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Upstate Medicare Division -
2008 Clinical Laboratory Fee Schedule – New York – Area 99 - Revised 4-24-08

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2007 by the American Medical Association.

Procedure	Modifier	Fee
ATP02		$7.28
ATP03		$8.93
ATP04		$8.93
ATP05		$8.93
ATP06		$10.96
ATP07		$11.20
ATP08		$11.20
ATP09		$12.13
ATP10		$12.13
ATP11		$12.34
ATP12		$12.62
ATP16		$14.77
ATP18		$14.87
ATP19		$15.45
ATP20		$15.95
ATP21		$16.45
ATP22		$16.95
ATP23		$16.95

HCPCS	MODIFIER	FEE
G0027		$5.04
G0103		$25.70
G0123		$25.88
G0143		$25.88
G0144		$26.76
G0145		$30.72
G0147		$14.76
G0148		$14.76
G0306		$10.79
G0307		$9.04
G0328		$17.41
G0328	QW	$17.41
G0394		$4.54

HCPCS	MODIFIER	FEE
P2038		$7.02
P3000		$14.76
P9612		$3.00
P9615		$3.00

HCPCS	MODIFIER	FEE
Q0111		$5.84
Q0112		$5.96
Q0113		$2.21
Q0114		$9.99
Q0115		$13.83

HCPCS	MODIFIER	FEE
36415		$3.00

HCPCS	MODIFIER	FEE
78267		$10.98
78268		$94.11

HCPCS	MODIFIER	FEE
80047		$30.29
80048		$11.20
80051		$8.93
80053		$14.77
80061		$18.72
80061	QW	$18.72
80069		$12.13
80074		$66.54
80076		$11.20
80100		$20.32
80101		$19.24
80101	QW	$19.24
80102		$18.51
80150		$21.06
80152		$25.01
80154		$25.84
80156		$20.34
80157		$18.52
80158		$25.23
80160		$24.05
80162		$18.55
80164		$18.93
80166		$21.66
80168		$22.83
80170		$22.90
80172		$22.76
80173		$20.34
80174		$24.05
80176		$20.52
80178		$9.24
80178	QW	$9.24
80182		$18.93
80184		$16.01
80185		$18.52
80186		$19.23
80188		$23.18
80190		$23.41
80192		$23.41
80194		$20.39
80195		$19.17
80196		$9.92
80197		$19.17
80198		$19.77
80200		$22.52
80201		$16.66
80202		$18.93
80299		$19.13
80400		$45.56
80402		$121.46
80406		$107.96
80408		$175.34
80410		$112.23
80412		$460.50
80414		$72.16
80415		$78.08
80416		$184.38
80417		$61.46
80418		$809.76
80420		$100.64
80422		$64.38
80424		$63.98
80426		$207.40
80428		$93.16
80430		$109.60
80432		$188.73
80434		$141.30
80435		$143.85
80436		$127.36
80438		$70.41
80439		$93.88
80440		$81.24

HCPCS	MODIFIER	FEE
81000		$4.43
81001		$4.43
81002		$3.57
81003		$3.14
81003	QW	$3.14
81005		$2.51
81007		$3.59
81007	QW	$3.59
81015		$4.02
81020		$5.15
81025		$8.84
81050		$4.19

