Name:
Absolute Leukocyte Count
PHL Test Code:
ABS
CPT Coding:
85048
Medical Necessity Documentation:
Blood Count ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Activated Partial Thromboplastin Time
PHL Test Code:
PTT
CPT Coding:
85730
Medical Necessity Documentation:
APTT ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Allergy Panel 1
PHL Test Code:
FWP1
CPT Coding:
86003 x 11
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Allergy Panel 2
PHL Test Code:
FWP2
CPT Coding:
86003 x 12
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Allergy Panel 3
PHL Test Code:
FWP3
CPT Coding:
86003 x 9
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Almond IgE, Allergen
PHL Test Code:
AG46
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Alpha Lactalbumin IgE, Allergen
PHL Test Code:
AG66
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Alpha-Fetoprotein Quad Screen, 2.5 MoM
PHL Test Code:
XQUAD
CPT Coding:
82105, 82677, 84702, 86336
Medical Necessity Documentation:
AFP ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
HCG ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Alpha-Fetoprotein Triple Marker Screen 2.0 MoM
PHL Test Code:
TR2A
CPT Coding:
82105, 82677, 84702
Medical Necessity Documentation:
AFP ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
HCG ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Alpha-Fetoprotein Tumor Marker
PHL Test Code:
AFPTM
CPT Coding:
82105
Medical Necessity Documentation:
AFP ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Alternaria alternata/tenuis IgE, Allergen
PHL Test Code:
AG19
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
American Beech IgE, Allergen
PHL Test Code:
AG91
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
AMI Panel
PHL Test Code:
AMI
CPT Coding:
83735, 84484, 85027, 85610, 85730 (Reflexes 85008)
Medical Necessity Documentation:
APTT ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
Hemogram ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
Magnesium ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
PT ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Amphetamines, Urine
PHL Test Code:
UAMPO
CPT Coding:
80101 (G0431 for Medicare)
Medical Necessity Documentation:
Amphetamines ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Ampicilloyl IgE, Allergen
PHL Test Code:
AGAP
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Animal Allergen Panel
PHL Test Code:
ANIM
CPT Coding:
86003 x 4
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Apple IgE, Allergen
PHL Test Code:
AG47
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Arthritis Profile Comprehensive
PHL Test Code:
ARTPC
CPT Coding:
82310, 84075, 84100, 84520, 84550, 85652, 86038, 86063, 86140, 86200, 86430 (Reflex 86039)
Medical Necessity Documentation:
ESR ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Aspergillus fumigatus IgE, Allergen
PHL Test Code:
AG20
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Aspergillus niger IgE, Allergen
PHL Test Code:
AG150
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Aubergine Eggplant, IgE Allergen
PHL Test Code:
AG196
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Aureobasidium Pullulans IgE, Allergen
PHL Test Code:
AG27
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Avocado IgE, Allergen
PHL Test Code:
AG201
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Bahia Grass IgE, Allergen
PHL Test Code:
AG11
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Banana IgE, Allergen
PHL Test Code:
AG48
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Barbiturates, Urine
PHL Test Code:
UBARO
CPT Coding:
80101 (G0431 for Medicare)
Medical Necessity Documentation:
Barbiturates ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Barley IgE, Allergen
PHL Test Code:
AG49
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Basil IgE, Allergen
PHL Test Code:
AG119
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Beef IgE, Allergen
PHL Test Code:
AG50
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Benzodiazephine, Urine
PHL Test Code:
UBENO
CPT Coding:
80101 (G0431 for Medicare)
Medical Necessity Documentation:
Benzodiazephine ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Bermuda Grass IgE, Allergen
PHL Test Code:
AG12
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Beta-2 Microglobulin
PHL Test Code:
BE2MC
CPT Coding:
82232
Medical Necessity Documentation:
Beta2 ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Beta-2 Microglobulin, Urine
PHL Test Code:
B2MCU
CPT Coding:
82232
Medical Necessity Documentation:
Beta2 ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Blackberry IgE, Allergen
PHL Test Code:
AG194
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Blue Mussel IgE, Allergen
