In-Office Testing List to Cover All EmblemHealth Members

03/27/2020

Starting July 1, 2020, we will be making it easier for you to perform the tests listed below in-office for ALL EmblemHealth members. Currently, the In-Office Lab List is only applicable to HIP members. We are reducing your administrative burden by extending our existing In-Office Testing policy to all Group Health Incorporated members. You will no longer need to figure out if the policy applies to a specific member. If they are an EmblemHealth member, the policy will apply. This policy eliminates the need to coordinate with an outside lab. For those new to this policy, please make note of Specialty limitations that may apply. If the Specialty is listed, it means only those providers may perform the test in-office.

Below is the In-Office Testing List. The list has been updated to reflect previously announced infertility coverage mandates.  Standard coding updates have also been applied. Please continue to direct all other tests to Quest Diagnostics (EmblemHealth’s preferred free-standing laboratory) or another applicable EmblemHealth participating laboratory. Reimbursement will be made according to contracted fee schedules. EmblemHealth will continue to prohibit members from being balanced billed for these services. If you have questions, please contact EmblemHealth Provider Customer Service at 866-447-9717. 

 

EMBLEMHEALTH
IN-OFFICE TESTING LIST

Code

Description

Specialty*

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

Ophthalmology

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

 

86486

Skin test; unlisted antigen, each

 

86510

Skin test; histoplasmosis

 

86580

Skin test; tuberculosis, intradermal

 

86701

OraQuick ADVANCE® rapid HIV-1 antibody test

 

86702

OraQuick ADVANCE® rapid HIV-2 antibody test

 

86703

HIV-1 and HIV-2 single assay

 

86735

Antibody; mumps

Infectious Disease, Allergy / Immunology

87210

Smear; wet mount, e.g., 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****

Streptococcus, group A 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

89250

Culture of oocyte(s)/embryo(s), less than 4 days

Urology / Reproductive Endocrinology

89251

Culture of oocyte(s)/embryo(s), less than 4 days; with co-culture of oocyte(s)/embryo(s)

Urology / Reproductive Endocrinology

89254

Oocyte identification from follicular fluid

Urology / Reproductive Endocrinology

89255

Preparation of embryo for transfer (any method)

Urology / Reproductive Endocrinology

89257

Sperm identification from aspiration (other than seminal fluid)

Urology / Reproductive Endocrinology

89258

Cryopreservation; embryo(s)

Urology / Reproductive Endocrinology

89259

Cryopreservation; sperm

Urology / Reproductive Endocrinology

89260

Sperm isolation; simple prep (e.g., sperm wash and swim-up) for insemination or diagnosis with semen analysis

Urology / Reproductive Endocrinology

89261

Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis

Urology / Reproductive Endocrinology

89264

Sperm identification from testis tissue, fresh or cryopreserved

Urology / Reproductive Endocrinology

89268

Insemination of oocytes

Urology / Reproductive Endocrinology

89272

Extended culture of oocyte(s)/embryo(s), 4-7 days

Urology / Reproductive Endocrinology

89290

Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); less than or equal to 5 embryos

Urology / Reproductive Endocrinology

89300

Semen analysis; Huhner test

Urology / Reproductive Endocrinology

89310

Semen analysis; motility and count

Urology / Reproductive Endocrinology

89320

Semen analysis; complete

Obstetrics / Gynecology / Urology / Reproductive Endocrinology

89321

Semen analysis; volume, count, motility, and differential

Urology / Reproductive Endocrinology

89322

Semen analysis; sperm presence and motility of sperm, if performed

Urology / Reproductive Endocrinology

89330

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

Urology/Reproductive Endocrinology

89335

Cryopreservation, reproductive tissue, testicular

Urology / Reproductive Endocrinology

89337

Cryopreservation, mature oocyte(s)

Urology / Reproductive Endocrinology

89342

Storage (per year); embryo(s)

Urology / Reproductive Endocrinology

89344

Storage (per year); reproductive tissue, testicular/ovarian

Urology / Reproductive Endocrinology

89346

Storage (per year); oocyte(s)

Urology / Reproductive Endocrinology

89352

Thawing of cryopreserved; embryo(s)

Urology / Reproductive Endocrinology

89353

Thawing of cryopreserved; sperm/semen, each aliquot

Urology / Reproductive Endocrinology

89354

Thawing of cryopreserved; reproductive tissue, testicular/ovarian

Urology / Reproductive Endocrinology

89356

Thawing of cryopreserved; oocyte(s), each aliquot

Urology / Reproductive Endocrinology

G0475

HIV antigen/antibody, combination assay, screening

 

G0476

HPV screening

 

Q0115

Postcoital direct, qualitative examinations of vaginal or cervical mucous

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.