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Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
MA00.030aj

Policy

Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) products require that the member obtain medically necessary laboratory services at the primary ​care physician's (PCP's) designated capitated laboratory site. In most cases, laboratory services that are rendered at a non-capitated site for members enrolled in HMO or HMO-POS products are not eligible for reimbursement consideration by the Company.

The Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes listed in Attachments A1 and A2 of the policy are included in capitation as part of the Company's capitated laboratory program for members enrolled in HMO or HMO-POS products. Reimbursement for the services are provided by the Company to the designated capitated laboratory site.
  • Attachment A1: CPT Codes Included in Capitation to the PCP's Designated Laboratory Site
  • Attachment A2: HCPCS Codes Included in Capitation to the PCP's Designated Laboratory Site
In certain circumstances, medically necessary laboratory services are eligible for reimbursement by the Company to participating providers at a non-capitated site. The circumstances for which a participating provider is eligible for reimbursement at a non-capitated site are listed in Attachments B1 and B2 of the policy.
The CPT and HCPCS codes listed in Attachments B1 and B2 are eligible for reimbursement by the Company when the criteria in the policy attachment are met.
  • Attachment B1: Services Eligible for Reimbursement When Performed in the Specialist Office
    • The services described in Attachment B1 of the policy are eligible for reimbursement based on the specified provider specialty and code(s) listed.
  • Attachment B2: Services Eligible for Reimbursement When Performed in the Outpatient Hospital Laboratory
    • Services described in Attachment B2 of the policy are not eligible for reimbursement when the hospital laboratory is the member's designated capitated site.
    • Services performed in the outpatient hospital laboratory are subject to facility global payment rules. The presence of a code on Attachment B2 will not result in separate payment to the professional provider when the reimbursement to the facility includes payment for both the professional and the technical component of the service.
REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, laboratory services are covered under the medical benefits of the Company’s Medicare Advantage products.

BILLING GUIDELINES

A laboratory requisition form should be provided to the primary care physician's (PCP's) designated capitated laboratory by the referring provider prior to services being rendered.

Description

Generally, members enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) products are required to obtain laboratory services at their primary care physician's (PCP's) designated capitated laboratory site.

There may be circumstances when it is medically necessary for laboratory services to be performed in the office of a participating professional provider or in the outpatient setting of a participating hospital that is not the member's designated capitated laboratory site.

References

Evidence of Coverage​.

Coding

CPT Procedure Code Number(s)
See Attachments.
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
N/A
HCPCS Level II Code Number(s)
See Attachments.
Revenue Code Number(s)
N/A

​

Coding and Billing Requirements

Policy History

Revisions From MA00.030aj:

01/01/2026

This policy has been identified and updated for the CPT/HCPCS code update effective 01/01/2026.


​The following CPT/HCPCS codes have been added to Attachment A1 of this policy:

87182, 87183, 87494, 87627, 0600U, 0601U, 0602U, 0603U, 0604U, 0605U, 0606U, 0607U, 0608U, 0609U, 0610U, 0611U​, 0612U, and 0613U​


​The following CPT/HCPCS codes on Attachment A1 of this policy have termed:

0033U, 0131U, 0132U, 0135U, 0361U, 0544U, 0550U, and 0551U​

Procedure code 87812 has been added to Attachment B2.


Revisions From MA00.030ai:

10/01/2025

This policy has been identified and updated for the CPT/HCPCS code update effective 10/01/2025.


The following CPT codes have been been added to Attahment A1 of this policy:

​0575U, 0576U, 0577U, 0578U, 0579U, 0580U, 0581U, 0582U, 0583U, 0584U, 0585U, 0586U, 0587U, 0588U, 0589U, 0590U, 0591U, 0592U, 0593U, 0594U, 0595U, 0596U, 0597U, 0598U, and 0599U


Revisions From MA00.030ah:

04/01/2025

​This policy has been identified and updated for the CPT/HCPCS code update effective 04/01/2025.


The following CPT codes have been added to attachment A1 of this policy: 

​0531U, 0532U, 0533U, 0534U, 0535U, 0536U, 0537U, 0538U, 0539U, 0540U, 0541U, 0542U, 0543U, 0544U, 0545U, 0546U, 0547U, 0548U, 0549U, 0550U, and 0551U


Revisions From MA00.030ag:

01/01/2025

This policy has been identified and updated for the CPT/HCPCS code update effective 01/01/2025.