PHL Test Code:
AG151
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Blueberry IgE, Allergen
PHL Test Code:
AG156
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Box Elder IgE, Allergen
PHL Test Code:
AG94
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Brazil Nut IgE, Allergen
PHL Test Code:
AG130
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Broccoli IgE, Allergen
PHL Test Code:
AG166
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Bumble Bee Venom IgE, Allergen
PHL Test Code:
AG10
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cabbage IgE, Allergen
PHL Test Code:
AG206
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cacao (Chocolate) IgE, Allergen
PHL Test Code:
AG57
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Calcium, Ionized
PHL Test Code:
CAION
CPT Coding:
82330
Medical Necessity Documentation:
Ionized Calcium ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Calcium, Ionized - Post Filter
PHL Test Code:
CAIPO
CPT Coding:
82330
Medical Necessity Documentation:
Ionized Calcium ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Calcium, Ionized - Pre Filter
PHL Test Code:
CAIPR
CPT Coding:
82330
Medical Necessity Documentation:
Ionized Calcium ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cancer Antigen 125
PHL Test Code:
C1251
CPT Coding:
86304
Medical Necessity Documentation:
CA 125 ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cancer Antigen 19-9
PHL Test Code:
CA199
CPT Coding:
86301
Medical Necessity Documentation:
CA19-9 ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cancer Antigen 27-29
PHL Test Code:
CA27
CPT Coding:
86300
Medical Necessity Documentation:
CA 27-29 ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Candida albicans IgE, Allergen
PHL Test Code:
AG21
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cannabinoid, Urine
PHL Test Code:
UCANO
CPT Coding:
80101 (G0431 for Medicare)
Medical Necessity Documentation:
Cannabinoid ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Carcinoembryonic Antigen
PHL Test Code:
CEA
CPT Coding:
82378
Medical Necessity Documentation:
CEA ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Carcinoembryonic Antigen, Fluid
PHL Test Code:
FCEA
CPT Coding:
82378
Medical Necessity Documentation:
CEA ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cardiac Stat Panel
PHL Test Code:
CARDC
CPT Coding:
80048, 82550, 84484, 85025 (Reflex 85007, 85008)
Medical Necessity Documentation:
Hemogram w/ Diff ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Carrot IgE, Allergen
PHL Test Code:
AG51
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Casein IgE, Allergen
PHL Test Code:
AG52
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cashew Nut IgE, Allergen
PHL Test Code:
AG53
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cat Epithelium/Dander IgE, Allergen
PHL Test Code:
AG1
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cayenne Pepper IgE, Allergen
PHL Test Code:
AG120
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cedar IgE, Allergen
PHL Test Code:
AG198
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Celery IgE, Allergen
PHL Test Code:
AG54
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cephalosporin IgE, Allergen
PHL Test Code:
AG137
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cheese Mold Type IgE, Allergen
PHL Test Code:
AG167
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cheese, Cheddar Type IgE, Allergen
PHL Test Code:
AG55
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Chicken Feathers IgE, Allergen
PHL Test Code:
AG2
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Chicken Meat IgE, Allergen
PHL Test Code:
AG56
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cholesterol
PHL Test Code:
CHOL
CPT Coding:
82465
Medical Necessity Documentation:
Cholesterol ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cholesterol, Fluid
PHL Test Code:
FCHOL
CPT Coding:
82465
Medical Necessity Documentation:
Cholesterol ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cinnamon IgE, Allergen
PHL Test Code:
AG169
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cladosporium herbarum IgE, Allergen
PHL Test Code:
AG22
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Clam IgE, Allergen
PHL Test Code:
AG58
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Coag Profile
PHL Test Code:
COAG
CPT Coding:
85049, 85610, 85730, 85384
Medical Necessity Documentation:
APTT ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
PT ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
Blood Count ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cocaine, Urine
PHL Test Code:
UCOCO
CPT Coding:
80101 (G0431 for Medicare)
