CurrentBlue Cross Blue Shield - NevadaPolicy N/A
Physician office approved laboratory test list
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Lists CPT/HCPCS laboratory tests approved for physician office reimbursement for Anthem (Connecticut commercial) and states that reimbursement is only available if the member benefit covers the test. Affects providers submitting outpatient/physician office lab claims.
Policy Summary
PayerBlue Cross Blue Shield - Nevada
PolicyPhysician office approved laboratory test list
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateNov 1, 2025
Next Review DateN/A
Key ActionReimbursement is only available if the member's contract covers the benefit; ensure benefit eligibility before billing.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
~200+listed CPT/HCPCS test codes
Nov 1, 2025effective date
CT (Commercial)jurisdiction
IncludedSARS-CoV-2 tests
Coverage and Approved Tests
Coverage conditions
Reimbursement condition and applicability
Reimbursement is available only if the test is a covered benefit under the member's contract.
Medical Policy edits will apply to coverage and reimbursement.
Approved test list
Approved tests for physician office reimbursement (CPT/HCPCS codes listed are approved when billed from physician office locations; unit/quantity qualifiers shown in the source apply where indicated).
Approved codes list
- 80050 — GENERAL HEALTH PANEL
- 80053 — COMPREHENSIVE METABOLIC PANEL
- 80055 — OBSTETRIC PANEL
- 80074 — ACUTE HEPATITIS PANEL
- 80076 — HEPATIC FUNCTION PANEL
- 80081 — OBSTETRIC PANEL INCLUDES HIV TESTING
- 80145 — DRUG ASSAY ADALIMUMAB
- 80155 — DRUG ASSAY CAFFEINE
- 80159 — DRUG ASSAY CLOZAPINE
- 80165 — DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE
- 80171 — DRUG SCREEN QUANTITATIVE GABAPENTIN
- 80175 — DRUG SCREEN QUANTITATIVE LAMOTRIGINE
- 80177 — DRUG SCREEN QUANTITATIVE LEVETIRACETAM
- 80180 — DRUG SCREEN QUANTITATIVE MYCOPHENOLATE
- 80181 — DRUG ASSAY FLECAINIDE
- 80183 — DRUG SCREEN QUANTITATIVE OXCARBAZEPINE
- 80201 — DRUG SCREEN QUANTITATIVE TOPIRAMATE
- 80202 — DRUG SCREEN QUANTITATIVE VANCOMYCIN
- 80203 — DRUG SCREEN QUANTITATIVE ZONISAMIDE
- 80230 — DRUG ASSAY INFLIXIMAB
- 80235 — DRUG ASSAY LACOSAMIDE
- 80299 — QUANTITATION DRUG NOT ELSEWHERE SPECIFIED
- 80306 — DRUG TEST PRESUMPTIVE READ INSTRUMENT ASSORTED DIRECT OPTICAL OBS
- 80307 — DRUG TEST PRESUMPTIVE INSTRUMENT CHEMICAL ANALYZERS
- 80329 — DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2
- 80330 — DRUG SCREEN ANALGESICS NON-OPIOID 3-5
- 80345 — DRUG SCREENING BARBITURATES
- 80346 — DRUG SCREENING BENZODIAZEPINES
- 80347 — DRUG SCREENING BENZODIAZEPINES 13 OR MORE
- 80348 — DRUG SCREENING BUPRENORPHINE
- 80355 — DRUG SCREENING GABAPENTIN NON-BLOOD (1)
- 80365 — DRUG SCREENING OXYCODONE (1)
- 80373 — DRUG SCREENING TRAMADOL (1)
- 80375 — DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 (1)
- 80377 — DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE (1)
- 81000 — URINALYSIS; BY DIP STICK OR TABLET REAGENT; NON-AUTOMATED, WITH MICROSCOPY (1)
- 81002 — URINALYSIS, NON-AUTOMATED, WITHOUT MICROSCOPY (1)
- 81003 — URINALYSIS, AUTOMATED, WITHOUT MICROSCOPY (1)
- 81005 — URINALYSIS, QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS (1)
- 81007 — URINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE OR DIPSTICK (1)
- 81025 — URINE PREGNANCY TEST (VISUAL COLOR COMPARISON METHODS) (1)
- 81517 — LIVER DISEASE ANALYSIS 3 BIOMARKERS IA SRM PROGNOSTIC ALGORITHM (1)
- 82009 — KETONE BODIES QUALITATIVE (1)
- 82075 — ASSAY OF ALCOHOL (ETHANOL) BREATH (1)
- 82270 — OCCULT BLOOD BY PEROXIDASE (GUIAC), FECES 1-3
- 82274 — OCCULT BLOOD BY IMMUNOASSAY, FECES 1-3 (effective 9/1/10) (1)
- 82803 — BLOOD GASES (for pulmonologists only) (1)
- 82947 — GLUCOSE; QUANTITATIVE, BLOOD (1)
- 82948 — GLUCOSE; BLOOD REAGENT STRIP (1)
- 82962 — GLUCOSE; BLOOD BY FDA-CLEARED HOME MONITORING DEVICE (1)
- 83036 — HEMOGLOBIN; GLYCATED (1)
- 83986 — PH, BODY FLUID, EXCEPT BLOOD (1)
- 85002 — BLEEDING TIME (1)
- 85007 — BLOOD COUNT; SMEAR WITH MANUAL DIFFERENTIAL (1)
- 85013 — SPUN MICROHEMATOCRIT (1)
- 85014 — HEMATOCRIT (HCT) (1)
- 85018 — HEMOGLOBIN (HGB) (1)
- 85025 — COMPLETE BLOOD COUNT (CBC) AUTOMATED (1)
- 85097 — BONE MARROW SMEAR INTERPRETATION (1)
- 86403 — PARTICLE AGGLUTINATION SCREEN, EACH ANTIBODY (1)
- 86580 — SKIN TEST: TUBERCULOSIS, INTRADERMAL (1)