The following CPT codes have been termed and removed from this policy:

81433, 81436, 81438, 86327, 86490, 88388, 0346U, 0352U, 0380U,0428U, 0448U, 0500T


The following CPT codes have been added to this policy:  

81515, 87626, 81195, 81558, 82233, 82234, 83884, 84393, 84394, 86581, 87513, 87564, 87594, 0523U, 0524U, 0525U, 0526U, 0528U, 0529U, 0530U 

The following CPT code narratives have been revised in this policy: ​
81432, 81435, 81437, 87624, 88387, 0095U,0365U


Revisions From MA00.030af:​

04/01/2024

This policy has been identified and updated for the CPT/HCPCS code update effective 04/01/2024.


The following CPT codes have been termed and removed from this policy:

0354U and 0416U


The following CPT codes have been added to this policy:  

0439U, 0440U, 0441U, 0442U, 0443U, 0444U, 0445U, 0446U, 0447U, 0448U and 0449U​​


Revisions From MA00.030ae:

01/01/2024

This policy has been identified and updated for the CPT/HCPCS code update effective 01/01/2024.

The following CPT code has been termed and removed from this policy:
0014M



The following CPT codes have been added to this policy:  

0420U, 0421U, 0422U, 0423U, 0424U, 0425U, 0426U, 0427U, 0428U, 0429U, 0430U, 0431U, 0432U, 0433U, 0434U, 0435U, 0436U, 0437U, 0438U, 81457, 81458, 81459, 81462, 81463, 81464, 81517, 82166, 86041, 86042, 86043, 86366, 87523, 0827T, 0828T, 0829T, 0830T, 0831T, 0832T, 0833T, 0834T, 0835T, 0836T, 0837T, 0838T, 0839T, 0840T, 0841T, 0842T, 0843T, 0844T, 0845T, 0846T, 0847T, 0848T, 0849T, 0850T, 0851T , 0852T, 0853T, 0854T, 0855T, 0856T​​

​

The following CPT code narratives have been revised in this policy: 

81171, 81172, 81243, 81244, 81445, 81449, 81450, 81451, 81455, 81456, 0351U, 0356U​

​01/01/2024
​Effective 01/01/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.​


Revisions From MA00.030ad:

10/01/2023

This policy has been identified and updated for the CPT/HCPCS code update effective 10/01/2023.

The following CPT codes have been termed and removed from this policy:
0357U and 0386U


The following CPT codes have been added to this policy:  

0403U, 0403U, 0404U, 0405U, 0406U, 0407U, 0409U, 0410U, 0411U, 0412U, 0413U, 0414U, 0416U, 0417U, 0418U, 0419U

The following CPT code narratives have been revised in this policy: 
0269U, 0271U, 0272U, 0274U, 0277U, 0278U, 0362U


Revisions From  MA00.030ac:

07/​31/2023

This version of the policy will become effective 07/31/2023.

Policy number MA00.030ac is being issued to communicate the removal of provider specialty exceptions in the office setting for certain laboratory services identified in attachment B1 of this policy.

89190, 83880, 85007, 85008, 85009, 85013, 85014, 85027, 85032, 85044, 85048, 81015, 81007, 89050, 89051, 89060, G0027, 83872, 85810, 89050, 89051, 89055, G0027, 81015, 81020, 87205 and 81007​​


Revisions From  MA00.030ab:

04/0​1/2023

This policy has been identified and updated for the CPT/HCPCS code update effective 04/01/2023.​


The following CPT codes have been termed and removed from this policy:​
G2023 and G2024


The following CPT codes have been added to this policy:  

0364U, 0365U, 0366U, 0367U, 0368U, 0370U, 0371U, 0372U, 0373U, 0374U, 

0375U, 0376U, 0379U, 0380U, 0381U, 0384U, 0385U, 0386U


The following CPT code narratives have been revised in this policy: 
0022U and 0095U​​


Revisions From  MA00.030aa:

01/01/202​3

This policy has been identified and updated for the CPT/HCPCS code update effective 01/01/2023


The following CPT codes have been added to this policy:  
81418, 81449, 81451, 81456, 84433, 87467, 87468, 87469, 87478, 87484, 0355U, 0356U, 0358U, 0359U, 0360U, 0361U, 0362U, 0363U, 0751T, 0752T, 0753T, 0754T, 0755T, 0756T, 0757T, 0758T, 0759T, 0760T, 0761T, 0762T and 0763T.


