Reflex Testing
Reflex testing plays an integral part of patient care, allowing additional testing to be done automatically, provided criteria established for the test are met. Reflex tests are billed only when performed. If the criteria were not met, no further charges will be generated.
Tests listed under "Reflex Order Options" can be ordered so that the reflex testing will be done automatically if indicated. To order without reflex, order the individual test. The next section of the chart represents what is considered by the Medical Executive Committees of York Hospital and Gettysburg Hospital to be “Standard of Practice” and, as such, will be routinely performed and billed as outlined above.
Reflex Order Options
| Initial Test | CPT Code | Price | Reflex Criteria | Reflex Test(s) | CPT Code | Price |
|---|---|---|---|---|---|---|
| Electrophoresis Serum Plus |
84165 |
$70.50 | Presence of monoclonal paraprotein | Serum IFE | 86334 | $109.50 |
| Electrophoresis Urine Plus |
84166 84156 |
$105.25 | Presence of monoclonal paraprotein | Urine IFE | 86335 | $143.75 |
| PAP Plus |
G0123 |
$90.00 |
ASCUS positive |
HPV If HPV detected the HPV Genotype will be done at no additional charge. |
87621 | $140.00 |
| Pernicious Anemia Panel (Vitamin B 12) | 82607 | $73.75 |
Vit B12 150-300 pg/mL |
Methylmalonic Acid |
83921 |
$80.50 |
| TSH Progressive | 84443 | $82.25 |
TSH 1-30 days TSH 30 days-5years TSH 5 years-adult |
Free T4 | 84439 | $44.25 |
| UACX | 81003 | $11.00 |
>28 WBC/uL (automated); or >358/uL bacteria; or positive nitrate. |
Urine Culture | 87086 | $39.50 |
Standards of Practice
| Initial Test | CPT Code | Price | Reflex Criteria | Reflex Test(s) | CPT Code | Price |
|---|---|---|---|---|---|---|
| Initial Test | CPT Code | Price | Reflex Criteria | Reflex Test(s) | CPT Code | Price |
|
Ab Screen |
86850 | $83.00 | Screen Positive |
Antibody ID Patient Antigen Direct Coombs |
86870 86905 86880 |
$159.00 $108.00 $44.75 |
| DAT Positive | DAT Eval | 86880x2 | $89.50 | |||
| Anti IgG Positive | Poss. Elution | 86860 | $114.50 | |||
| Pregnant + Antibody | Poss. Ab titer | 86886 | $186.75 | |||
| ADAMTS13 Activity Progressive | 85397 | $156.25 |
Result < or = 30% ADAMTS13 Inhibitor Screen Positive |
ADAMTS13 Inhibitor Screen ADAMTS13 Inhibitor Titer |
85335 85335 |
$68.75 $68.75 |
|
Antibody Identification |
86870 | $159.00 | Anti-M or Anti-P detected | Antibody Screen Tube Discrepancy | 86850 | $83.00 |
| ANA Screen | 86038 | $59.25 | Screen Positive | ANA Titer | 86039 | $54.75 |
| Anti-dsDNA Ab Screen (Native DNA) | 86225 | $67.25 | Screen Positive | dsDNA Titer | 86039 | $54.75 |
| Breast Biopsy | 88305 | $450.00 |
All Invasive Breast Cancer (New, metastatic, recurrence) |
ER, PR, Ki67 Oncotype DX |
88360x3; 88367x2 84999 |
$1245.00 Approx $4000.00 |
| Breast Biopsy | 88305 | $450.00 | Newly Diagnosed DCIS | ER, PR | 88360x2 | $830.00 |
| Cord Blood to Hold | n/a | n/a | Mother Type O, or Rho(D) negative | Cord Blood Workup (YH) |
86900 |
$35.75 |
|
Mother Type O (D) negative |
RhIG Workup on Mother |
85461 |
$32.50 |
|||
| Crossmatch |
86920 |
