screening and Testing | CPCPLAB032 | 09/30/2024 | 01/01/2025 | N/A |
| Pancreatic Enzyme Testing for Acute Pancreatitis | CPCPLAB047 | 09/30/2024 | 01/01/2025 | N/A |
| Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing | CPCPLAB055 | 09/30/2024 | 01/01/2025 | N/A |
| Pathogen Panel Testing | CPCPLAB045 | 09/30/2024 | 01/01/2025 | N/A |
| Pediatric Preventive Screening | CPCPLAB016 | 09/30/2024 | 01/01/2025 | N/A |
| Prenatal Screening (Nongenetic) | CPCPLAB014 | 09/30/2024 | 01/01/2025 | N/A |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting | CPCPLAB070 | 09/30/2024 | 01/01/2025 | N/A |
| Prostate Biopsies Specimen Analysis | CPCPLAB005 | 09/30/2024 | 01/01/2025 | N/A |
| Prostate Specific Antigen (PSA) Testing | CPCPLAB006 | 09/30/2024 | 01/01/2025 | N/A |
| Salivary Hormone Testing | CPCPLAB034 | 09/30/2024 | 01/01/2025 | N/A |
| Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases | CPCPLAB036 | 09/30/2024 | 01/01/2025 | N/A |
| Serum Tumor Markers for Malignancies | CPCPLAB037 | 09/30/2024 | 01/01/2025 | N/A |
| Testing for Alpha-1 Antitrypsin Deficiency | CPCPLAB061 | 09/30/2024 | 01/01/2025 | N/A |
| Testing for Diagnosis of Active or Latent Tuberculosis | CPCPLAB027 | 09/30/2024 | 01/01/2025 | N/A |
| Testing for Vector-Borne Infections | CPCPLAB052 | 09/30/2024 | 01/01/2025 | N/A |
| Testing of Homocysteine Metabolism-Related Conditions | CPCPLAB067 | 09/30/2024 | 01/01/2025 | N/A |
| Testosterone | CPCPLAB009 | 09/30/2024 | 01/01/2025 | N/A |
| Thyroid Disease Testing | CPCPLAB019 | 09/30/2024 | 01/01/2025 | N/A |
| Urinary Tumor Markers for Bladder Cancer | CPCPLAB038 | 09/30/2024 | 01/01/2025 | N/A |
| Urine Culture Testing for Bacteria | CPCPLAB050 | 09/30/2024 | 01/01/2025 | N/A |
| Venous and Arterial Thrombosis Risk Testing | CPCPLAB058 | 09/30/2024 | 01/01/2025 | N/A |
| Vitamin B12 and Methylmalonic Acid Testing | CPCPLAB010 | 09/30/2024 | 01/01/2025 | N/A |
| Vitamin D Testing | CPCPLAB003 | 09/30/2024 | 01/01/2025 | N/A |