The following CPT code narratives have been revised in this policy: 
81445, 81450 and 81455  ​


Revisions From​ MA00.030z:

10/01/2022​
This policy has been identified and updated for the CPT/HCPCS code update effective 10/01​/2022.

The following CPT code has been deleted from this policy: 
0012U 

The following CPT codes have been added to this policy:  
0332U, 0333U, 0334U, 0335U, 0336U, 0337U, 0338U, 0339U, 0340U, 0341U, 0342U, 0343U, 0344U, 0345U, 0346U, 0347U, 0348U, 0349U, 0350U, 0351U, 0352U, 0353U and 0354U


The following CPT code narrative has been revised in this policy: 

0276U​​


Revisions From​ MA00.030x:

04/01/2022
This policy has been identified and updated for the CPT/HCPCS code update effective 04/01​/2022.

The following CPT codes have been deleted from this policy: 
0097U and 0151U

The following CPT codes have been added to this policy:  

0306U, 0307U, 0308U, 0309U, 0310U, 0311U, 0312U, 0313U, 0314U, 0315U, 0316U, 0317U, 0318U, 0319U, 0320U, 0321U and 0322U


The following CPT code narrative has been revised in this policy: 
0022U

Revisions From MA00.030w:
01/02/2022
This policy has been identified and updated for the CPT/HCPCS code update effective 01/02/2022.

The following CPT codes have been deleted from this policy: 
0423T, 80500, and 80502

The following CPT codes have been added to t​​his policy:  
0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0295U, 0296U, 0297U, 0298U, 0299U, 0300U, 0301U, 0302U, 0303U, 0304U, 0305U, 80220, 80503, 80504, 80505, 80506, 81349, 81523, 81560, 82653, 83521, 83529, 86015, 86036, 86037, 86051, 86052, 86053, 86231, 86258, 86362, 86363, 86364, 86381, 86596, and 87154
​
The following CPT code narratives have been revised in this policy: 
81228, 81229, 82656, 87426, and 87449

Revisions From MA00.030v:
01/01/2022This version of the policy will become effective 01/01/2022.

Policy number MA00.030v is being issued to introduce a HMO or HMO-POS member's designated laboratory capitation exception to allow fee-for-service reimbursement consideration by the Company for certain Assisted Reproductive Technology (ART) services, as identified in this policy, when performed in the office setting by Reproductive Endocrinology specialty providers. 

The following CPT codes have been added to the applicable table in Attachment B1: 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89352, 89353, 89354, 89356

In addition, this policy has been impacted by the 01/01/2022 Annual Code Update​.

The following CPT codes have been added to Attachment A1: 

placeholder for new 1/1 codes to be added. 

Revisions From MA00.030u:

10/01/2021

This policy has been identified for the 10/1/2021 Quarterly Code Update. This version of the policy will become effective 10/01/2021. ​

The following CPT codes have been deleted from this policy: 0139U, 0168U

The following CPT & HCPCS codes have been added to this policy:  0018M, 0248U, 0249U, 0250U, 0251U, 0252U, 0253U, 0254U, ​0255U, 0256U, 0257U, 0258U, 0259U, 0260U, 0261U, 0262U, 0263U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0275U, 0276U, 0277U, 0278U, 0279U, 0280U, 0281U, 0282U, 0283U, 0284U, G0327

Revisions From MA00.030t:
04/01/2021This policy has been identified for the 04/01/2021 Quarterly Code Update. This version of the policy will become effective 04/01/2021.

The following CPT codes have been added to Attachment A1: 0242U, 0243U, 0244U, 0245U, 0246U, 0247U.

The following CPT codes have been deleted from Attachment A1: 0098U, 0099U, 0100U.

Revisions From​ MA00.030s:
01/01/2021This policy has been identified for the 01/01/2021 Annual Code Update. This version of the policy will become effective 01/01/2021.