Medical Necessity Documentation:
Cocaine ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cocklebur IgE, Allergen
PHL Test Code:
AG32
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cocksfoot (Orchard Grass) IgE, Allergen
PHL Test Code:
AG16
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Coconut IgE, Allergen
PHL Test Code:
AG161
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Codfish IgE, Allergen
PHL Test Code:
AG59
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Coffee IgE, Allergen
PHL Test Code:
AG171
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Collagen Profile
PHL Test Code:
COLL
CPT Coding:
85025, 85652, 86038, 86140, 86430 (Reflexes 85007, 85008, 86039, 86431)
Medical Necessity Documentation:
Hemogram w/ Diff ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
ESR ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Common Ragweed, IgE Allergen
PHL Test Code:
AG108
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Common Silver Birch IgE, Allergen
PHL Test Code:
AG92
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Complete Blood Count
PHL Test Code:
CBCND
CPT Coding:
85027 (Reflexes 85008)
Medical Necessity Documentation:
Hemogram ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Complete Blood Count with Differential
PHL Test Code:
CBCWD
CPT Coding:
85025 (Reflex 85007, 85008)
Medical Necessity Documentation:
Hemogram w/ Diff ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Corn (Pollen) IgE, Allergen
PHL Test Code:
MSOT
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Corn IgE, Allergen
PHL Test Code:
AG60
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cotton Seed IgE, Allergen
PHL Test Code:
AG178
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cottonwood IgE, Allergen
PHL Test Code:
AG95
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cow Dander IgE, Allergen
PHL Test Code:
AG162
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cow Milk IgE, Allergen
PHL Test Code:
AG69
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Crab IgE, Allergen
PHL Test Code:
AG61
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cranberry IgE, Allergen
PHL Test Code:
AG170
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
C-Reactive Protein, Ultrasensitive
PHL Test Code:
CRPS1
CPT Coding:
86141
Medical Necessity Documentation:
CRP ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
CTx Collagen Type I-C
PHL Test Code:
CCTX
CPT Coding:
82523
Medical Necessity Documentation:
CTx ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cucumber IgE, Allergen
PHL Test Code:
AG168
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Cumin Seed IgE, Allergen
PHL Test Code:
AG125
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Curry IgE, Allergen
PHL Test Code:
AG126
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Dermatophagoides farinae IgE, Allergen
PHL Test Code:
AG29
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Dermatophagoides pteronyssinus IgE, Allergen
PHL Test Code:
AG30
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Digoxin
PHL Test Code:
DIG
CPT Coding:
80162
Medical Necessity Documentation:
Digoxin ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Dill IgE, Allergen
PHL Test Code:
AG121
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Disseminated Intravascular Coagulation Panel
PHL Test Code:
DIC2
CPT Coding:
85049, 85379, 85384, 85610, 85730
Medical Necessity Documentation:
APTT ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
PT ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
Blood Count ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Dog Dander IgE, Allergen
PHL Test Code:
AG105
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
DPD N-Telopeptide
PHL Test Code:
DPDTP
CPT Coding:
82523
Medical Necessity Documentation:
DPD ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Drug Screen 10, Abuse
PHL Test Code:
DRU10
CPT Coding:
80101 x 10 (G0431 x 10 for Medicare)
Medical Necessity Documentation:
Drug Screen 10 ABN: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Drug Screen 10, and Expanded Opiates, Confirmation
PHL Test Code:
DRUX
CPT Coding:
80101 x 11 (G0431 for Medicare), Positives add as 82145, 82205, 80154, 82520, 82542, 83840, 82542 x 5, 83992
Medical Necessity Documentation:
Drug Screen 10 ABN: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Drug Screen 7, Triage
PHL Test Code:
UDRGS
CPT Coding:
80104
Medical Necessity Documentation:
Drug Screen 7: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Drug Screen, Clinical
PHL Test Code:
UDS
CPT Coding:
80101 x 8 (Medicare - G0431)
Medical Necessity Documentation:
Drug Screen ABN: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Duck Feathers IgE, Allergen
