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  • Care Management > Laboratory Services

    The laboratories contracted with EmblemHealth to provide covered laboratory services are listed in our Find a Doctor tool at www.emblemhealth.com/find-a-doctor.

    Quest Diagnostics Incorporated

    Quest Diagnostics Incorporated (Quest) is contracted with all EmblemHealth plans to provide general laboratory services (all 8000 CPT codes).

    • Quest Diagnostics Patient Services Locator: 1-800-377-7220
    • Quest Diagnostics Customer Service department: 1-866-MY-QUEST (1-866-697-8378)
    • Quest Diagnostics website: www.questdiagnostics.com

      Quest laboratories will provide a collection box and courier service to and from the practitioner's office for specimen collection. If specimens need to be drawn outside of the practitioner's office, members should be directed to the nearest contracted laboratory Patient Service Center and given the requisition form to hand carry.

      Selected tests are available on a STAT (emergency) basis. Specimens requiring STAT services should not be given to your routine Route Service Representative. Instead, practitioners should call their local Quest Diagnostics laboratory to request a STAT service or pick-up. STAT results are reported by telephone as soon as available. Written and/or electronic reports will follow per your routine medical report delivery system.

      Note: Quest is able to provide most laboratory services. For specialty lab tests not available from Quest, we have contracts with other labs. For network hospitals with their own lab contracted with EmblemHealth, physicians may use this lab rather than Quest if applicable. 

      In-Office Testing List (For CompreHealth EPO, Medicare HMO, HIP and Vytra Plans)

      For members in the CompreHealth EPO, Medicare HMO, HIP and Vytra plans listed below, practitioners may perform the lab tests noted in the In-Office Testing List below in their offices without a prior approval. Reimbursement will be made according to contracted fee schedules.

      • HMO
      • POS
      • Medicare HMO
      • Medicare Dual Eligible HMO SNP
      • Medicaid
      • Child Health Plus

        Members whose care is managed by Montefiore (CMO), HealthCare Partners (HCP) and/or Inspiris may not have their lab tests administered in a practitioner's office, even if the members are in one of the above-listed benefits plans. (See the member's ID card or eligibility information when you sign in to www.emblemhealth.com to determine whether HIP, CMO or HCP is responsible for managing a member's care.)

        In addition, if a HIP member has selected a PCP assigned to St. Barnabas Hospital or to AdvantageCare Physicians (look for Manhattan's Physician Group, Preferred Health Partners, Queens-Long Island Medical Group or Staten Island Physician Practice logo on the member's ID), the member may not have these lab tests administered in a practitioner's office. The member must go to a network laboratory for the services to be covered.

        In-Office Testing List - HIP/CompreHealth EPO/Vytra
        Effective April 13, 2016
        Code Description Specialty*

        G0475

        HIV antigen/antibody, combination assay, screening


        G0476

        HPV screening*
        *Effective July 9, 2016


        G0477

        Drug screen; multiple

        Pain Medicine, Addiction Medicine

        G0478

        Drug screen; single

        Pain Medicine, Addiction Medicine

        81000

        Urinalysis; non-automated, with microscopy


        81002

        Urinalysis; non-automated, without microscopy


        81003

        Urinalysis; automated, without microscopy


        81025

        Urine pregnancy test


        82247

        Bilirubin; total

        Pediatrics

        82248

        Bilirubin; direct

        Pediatrics

        82270

        Blood, occult, by peroxidase activity, qualitative, feces, 1 determination


        82272

        Blood, occult, by peroxidase activity; qualitative, feces, 1 to 3 simultaneous determinations


        82274

        Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1 to 3 simultaneous determinations


        82670

        Estradiol

        OB/GYN / Maternal Fetal Medicine / Reproductive Endocrinology

        82803

        Gases, blood, any combination of pH, pCO2, pO2 , CO2, HCO3


        82947

        Glucose; quantitative, blood (except reagent strip)


        82948

        Glucose; blood, reagent strip


        82962

        Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use


        83516

        InflammaDry

        Opthalmology

        83655

        Lead


        83861 Microfluid analysis tears  Ophthalmology 

        84132

        Potassium; serum, plasma or whole blood


        85007

        Blood count; blood smear, microscopic examination with manual differential WBC count (includes RBC morphology and platelet estimation)