The following CPT & HCPCS codes have been added to this policy: 80143, 80151, 80161, 80167, 80179, 80181, 80189, 80193, 80204, 80210, 81168, 81191, 81192, 81193, 81194, 81278, 81279, 81338, 81339, 81347, 81348, 81351, 81352, 81353, 81357, 81360, 81419, 81513, 81514, 81529, 81546, 81554, 82077, 82681, U0005, 0017M, 0225U, 0226U, 0227U, 0228U, 0229U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U

The following CPT & HCPCS codes have been deleted from this policy: 0111T, 81545

The following CPT code narratives have been revised in this policy​: 80414, 80415, 82075, 82670, 0152U

Revisions From MA00.030r:


10/01/2​​020This policy has been identified for the October Quarterly Code Update. This version of the policy will become effective 10/01/2020. Due to the COVID-19 Public Health Emergency, certain procedure codes have been released off-cycle and have varying effective dates. 

The following CPT & HCPCS codes have been added to this policy: 0015M, 0016M, 0203U, 0204U, 0205U, 0206U, 0207U, 0208U, 0209U, 0210U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0219U, 0220U, 0221U, 0222U, 0240U, 0241U, 86413, 87636, 87637, 87811, 87428.​

Revisions From MA00.030q:
07/01/2020This policy has been identified for the Quarterly Code Update. This version of the policy will become effective 07/01/2020.

The following CPT codes have been deleted from this policy: 0124U, 0125U, 0126U, 0127U, 0128U.

The following CPT codes have been added to this policy: 0172U, 0173U, 0174U, 0175U, 0176U, 0177U, 0178U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0202U, 0223U, 0224U, 87426

The following CPT codes have been revised in this policy: 0165U

Revisions From MA00.030p:
04/01/2020This policy has been identified for the Quarterly Code Update. This version of the policy will become effective 04/01/2020.
    • The following CPT codes have been deleted from this policy: 0081U, 0085U
    • The following CPT & HCPCS codes have been added to this policy: 0014M, 0163U, 0164U, 0165U, 0166U, 0167U, 0168U, 0169U, 0170U, 0171U, U0001, U0002, U0003, U0004, G2023, G2024, 0564T, 80145, 80187, 80230, 80235, 80280, 80285, 80305, 80306, 81277, 81307, 81308, 81309, 81522, 81542, 81552, 86328, 86769, 87563, 87653, 0139U, 0140U, 0141U, 0142U, 0143U, 0144U, 0145U, 0146U, 0147U, 0148U, 0149U, 0150U, 0151U, 0152U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U

Revisions From MA00.030o:
10/01/2019This policy has been identified for the Quarterly Code Update. This version of the policy will become effective 10/01/2019.
    • The following CPT code has been deleted from this policy: 0104U
    • The following CPT codes have been added to this policy: 0105U, 0106U, 0107U, 0108U, 0109U, 0110U, 0111U, 0112U, 0113U, 0114U, 0115U, 0116U, 0117U, 0118U, 0119U, 0120U, 0121U, 0122U, 0123U, 0124U, 0125U, 0126U, 0127U, 0128U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U

Revisions From MA00.030n:
07/01/2019This policy has been identified for the Quarterly Code Update. This version of the policy will become effective 07/01/2019.

The following CPT codes have been added to this policy:
0084U, 0085U, 0086U, 0087U, 0088U, 0089U, 0090U, 0091U, 0092U, 0093U, 0094U, 0095U, 0096U, 0097U, 0098U, 0099U, 0100U, 0101U, 0102U, 0103U, 0104U

Revisions From MA00.030m:
01/01/2019This version of the policy will become effective 01/01/2019.

The following CPT codes have been deleted from this policy:
81211, 81213, 81214

The following CPT codes have been added to this policy:
81163, 81164, 81165, 81166, 81167, 81171, 81172, 81173, 81174, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81204, 81233, 81234, 81236, 81237, 81239, 81271, 81274, 81284, 81285, 81286, 81289, 81305, 81306, 81312, 81320, 81329, 81333, 81336, 81337, 81343, 81344, 81345, 81443, 81518, 81596, 82642, 83722, 0080U, 0081U, 0082U, 0083U

The following CPT code narratives have been revised in this policy:
81162, 81212, 81215, 81216, 81217, 81244, 81287, 81327

Revisions From MA00.030l:
01/01/2018This policy has been identified for the CPT/HCPCS code update.