$191.50 | Ab ID Positive | Poss. Ag Typing (unit) | 86902 | $108.00 |
| Dilute Russel Viper Venom Time | 85613 | $47.00 |
If >45 sec If dRVVT confirm Positive |
dRVVT Confirm dRVVT 1:1 Mix |
85598 85613 |
$88.00 $47.00 |
| Drugs of Abuse Progressive Random Urine |
G0431 | $356.25 | Screen Positive | Specific Drug Confirmation |
Various | Varies |
| Electrolytes | 80051 | $34.50 | ED or Inpatient >=12 yrs no Creatinine in 20 hrs |
Creatinine | 82565 | $25.00 |
| Endomysial IgA Ab | 86255 | $59.00 | Screen Detected | Endomysial IgA Titer | 86256 | $42.75 |
| Fetal Cell Scrn | 85461 | $38.00 | Screen Positive | Fetal Hgb Stain | 85460 | $38.00 |
| Glucose Tolerance Testing |
82950 |
Various | Initial fingerstick glucose >140 mg/dL | Do not perform glucose tolerance, obtain lab glucose | 82947 | $19.25 |
|
Heparin Induced |
86022 | $100.00 | Positive | Serotonin Release Assay |
86022 | $62.00 |
| Herpes 1 & 2 IgM Ab |
86695 |
$159.25 | Screen Positive |
Herpes 1 IgM Titer |
86695 |
$64.50 |
|
HIV Ag/Ab |
87389 | $118.00 | HIV Ag/Ab Positive | HIV MultiSpot | 86689 | No Add'l Charge |
| HIV 1 Rapid | 86701 | $43.50 | HIV 1 Positive | HIV MultiSpot | 86689 | No Add'l Charge |
| HTLV1/2 Ab | 86687 | $41.00 | HTLV 1/2 Positive | HTLV 1/2 WB | 86689 | $94.75 |
| Influenza A & B and RSV PCR | 87631 | $312.25 | Positive Influenza A | H1 Swine, H1 Seasonal, H3 Seasonal |
87503 87502 87502 |
No Add'l Charge |
| Lamellar Body Count | 83664 | $92.75 | Diabetic mother <45 yrs; or Non-Diabetic mother <30 yrs. | %PG and L/S Ratio |
83661 |
$107.75 |
| Lipid Panel | 80061 | $61.50 | Triglyceride >400 mg/dL | Direct LDL | 83721 | $46.75 |
| Lupus Anticoagulant | 85730 | $29.50 | Screen Positive | Hexagonal Phase Confirmation | 85598 | $88.00 |
| Lyme Ab | 86618 | $83.50 | Screen Positive | Lyme WB IgG Lyme WB IgM |
86617 |
$76.00 |
| Massive Transfusion Protocol-Fibrinogen | 85384 | $44.50 | Massive Transfusion Protocol | 3 pools of 6 cryoprecipitate |
P9012 |
$3568.50 |
| Massive Transfusion Protocol-Platelet | 85027 | $31.75 | Massive Transfusion Protocol | Unit of platelets | P9031x5 or P9035 |
$2083.75 |
| Microbiology Culture | Varies by source | Varies by source | Growth of Pathogen |
Bacterial ID |
87077 |
$31.50 |
| Preg BHCG | 84702 | $71.00 |
Positive Preg result |
ABORh type if no previous ABORh |
86900 |
$71.50 |
| Rapid Strep A Antigen | 87880 | $54.00 | Rapid Strep Negative | Throat culture screen | 87081 | $31.50 |
| RPR (Serum VDRL) | 86592 | $21.00 | Screen Positive |
RPR Quant |
86953 |
$21.50 |
| Transfusion Reaction workup |
86880 |
$44.75 |
Post DAT Positive If Pre DAT negative |
Pre DAT Transfusion Reaction workup extended
|
86880 |
$44.75 $166.00 |
| Type + Screen |
86900 |
$35.75 |
Screen Positive |
Antibody ID |
86870 |
$159.00 |
| Urinalysis | 81003 | $11.00 | Albumin, blood, nitrite, or leukocyte esterase positive | Urine Microscopic | 81015 | $15.00 |
| Urinalysis – Cath Urine | 81003 | $11.00 | Age <9 | Urine Culture | 87086 | $39.50 |
| Von Willebrand Factor Protease Activity Progressive | 85397 | $156.25 | If <=40 sec | vWF Protease Inhibitor | 85335 | $156.25 |