        Hematology / Oncology

        85014

        Blood count; hematocrit (Hct)

        Hematology / Oncology

        85018

        Blood count; hemoglobin (Hgb)

        Hematology / Oncology /Pediatrics**

        85025

        Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count

        Hematology / Oncology / Pediatrics***

        85027

        Blood count; complete (CBC), automated (Hgb, Hct, RBC, WEB and platelet count)

        Hematology / Oncology

        85060

        Blood smear, peripheral, interpretation by physician with written report

        Hematology / Oncology

        85610

        Prothrombin time


        85651

        RBC sedimentation rate; non-automated

        Ophthalmology

        85652

        RBC sedimentation rate; automated

        Ophthalmology

        86403

        Particle agglutination; screen, each antibody


        86485

        Skin test; candida

        Infectious Disease, Allergy / Immunology

        86486

        Skin test, unlisted antigen, each


        86510

        Skin test; histoplasmosis


        86580

        Skin test; tuberculosis, intradermal


        86701-QW

        OraQuick ADVANCE® rapid HIV-1 antibody test


        86702-QW

        OraQuick ADVANCE® rapid HIV-2 antibody test


        86703-QW

        HIV-1 and HIV-2 single assay


        86735

        Antibody; mumps

        Infectious Disease, Allergy / Immunology

        87210

        Smear; wet mount, eg. saline, India ink, KOH preps (for suspected vaginitis when doing pelvic exam)


        87220

        Smear; tissue exam by KOH preps


        87430

        Streptococcus, group A (detection by enzyme immunoassay technique)


        87651****

        Group A Streptococcus testing

        Midwives, Nurse Practitioners and all Physicians

        87804

        Influenza rapid test


        87806

        HIV 1 Antigen with HIV1 and
        HIV 2 antibodies


        87880

        Streptococcus, group A (detection by immunoassay with direct optical observation)


        89060

        Joint fluid crystals - crystal identification by light microscopy with or without polarizing lens analysis

        Orthopedics / Rheumatology

        89300

        Semen analysis; Huhner test

        Urology / Reproductive Endocrinology

        89310

        Semen analysis; motility and count

        Urology / Reproductive Endocrinology

        89320

        Semen analysis; complete

        Urology / Reproductive Endocrinology

        89330

        Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test

        Urology / Reproductive Endocrinology

        *Most of the codes on the In-Office Testing List may be performed by all practitioners. However, some codes may only be performed by practitioners in the specialty type(s) listed within the "Specialty" column of the table.

        **Pediatrics added November 15, 2012.

        ***Pediatrics added December 26, 2013.

        ****Limited to Members participating in EmblemHealth Enhanced Care (Medicaid) Network.

        In-Office Testing List - CompreHealth EPO/HIP/Vytra
        Expired October 31, 2010 (To be used for back billing only.)
        Code Description Specialty

        81000

        Urinalysis


        81002

        Urinalysis; non-automated, without microscopy


        81003

        Urinalysis; automated, without microscopy


        81025

        Urine pregnancy test


        82247

        Bilirubin; total

        Pediatrics

        82248

        Bilirubin; direct

        Pediatrics

        82270

        Blood, occult, by peroxidase activity, qualitative, feces, 1 determination


        82272

        Blood, occult, by peroxidase activity; qualitative, feces, 1 to 3 simultaneous determinations


        82274

        Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1 to 3 simultaneous determinations


        82670

        Estradiol

        OB/GYN / Maternal Fetal Medicine / Reproductive Endocrinology

        82803

        Gases, blood, any combination of pH, pCO2, pO2 , CO2, HCO3


        82947

        Glucose; quantitative, blood (except reagent strip)


        82948

        Glucose; blood, reagent strip


        82962

        Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use


        83655

        Lead


        84132

        Potassium; serum, plasma or whole blood


        85007

        Blood count; blood smear, microscopic examination with manual differential WBC count (includes RBC morphology and platelet estimation)

        Hematology / Oncology

        85014

        Blood count; hematocrit (Hct)

        Hematology / Oncology

        85018

        Blood count; hemoglobin (Hgb)

