|
NCD Number
|
NCD Description
|
CPT CODE
|
Sunquest Codes
|
Frequency Limitations
|
|
190.12
|
Urine Culture, Bacterial
|
87086
|
CURINE
|
None
|
|
87088
|
|
|
190.13
|
Human Immunodeficiency Virus (HIV)Testing (Prognosis Including Monitoring)
|
87536
|
HIVIUL
|
None
|
|
87539
|
|
|
190.14
|
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
|
86689
|
HTLVA,
|
None
|
|
86701
|
HIVRA, HIV4GC
|
|
86702
|
HIV4GC
|
|
86703
|
|
|
87390
|
|
|
87391
|
|
|
87534
|
|
|
87535
|
HIP12M, HIS12M
|
|
87537
|
|
|
87538
|
HIP12M, HIS12M
|
|
190.15
|
Blood Counts
|
85004
|
|
None
|
|
85007
|
|
|
85008
|
|
|
85013
|
|
|
85014
|
HCRT, FLHCT, HGBHT
|
|
85018
|
HGBNM HGBHT
|
|
85025
|
CBCWD
|
|
85027
|
CBCND
|
|
85032
|
|
|
85048
|
EOSCNT, WBCCNT, WBCWD
|
|
85049
|
PLTCNT
|
|
190.16
|
Partial Thromboplastin Time (PTT)
|
85730
|
PTT, ANTLUP, TRRPA, AATHRM
|
None
|
|
190.17
|
Prothrombin Time (PT)
|
85610
|
PTM, AATHRM, TRRPA
|
Once (1) per week
|
|
190.18
|
Serum Iron Studies
|
82728
|
FERR, NAFL, THEVPM
|
Once (1) every three (3) months
|
|
83540
|
FE, TIBCLL, FETM
|
|
83550
|
TIBCLL
|
|
84466
|
TRANSF
|
|
190.19
|
Collagen Crosslinks, Any Method
|
82523
|
CTXM
|
Once (1) every three (3) months in first year, annually thereafter
|
|
190.2
|
Blood Glucose Testing
|
82948
|
|
Four (4) times a year
|
|
82962
|
BDGLU
|
|
82947
|
GLU, GLUF, NAFL
|
|
190.21
|
Glycated Hemoglobin/Glycated Protein
|
82985
|
FA1GPM, FRUCM
|
Once (1) every three (3) months
|
|
83036
|
GLYLMW
|
|
190.22
|
Thyroid Testing
|
84436
|
FRTUPM, T4
|
Two (2) times a year
|
|
84439
|
FRT4DM, TSH3GR, T4FREE
|
|
84443
|
TSH3G, TSH3GR
|
|
84479
|
FRTUPM, T3UTAA
|
|
190.23
|
Lipids Testing
|
83721
|
LDLD
|
Lipid Panel:
Once (1) per year
Individual components:
Six (6) times per year
|
|
83700
|
LPAWSM, LMPPM
|
|
83701
|
LPAWSM
|
|
83704
|
NMRLPM
|
|
80061
|
LIPIDP
|
|
82465
|
CHOL, LMPPM
|
|
83718
|
HDL, LMPPM
|
|
84478
|
LMPPM, TRIG, FTRIG
|
|
190.24
|
Digoxin Therapeutic Drug Assay
|
80162
|
DIG
|
None
|
|
190.25
|
Alpha-fetoprotein
|
82105
|
AFPTM, MSINT2, MSNTD, MSQUAD
|
None
|
|
190.26
|
Carcinoembryonic Antigen
|
82378
|
CEA, FCEA
|
Once (1) per chemotherapy treatment cycle or every two (2) months post-surgical treatment
|
|
190.27
|
Human Chorionic Gonadotropin
|
84702
|
HCGT, HCGQNT, MS1TRI, MSINT2, MSQUAD
|
Once (1) per month for diagnostic purposes
|
|
190.28
|
Tumor Antigen by Immunoassay CA 125
|
86304
|
CA125
|
None
|
|
190.29
|
Tumor Antigen by Immunoassay CA 15-3/CA 27.29
|
86300
|
2729M, CA153M
|
None
|
|
190.30
|
Tumor Antigen by Immunoassay CA 19-9
|
86301
|
CA199
|
None
|
|
190.31
|
Prostate Specific Antigen
|
84153
|
PSAT, PSATF
|
Once (1) year (12 months)
|
|
190.32
|
Gamma Glutamyl Transferase
|
82977
|
GGT, FIBMET
|
Once (1) per week
|
|
190.33
|
Hepatitis Panel/Acute Hepatitis Panel
|
80074
|
HBAT
|
After a hepatitis diagnosis is established, only individual tests are needed.
|
|
190.34
|
Fecal Occult Blood Test
|
82272
|
SOCBSC, SOCBD3
|
None
|