PHL Test Code:
AG3
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Dust Allergen Panel
PHL Test Code:
DSPNP
CPT Coding:
86003 x 5
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Eastern Midwest Panel
PHL Test Code:
EMWPP
CPT Coding:
86003 x 25
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Egg White IgE, Allergen
PHL Test Code:
AG106
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Egg Whole IgE, Allergen
PHL Test Code:
AG107
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Egg Yolk IgE, Allergen
PHL Test Code:
AG62
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
EHS Panel
PHL Test Code:
EHSP
CPT Coding:
80051, 82040, 82247, 82248, 82565, 82947, 84075, 84155, 84450, 84460, 84520, 85025 (Reflex 85007, 85008)
Medical Necessity Documentation:
Hemogram w/ Diff ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
Glucose ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Electron Microscopy, Renal Biopsy
PHL Test Code:
PS
CPT Coding:
88348, 88305, 88346
Medical Necessity Documentation:
Electronic Microscopy ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Electron Microscopy, Tissue
PHL Test Code:
PS
CPT Coding:
88348, (Based on tissue type - 88302, 88304, 88305, 88307, 88309)
Medical Necessity Documentation:
Electronic Microscopy ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Elm IgE, Allergen
PHL Test Code:
AG96
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Enteric Allergen Panel
PHL Test Code:
ENTWT
CPT Coding:
86003 x 16, 82785
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Erythromycin IgE, Allergen
PHL Test Code:
AG136
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
False Ragweed IgE, Allergen
PHL Test Code:
AG39
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Ferritin
PHL Test Code:
FER
CPT Coding:
82728
Medical Necessity Documentation:
Ferritin ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Fibro Panel
PHL Test Code:
FIBRO
CPT Coding:
Refer to Individual Tests
Medical Necessity Documentation:
ESR - For acceptable narrative descriptions and ICD-9 information see Addendum C
Glucose - For acceptable narrative descriptions and ICD-9 information see Addendum C
MG - For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Fibro Panel no Urine
PHL Test Code:
FIBNU
CPT Coding:
Refer to Individual Tests
Medical Necessity Documentation:
ESR - For acceptable narrative descriptions and ICD-9 information see Addendum C
Glucose - For acceptable narrative descriptions and ICD-9 information see Addendum C
MG - For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Fire Ant IgE, Allergen
PHL Test Code:
AG9
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Firebush, Kochia IgE, Allergen
PHL Test Code:
AG35
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Flounder IgE, Allergen
PHL Test Code:
AG116
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Fluorescent Treponemal Antibody
PHL Test Code:
FTA
CPT Coding:
86780
Medical Necessity Documentation:
FTA- ABS ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Food Allergy Panel
PHL Test Code:
FD10P
CPT Coding:
86003 x 10
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Fructosamine
PHL Test Code:
FRUC
CPT Coding:
82985
Medical Necessity Documentation:
Fructosamine ABN: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Gamma-Glutamyl Transferase
PHL Test Code:
GGT
CPT Coding:
82977
Medical Necessity Documentation:
GGT ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Garlic IgE, Allergen
PHL Test Code:
AG63
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
General Health Panel
PHL Test Code:
GHP1
CPT Coding:
80053, 84443, 85025 (Reflex 85007, 85008)
Medical Necessity Documentation:
Hemogram w/ Diff ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
TSH ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
German Cockroach IgE, Allergen
PHL Test Code:
AG8
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Giant Ragweed IgE, Allgergen
PHL Test Code:
AG40
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Ginger IgE, Allergen
PHL Test Code:
AG124
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Glucose
PHL Test Code:
GLU
CPT Coding:
82947
Medical Necessity Documentation:
Glucose ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Glucose Diabetes Screening
PHL Test Code:
GTTDM
CPT Coding:
82947, 82950
Medical Necessity Documentation:
Glucose ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Glucose Post Prandial
PHL Test Code:
GLPP
CPT Coding:
82947
Medical Necessity Documentation:
Glucose ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Glucose, 4 PM
PHL Test Code:
GLU4P
CPT Coding:
82947
Medical Necessity Documentation:
Glucose ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Gluten IgE, Allergen
PHL Test Code:
AG64
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Glycohemoglobin
PHL Test Code:
GLYCO
CPT Coding:
83036
Medical Necessity Documentation:
Glyco ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Goldenrod IgE, Allergen
PHL Test Code:
AG34
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Goose Feathers IgE, Allergen
PHL Test Code:
AG4
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Goosefoot, Lambs Quarters IgE, Allergen
PHL Test Code:
AG36
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Grape IgE, Allergen
PHL Test Code:
AG181
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Grapefruit IgE, Allergen
PHL Test Code:
AG207
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Great Lakes Panel
PHL Test Code:
GLWG
CPT Coding:
86003 x 10
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Green Bean IgE, Allergen
PHL Test Code:
AG200
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Green Pepper IgE, Allergen
PHL Test Code:
AG183
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Guinea Pig Epithelium IgE, Allergen
PHL Test Code:
AG155
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Halibut IgE, Allergen
PHL Test Code:
AG114
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hazel IgE, Allergen
PHL Test Code:
AG177
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hazel Nut IgE, Allergen
PHL Test Code:
AG65
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
hCG Tumor Marker
PHL Test Code:
HCGTM
CPT Coding:
84702
Medical Necessity Documentation:
HCG ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Helminthosporium Halodes IgE, Allergen
PHL Test Code:
AG133
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Helminthosporium sativum/drecshlera IgE, Allergen
PHL Test Code:
AG23
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hematocrit
PHL Test Code:
HCT
CPT Coding:
85014
Medical Necessity Documentation:
Hematocrit ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hematocrit, Fluid
PHL Test Code:
FHCT
CPT Coding:
85013
Medical Necessity Documentation:
Hematocrit Micro ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hematocrit, Micro
PHL Test Code:
MHCT
CPT Coding:
85013
Medical Necessity Documentation:
Hematocrit Micro ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hemoglobin
PHL Test Code:
HGB
CPT Coding:
85018
Medical Necessity Documentation:
Hemoglobin ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hemoglobin and Hematocrit
PHL Test Code:
HH
CPT Coding:
85014, 85018
Medical Necessity Documentation:
H & H ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis A Antibody, Total with reflex IgM
PHL Test Code:
HEPR
CPT Coding:
86708 (Reflex 86709)
Medical Necessity Documentation:
HAV Total w/Reflex IgM ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis A IgM Antibody
PHL Test Code:
HAV
CPT Coding:
86709
Medical Necessity Documentation:
HAV IgM ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis A Virus Total Antibodies
PHL Test Code:
HEPA2
CPT Coding:
86708
Medical Necessity Documentation:
HAV ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis B Core Antibody IgM
PHL Test Code:
HBCAB
CPT Coding:
86705
Medical Necessity Documentation:
HBCAB IgM ABN FORM: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis B Core Total Antibody
PHL Test Code:
HBCOR
CPT Coding:
86704
Medical Necessity Documentation:
HBCAB ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis B Surface Antibody
PHL Test Code:
HBSAB
CPT Coding:
86706
Medical Necessity Documentation:
HBSAB ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis B Surface Antigen
PHL Test Code:
HBSAG
CPT Coding:
87340 (Reflexes 87341)
Medical Necessity Documentation:
HBSAG ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis Be Antibody
PHL Test Code:
HBEAB
CPT Coding:
86707
Medical Necessity Documentation:
HBEAB ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis Be Antigen
PHL Test Code:
HBEAG
CPT Coding:
87350
Medical Necessity Documentation:
For acceptable narrative descriptions and ICD-9 information see Addendum C
HBEAG ABN Form
|
Name:
Hepatitis C Antibody
PHL Test Code:
HEPC3
CPT Coding:
86803
Medical Necessity Documentation:
HCV ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis Immunity Panel
PHL Test Code:
HEPIM
CPT Coding:
86704, 86706
Medical Necessity Documentation:
Hep Imm Panel ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hepatitis Panel
PHL Test Code:
HEP3
CPT Coding:
80074
Medical Necessity Documentation:
Hepatitis Panel: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
High Density Lipoprotein
PHL Test Code:
HDL
CPT Coding:
83718
Medical Necessity Documentation:
HDL ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
HIV 1 & 2 Antibody
PHL Test Code:
HIV
CPT Coding:
86703 (Reactive 86689)
Medical Necessity Documentation:
HIV ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
HIV 1 Antibodies Confirmation
PHL Test Code:
WESBL
CPT Coding:
86689
Medical Necessity Documentation:
Western Blot ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
HIV 1 DNA, Qualitative
PHL Test Code:
HVPC1
CPT Coding:
87535
Medical Necessity Documentation:
HIV PCR ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
HIV 1 RNA bDNA, Ultrasensative Quantitation
PHL Test Code:
HIVL
CPT Coding:
87536
Medical Necessity Documentation:
HIV Prognosis ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
HIV Rapid
PHL Test Code:
HIVR
CPT Coding:
86703
Medical Necessity Documentation:
HIV ABN: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Homocysteine
PHL Test Code:
HCYS1
CPT Coding:
83090
Medical Necessity Documentation:
Homocysteine ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Honey, IgE Allergen
PHL Test Code:
AG197
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Honeybee Venom IgE, Allergen
PHL Test Code:
AG110
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Horse Dander IgE, Allergen
PHL Test Code:
AG5
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
House Dust - Hollister Stier IgE, Allergen
PHL Test Code:
AG160
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
House Dust-Greer IgE, Allergen
PHL Test Code:
AG31
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
HTLV I/II Antibody, w/Reflex to Confirmatory Assay
PHL Test Code:
HTLVP
CPT Coding:
86790 (reflexes 86689)
Medical Necessity Documentation:
HIV Abn: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Human Chorionic Gonadotropin, Quantitative
PHL Test Code:
HCGQ
CPT Coding:
84702
Medical Necessity Documentation:
HCG ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Hyper Alimentation Panel
PHL Test Code:
HYPAL
CPT Coding:
80051, 82310, 83735, 84100
Medical Necessity Documentation:
Magnesium ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Immunoperoxidase Stains
PHL Test Code:
PS
CPT Coding:
88342 per stain
Medical Necessity Documentation:
Immunoperoxidase Stain ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Inflammatory Group 1 with Westergren Sed Rate
PHL Test Code:
INFLP
CPT Coding:
86038, 86140, 86430, 86060, 84550, 85652 (Reflex 86039)
Medical Necessity Documentation:
ESR ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Inhalant Panel
PHL Test Code:
ENTP
CPT Coding:
86003 x 16, 82785
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Iron
PHL Test Code:
IRON
CPT Coding:
83540
Medical Necessity Documentation:
Iron ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Iron Deficiency Panel
PHL Test Code:
IDP
CPT Coding:
82728, 83540, 83550
Medical Necessity Documentation:
Iron Deficincy Panel ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Iron Profile
PHL Test Code:
IRONP
CPT Coding:
83540, 83550
Medical Necessity Documentation:
Iron Panel ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Johnson Grass IgE, Allergen
PHL Test Code:
AG13
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Kiwi IgE, Allergen
PHL Test Code:
AG163
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Latex IgE
PHL Test Code:
LATX
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
LDL, Direct Measure
PHL Test Code:
LDL
CPT Coding:
83721
Medical Necessity Documentation:
LDL ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Lemon IgE, Allergen
PHL Test Code:
AG204
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Lettuce IgE, Allergen
PHL Test Code:
AG67
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Lima Bean IgE, Allergen
PHL Test Code:
AG175
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Lipid Profile
PHL Test Code:
LIPID
CPT Coding:
80061 (Reflex 83721)
Medical Necessity Documentation:
Lipid Profile ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Lipoprotein Electrophoresis
PHL Test Code:
LIPE
CPT Coding:
82465, 83700, 84478
Medical Necessity Documentation:
Lipoprotein Electrophoresis: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Liver Profile
PHL Test Code:
LIVER
CPT Coding:
80076
Medical Necessity Documentation:
Liver Profile ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Lobster IgE, Allergen
PHL Test Code:
AG68
CPT Coding:
86003
Medical Necessity Documentation:
Rast Testing: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
LSD Screen, Urine
PHL Test Code:
LSDUR
CPT Coding:
80101
Medical Necessity Documentation:
LSD ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
|
Name:
Macadamia Nut IgE, Allergen
PHL Test Code:
AG185
CPT Coding:
86003
Medical Necessity Documentation:
|