The following LAB CPT codes have been added to Attachment A1 of this policy, effective 01/01/2018:

0011M, 0024U, 0025U, 0026U, 0027U, 0028U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0500T, 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81175, 81176, 81230, 81231, 81232, 81238, 81247, 81248, 81249, 81258, 81259, 81269, 81283, 81328, 81334, 81335, 81346, 81361, 81362, 81363, 81364, 81448, 81520, 81521, 81541, 81551, 86794, 87634, 87662, 86008

The following LAB CPT codes have been deleted from this policy, effective 12/31/2017:

83499, 84061, 86185, 86243, 86378, 86729, 86822, 87277, 87470, 87477, 87515, 88154

The following LAB code narratives have been revised in this policy, effective 01/01/2018:

80305, 80306, 80307, 81257, 81432, 81439, 82042, 82043, 82044, 86003, 86005

Revisions From MA00.030k:
12/01/2017Participating Physician Assistants (PAs) practicing within the scope of their license may be eligible for reimbursement at a non-capitated site when rendered by specific specialists for services listed in Attachment B1.

Revisions From MA00.030j:
10/01/2017This policy has been identified for the Proprietary Laboratory Analyses (PLA) code update, effective 10/01/2017.

The following CPT / HCPCS codes have been added to this policy: 0022U, 0023U

Revisions From MA00.030i:
08/21/2017 This policy has been identified for the Proprietary Laboratory Analyses (PLA) code update, effective 08/01/2017.

The following CPT / HCPCS codes have been added to this policy:

0012U, 0016U, 0017U

Revisions From MA00.030h:
08/01/2017Participating Certified Registered Nurse Practitioners (CRNPs) practicing within the scope of their license may be eligible for reimbursement at a non-capitated site when rendered by specific specialists for services listed in Attachment B1.

Revisions From MA00.030g:
02/01/2017This policy has been identified for the Proprietary Laboratory Analyses (PLA) code update, effective 02/01/2017.

The following CPT / HCPCS codes have been added to this policy:
0001U, 0002U, 0003U

Revisions From MA00.030f:
01/01/2017This policy has been identified for the CPT code update.

The following CPT codes have been added to this policy, effective 01/01/2017: 80305, 80306, 80307, 81327, 81413, 81414, 81422, 81439, 81539, 84410, 87483, G0659

The following CPT codes has been deleted from this policy, effective 12/31/2016: 80300, 80301, 80302, 80303, 80304, 81280, 81281, 81282

The following CPT codes have narrative revisions, effective 01/01/2017: 83015, 83018, 83704, 87147, 87197, 87253

Revisions From MA00.030e:
01/01/2016This policy has been identified for the CPT code update effective 01/01/2016.

The following codes have been added: 80081, 81490, 81493, 81525, 81528, 81535, 81536, 81538, 81540, 81545, 81595, 88350, 0423T, G0475, G0476, G0477, G0478, G0479, G0480, G0481, G0482, G0483, 81162, 81170, 81218, 81219, 81272, 81273, 81276, 81311, 81314, 81412, 81432, 81433, 81434, 81437, 81438, 81442

The following codes have been termed: 82486, 82487, 82488, 82489, 82491, 82541, 82543, 82544, 83788, 88347, 0103T, S3721, S3854, S3890, G0431, G0434

Revisions From MA00.030d:
12/01/2015The following CPT code has been termed from this policy, effective 11/30/2015:

86580

Per Steering committee, decision was made to term from MA00.030d and add to MA00.033b: Services Paid Above Capitation for Health Maintenance Organization (HMO) Primary Care Physicians.

86580 is NOT a lab – it is a diagnostic test – even though it has a 8000 series code.

Revisions From MA00.030c:
07/01/2015This policy has been identified for CPT code update, effective 07/01/2015.

The following CPT codes been added to this policy: 0009M, 0010M

Revisions From MA00.030b:
03/01/2015Policy MA00.030a has been revised. The policy will be reissued as MA00.030b effective 04/08/2015.
  • The specialty, Interventional Cardiology, is a new specialty effective 01/01/2015. The specialty was added to this policy to correspond with Cardiology
  • Added service code 83880 effective 12/10/2014.

Revisions From MA00.030a:
01/02/2015Policy # MA00.030 has been identified for the 2015 annual CPT code update. The policy will be reissued as MA00.030a.

