Provider Alert! Reminder – Updated- Approved in-office lab list

Provider Alert! Reminder – Updated- Approved in-office lab list

Date: September 9, 2021

Attention: All Providers

Effective date for procedure code 83655, lead screening: June 22, 2021

Call to action: Texas Children’s Health Plan (TCHP) utilizes Quest Diagnostics as our exclusive reference lab provider. This alert is to serve as a reminder of the specific labs on our pre-approved list that may be run in a network provider’s office.

How this impacts providers: Providers may perform specific lab tests in their office and receive reimbursement from TCHP. All other lab tests must be referred to Quest Diagnostics or State of Texas Laboratories. Per state regulations, laboratory specimens that are required to be sent to state laboratories for processing will continue to follow guidelines available here:

As a reminder, all genetic testing requires a prior authorization, with the exception of Cystic Fibrosis and Spinal Muscular Atrophy Screening effective June 1, 2021, even when processed by Quest Diagnostics. The prior authorization form is available here.

Effective June 22, 2021, initial blood lead testing using point-of-care testing, procedure code 83655 with modifier QW, may be billed to a THSteps visit per guidance from TMPPM, Children Services Handbook, section Providers must have a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver.

Blood lead testing is part of the encounter rates for FQHCs and RHCs and is not reimbursed separately.

Reporting all blood lead levels is a law in Texas. For more information,

Next steps for providers: Providers may only perform the following pre-approved labs in their office and bill with the correct CPT code:

CPT Test Description
83655 Lead screening
80061 Lipid Panel
81000 Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy
81001 Urinalysis with Microscopy, Automated
81002 Urnls Dip Stick/Tablet Rgnt Non-Auto w/o Micrscp
81003 Urinalysis w/o Microscopy, Automated.
81005 Urinalysis, Qualitative
81007 Urine Screen for Bacteria
81025 Urine Pregnancy Test Visual Color Cmprsn Meths
82009 Acetone or Other Ketone Bodies
82044 Urine Dipstick for Micro-Albumin
82120 Amines Vaginal Fluid Qualitative
82247 Bilirubin Total
82270 Blood Occult Peroxidase Actv Qual Feces 1 Deter
82465 Cholesterol Serum/Whole Blood Total
82731 Ftl Fibronectin Cervicovag Secretions Semi-Quan
82947 Glucose Quantitative Blood Xcpt Reagent Strip
82948 Glucose, Blood Reagent Strip
82950 Glucose Post Glucose Dose
82948 Glucose Blood Test
83036 Hemoglobin A1C
83037 Hemoglobin A1C
84112 Aminsure
84450 Transferase Aspartate Amino Ast Sgot
84460 Transferase Alanine Amino Alt Sgpt
84703 Chorionic Gonadotropin Assay
85007 Blood Count Smear Mcrscp w/Mnl Difrntl WBC Count
85013 Spun Hematocrit
85014 Blood Count Hematocrit
85018 Blood Count Hemoglobin
85025 Blood Count Complete Auto & Auto Difrntl WBC Count
85027 Blood Count Complete Automated
85048 WBC
85610 Prothrombin Time
85651 Sedimentation Rate
86308 Heterophile Antibodies Screen
86403 Particle Agglutination (Rapid Strep)
87081 Cul Prsmptv Pthgnc Organism Scrn w/Colony Estimj
87210 Smr Prim Src Wet Mount Nfct Agt
87220 KOH—tissue exam for fungi
87420 Iaad Eia Respiratory Synctial Virus-Infectious agent antigen detection by immunoassay technique
87430 Strep Screen
87800 Infectious agent detection by nucleic acid -ladna Multiple Organisms Direct Probe TQ
   For laadiado, infectious agent antigen detection by immunossay with direct optical observation for these:
87801 Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique
87804 Iaadiadoo Influenza
87807 Iaadiadoo Respiratory Synctial Virus- Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
87880 Iaadiadoo Streptococcus Group A
88720 Bilirubin Total Transcutaneous
89060 Crystal Id Light Microscopy Alys Tiss/Any Fluid
80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures
80306 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures
87502 Infectious agent detection by nucleic acid (DNA or RNA); influenza virus
87651 Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique
83036 Hemoglobin; glycosylated (A1C)
83037 Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use
87634 Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe technique


COVID-19 Testing:

Special guidance is in place during the disaster declaration period regarding COVID-19 testing; please refer to the Provider Alert that posted titled COVID-19 Testing expanded to include Out-of-Network (OON) Laboratories. Here is a link to the alert:

If you have any questions, please email Provider Network Management at:
For access to all provider alerts, log into: or


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