        Hematology / Oncology

        85025

        Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count

        Hematology / Oncology

        85027

        Blood count; complete (CBC), automated (Hgb, Hct, RBC, WEB and platelet count)

        Hematology / Oncology

        85060

        Blood smear, peripheral, interpretation by physician with written report

        Hematology / Oncology

        85610

        Prothrombin time


        85651

        RBC sedimentation rate; non-automated

        Ophthalmology

        85652

        RBC sedimentation rate; automated

        Ophthalmology

        86403

        Particle agglutination; screen, each antibody

        Infectious Disease

        86485

        Skin test; candida

        Infectious Disease

        86486

        Skin test, unlisted antigen, each


        86510

        Skin test; histoplasmosis


        86580

        Skin test; tuberculosis


        86701-QW

        OraQuic rapid HIV-1 antibody test


        86703-QW

        HIV-1 and HIV-2 single assay


        86735

        Antibody; mumps

        Infectious Disease

        87210

        Smear; wet mount, eg. saline, India ink, KOH preps (for suspected vaginitis when doing pelvic exam)


        87220

        Smear; tissue exam by KOH preps


        87430

        Streptococcus, group A (detection by enzyme immunoassay technique)


        87804

        Influenza rapid test


        87880

        Streptococcus, group A (detection by immunoassay with direct optical observation)


        89060

        Joint fluid crystals - crystal identification by light microscopy with or without polarizing lens analysis

        Orthopedics / Rheumatology

        89300

        Semen analysis; Huhner test

        Urology / Reproductive Endocrinology

        89310

        Semen analysis; motility and count

        Urology / Reproductive Endocrinology

        89320

        Semen analysis; complete

        Urology / Reproductive Endocrinology

        89330

        Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test

        Urology / Reproductive Endocrinology

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        Glossary terms found on this page:

        Services available to a member as defined in his or her contract. Benefit design includes the types of benefits offered, limits (e.g., number of visits, percentage paid or dollar maximums applied) and subscriber responsibility (cost sharing components).

        An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

        A legal agreement between an individual member or an employer group and a health plan that describes the benefits and limitations of the coverage.

        A determination of whether or not a person meets the requirements to participate in the plan and receive coverage under the plan.

        Means a medical or behavioral condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in (a) placing the health of the person afflicted with such condition in serious jeopardy, or in the case of a behavioral condition, placing the health of such person or others in serious jeopardy; (b) serious impairment to such person’s bodily functions; (c) serious dysfunction of any bodily organ or part of such person; or (d) serious disfigurement of such person.

        A health care benefit arrangement that is similar to a preferred provider organization in administration, structure and operation but does not cover out-of-network care. Also called an Exclusive Provider Organization.

        The fee determined by the insurer to be acceptable for a procedure or service that the physician agrees to accept as payment in full.

        An organization that provides comprehensive health care coverage to its members through a network of doctors, hospitals and other health care providers. Also called a Health Maintenance Organization.

        An institution which provides inpatient services under the supervision of a physician, and meets the following requirements:

        • Provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery
        • Has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry
        • Has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff
        • Maintains medical records for all patients
        • Has a requirement that every patient be under the care of a member of the medical staff
        • Provides 24-hour patient services
        • Has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements

        A card which allows the subscriber to identify himself or his covered dependents to a provider for health care services.

        An organization comprised of individual physicians or physicians in group practices that contracts with the managed care organization on behalf of its member physicians to provide health care services. Also called an Independent Practice Association.

        Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

        A jointly funded federal and state program that provides hospital and medical coverage to the low-income population and certain aged and disabled individuals.

        A nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.

        An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

        The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.

        A hospital that is part of EmblemHealth's provider network and has signed an agreement to provide covered services to its members. Sometimes, network hospitals and facilities are referred to as participating hospitals.

        A family physician, family practitioner, general practitioner, internist or pediatrician who is responsible for delivering or coordinating care. Also called a primary care physician.

        A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.

        The process of obtaining advanced approval of coverage for a health care service or medication. The request for services is reviewed to assess medical necessity and appropriateness of elective hospital admissions and non-emergency outpatient services before the services are provided. Also called pre-authorization or pre-certification or pre-determination.

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