The following codes have been deleted from Attachments A1/A2:
80100, 80101, 80102, 80103, 80104, 80152, 80154, 80160, 80166, 80172, 80174, 80182, 80196, 80440, 82000, 82003, 82055, 82101, 82145, 82205, 82520, 82646, 82649, 82651, 82654, 82666, 82690, 82742, 82953, 82975, 82980, 83008, 83055, 83071, 83634, 83805, 83840, 83858, 83866, 83887, 83925, 84022, 84127, 87001, 87620, 87621, 87622, 88343, 88349, G0417, G0418, G0419, G0461,G0462

The following codes have been revised from Attachments A1/A2:
80162, 80164, 80171, 80299, 81245, 82541, 82542, 82543, 82544, 84600, 86900, 86901, 86902, 86904, 86905, 86906, 87501, 87502, 87503, 87631, 87632, 87633, 88342, 88360, 88361, 88365, 88367, 88368, G0416

The following codes have been added from Attachments A1/A2:
80163, 80165, 80300, 80301, 80302, 80303, 80304, 80320, 80321, 80322, 80323, 80324, 80325, 80326, 80327, 80328, 80329, 80330, 80331, 80332, 80333, 80334, 80335, 80336, 80337, 80338, 80339, 80340, 80341, 80342, 80343, 80344, 80345, 80346, 80347, 80348, 80349, 80350, 80351, 80352, 80353, 80354, 80355, 80356, 80357, 80358, 80359, 80360, 80361, 80362, 80363, 80364, 80365, 80366, 80367, 80368, 80369, 80370, 80371, 80372, 80373, 80374, 80375, 80376, 80377, 81246, 81288, 81313, 81410, 81411, 81415, 81416, 81417, 81420, 81425, 81426, 81427, 81430, 81431, 81435, 81436, 81440, 81445, 81450, 81455, 81460, 81465, 81470, 81471, 81519, 83006, 87505, 87506, 87507, 87623, 87624, 87625, 87806, 88341, 88344, 88364, 88366, 88369, 88373, 88374, 88377, G0464, G6030, G6031, G6032, G6034, G6035, G6036, G6037, G6038, G6039, G6040, G6041, G6042, G6043, G6044, G6045, G6046, G6047, G6048, G6049, G6050, G6051, G6052, G6053, G6054, G6055, G6056, G6057, G6058

Revisions From MA00.030:
01/01/2015This is a new policy.

1/1/2026
2/3/2026
MA00.030
Claim Payment Policy Bulletin
Medicare Advantage
{"771": {"Id":771,"MPAttachmentLetter":"B2","Title":"SERVICES ELIGIBLE FOR REIMBURSEMENT IN THE OUTPATIENT HOSPITAL LABORATORY","MPPolicyAttachmentInternalSourceId":10460,"PolicyAttachmentPageName":"dbeba9de-d1fd-4503-8d7c-29adbf4dfca3"},"772": {"Id":772,"MPAttachmentLetter":"A2","Title":"HCPCS CODES INCLUDED IN CAPITATION TO THE PCP'S DESIGNATED LABORATORY SITE","MPPolicyAttachmentInternalSourceId":10461,"PolicyAttachmentPageName":"228bf5e6-4f4c-4227-b23c-c402ac8177a4"},"773": {"Id":773,"MPAttachmentLetter":"B1","Title":"SERVICES ELIGIBLE FOR REIMBURSEMENT WHEN PERFORMED IN THE SPECIALIST OFFICE (THIS INCLUDES THE CERTIFIED REGISTERED NURSE PRACTITIONER (CRNP) AND PHYSICIAN ASSISTANT (PA) PRACTICING WITHIN THE SCOPE OF THEIR SPECIALTY)","MPPolicyAttachmentInternalSourceId":10462,"PolicyAttachmentPageName":"9a075840-7b83-4bce-9a64-2bd3320bd2b9"},"774": {"Id":774,"MPAttachmentLetter":"A1","Title":"CPT CODES INCLUDED IN CAPITATION TO THE PCP'S DESIGNATED LABORATORY SITE","MPPolicyAttachmentInternalSourceId":10463,"PolicyAttachmentPageName":"cfc0fe22-ea9c-41c1-b4b6-21f0ff2d6505"},}
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