- 86585 — SKIN TEST: TUBERCULOSIS, TINE TEST (1)
- 87081 — PRESUMPTIVE CULTURE, PATHOGENIC ORGANISMS, SCREENING ONLY (1)
- 87210 — SMEAR WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS (1)
- 87220 — TISSUE EXAMINATION BY KOH SLIDE (1)
- 87430 — INFECTIOUS AGENT ANTIGEN DETECTION BY EIA, QUALITATIVE; MULTI-STEP (1)
- 87802 — INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY; STREPTOCOCCUS GROUP B (1)
- 87804 — INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY; INFLUENZA (1)
- 87880 — INFECTIOUS AGENT DETECTION BY IMMUNOASSAY; STREPTOCOCCUS GROUP A (1)
- 88738 — TRANSCUTANEOUS HEMOGLOBIN (HGB) QUANTITATIVE (1)
- 89060 — CRYSTAL IDENTIFICATION BY LIGHT MICROSCOPY (1)
- 89260 — SPERM ISOLATION; SIMPLE PREP (1)
- 89261 — SPERM ISOLATION; COMPLEX PREP (1)
- 89300 — SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY (1)
- 89310 — SEMEN ANALYSIS; MOTILITY & COUNT (1)
- 89320 — SEMEN ANALYSIS; COMPLETE (1)
- 89321 — SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY (1)
- 89330 — SPERM EVALUATION; CERVICAL MUCUS PENETRATION TEST (1)
- G0328 — COLORECTAL CANCER SCREENING; FOBT IMMUNO 1-3 SIMULTANEOUS (1)
- G0480 — DRUG TEST DEFINITIVE DRUG ID METHOD P DAY 1-7
- G0481 — DRUG TEST DEFINITIVE DRUG ID METHOD P DAY 8-14
- G0482 — DRUG TEST DEFINITIVE DRUG ID METHOD P DAY 15-21
- G0659 — DRUG TEST DEFINITIVE DRUG ID METHOD ANY # DRUG CLASSES (1)
- P9016 — RED BLOOD CELLS LEUKOCYTES REDUCED EACH UNIT (1)
- Q0111 — WET MOUNTS INCLUDING PREP VAGINAL/CERVICAL/SKIN SPECIMENS (1)
- Q0114 — FERN TEST (1)
- U0002 — 2019‑NCOV CORONAVIRUS SARS‑COV‑2/2019‑NCOV (1)
Unit/quantity qualifiers (e.g., '1', '1-3', '13 OR MORE') are included in the source list where specified and apply to reimbursement as shown.
Physician Office Laboratory CPT/HCPCS Codes
Unit / quantity notes
Quantity qualifiers presentSome CPT/HCPCS lines include numeric quantity or grouping qualifiers such as '1', '1-3', and '7/MORE' as shown in the listed codes (e.g., 80355 = 1, 80375 = 1-3, 80377 = 7/MORE).
Example: single-unit testsMultiple codes are specified with '1' indicating single-unit reporting (e.g., 80355, 80365, 81007, 82330).
Example: grouped testsSome panel/definitive tests are presented with a numeric range for simultaneous items (e.g., 80375 = 1-3).
Example: large-group qualifierCertain drug/substance definitive tests use '7/MORE' to indicate larger grouping (e.g., 80377 = 7/MORE).
Most actionable noteFollow the exact numeric/grouping qualifiers on the code list when billing — report the unit or group quantity shown (highlighted requirement).
Billing and Benefit Requirements
Billing Rule
Benefit coverage requirement
Reimbursement for physician office laboratory tests is available only when the test is a covered benefit under the member's contract. Medical Policy edits will apply to coverage and reimbursement effective November 1, 2025.
Scope and Reimbursement Definitions
Reimbursement contingent on member contract
Coverage dependencyReimbursement is only available if the benefit is covered under the member's contract (Effective November 1, 2025).
Medical Policy editsMedical Policy edits will apply to coverage and reimbursement decisions per the document.
Scope of effectApplies to physician office laboratory test reimbursement for Connecticut commercial lines as listed.
Physician office-approved tests (selected examples)
Physician office billing allowedThe listed CPT/HCPCS tests are approved to be performed and paid when billed from physician office locations as enumerated in the document.
Included test examplesExamples from the list include glucose monitoring (82962), hemoglobin A1c (83036), urinalysis/dipstick entries (81007), and drug screening panels (80355, 80365, 80373).
Infectious agent and culture testsApproved office-performed infectious disease tests and cultures are listed (e.g., 87210, 87220, 87430, 87081).
Hematology and chemistry examplesCommon CBC and chemistry tests included for office billing: 85025 (CBC automated), 85014 (hematocrit), 82330 (calcium ionized).
Policy Summary
PayerBlue Cross Blue Shield - Nevada
PolicyPhysician office approved laboratory test list
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateNov 1, 2025
Next Review DateN/A
Key ActionReimbursement is only available if the member's contract covers the benefit; ensure benefit eligibility before billing.
SourceLink
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