HCPCS	MODIFIER	FEE
82000		$17.31
82003		$28.28
82009		$6.31
82010		$11.42
82010	QW	$11.42
82013		$15.61
82016		$19.37
82017		$14.94
82024		$53.97
82030		$36.05
82040		$6.92
82042		$7.23
82043		$7.97
82044		$6.39
82044	QW	$6.39
82045		$43.81
82055		$15.10
82055	QW	$15.10
82075		$16.84
82085		$13.56
82088		$56.94
82101		$36.54
82103		$18.77
82104		$20.20
82105		$23.15
82106		$23.15
82107		$40.56
82108		$35.60
82120		$5.25
82120	QW	$5.25
82127		$19.37
82128		$19.37
82131		$23.57
82135		$23.00
82136		$14.94
82139		$14.94
82140		$20.36
82143		$9.61
82145		$21.72
82150		$9.06
82154		$40.29
82157		$40.90
82160		$34.94
82163		$28.68
82164		$20.39
82172		$19.97
82175		$26.51
82180		$13.81
82190		$7.61
82205		$16.01
82232		$22.61
82239		$8.09
82240		$37.13
82247		$7.02
82248		$7.02
82252		$6.35
82261		$14.94
82270		$4.54
82271		$4.54
82271	QW	$4.54
82272		$4.54
82272	QW	$4.54
82274		$17.41
82274	QW	$17.41
82286		$9.62
82300		$32.33
82306		$40.56
82307		$45.02
82308		$37.41
82310		$7.20
82310	QW	$7.20
82330		$19.09
82331		$7.23
82340		$8.43
82355		$16.17
82360		$17.99
82365		$16.26
82370		$17.51
82373		$25.23
82374		$6.83
82375		$14.29
82376		$8.37
82378		$26.51
82379		$14.94
82380		$12.89
82382		$24.02
82383		$27.30
82384		$31.99
82387		$13.66
82390		$13.66
82397		$14.94
82415		$17.70
82435		$6.42
82436		$6.37
82438		$6.37
82441		$8.38
82465		$6.08
82465	QW	$6.08
82480		$11.01
82482		$10.74
82485		$28.85
82486		$25.23
82487		$22.30
82488		$29.85
82489		$25.84
82491		$25.23
82492		$25.23
82495		$28.34
82507		$38.85
82520		$21.17
82523		$26.11
82523	QW	$26.11
82525		$17.34
82528		$30.43
82530		$23.35
82533		$22.78
82540		$6.48
82541		$25.23
82542		$25.23
82543		$25.23
82544		$25.23
82550		$9.10
82552		$18.71
82553		$10.68
82554		$10.68
82565		$7.16
82565	QW	$7.16
82570		$6.11
82570	QW	$6.11
82575		$13.20
82585		$11.98
82595		$9.04
82600		$27.11
82607		$20.53
82608		$20.01
82610		$15.86
82615		$9.11
82626		$35.31
82627		$31.07
82633		$43.28
82634		$40.90
82638		$17.11
82646		$28.85
82649		$35.91
82651		$36.07
82652		$53.78
82654		$19.34
82656		$16.01
82657		$25.23
82658		$25.23
82664		$48.00
82666		$30.01
82668		$22.37
82670		$39.04
82671		$45.13
82672		$30.30
82677		$30.73
82679		$32.89
82679	QW	$32.89
82690		$24.15
82693		$20.82
82696		$32.95
82705		$6.11
82710		$23.47
82715		$24.05
82725		$18.60
82726		$25.23
82728		$19.03
82731		$40.56
82735		$25.91
82742		$27.66
82746		$18.85
82747		$24.20
82757		$24.24
82759		$30.01
82760		$15.64
82775		$29.43
82776		$11.71
82784		$12.99
82785		$23.01
82787		$5.96
82800		$11.83
82803		$27.04
82805		$39.65
82810		$12.20
82820		$10.76
82926		$7.61
82928		$9.15
82938		$24.72
82941		$24.64
82943		$19.97
82945		$5.48
82946		$21.06
82947		$5.48
82947	QW	$5.48
82948		$4.43
82950		$6.11
82950	QW	$6.11
82951		$16.12
82951	QW	$16.12
82952		$5.48
82952	QW	$5.48
82953		$6.11
82955		$13.55
82960		$7.94
82962		$3.27
82963		$30.01
82965		$9.77
82975		$22.13
82977		$10.06
82978		$19.91
82979		$9.62
82980		$25.22
82985		$21.06
82985	QW	$21.06

HCPCS	MODIFIER	FEE
83001		$25.97
83001	QW	$25.97
83002		$25.88
83002	QW	$25.88
83003		$23.29
83008		$23.45
83009		$94.11
83010		$17.58
83012		$21.70
83013		$94.11
83014		$10.98
83015		$26.31
83018		$30.68
83020		$17.99
83021		$25.23
83026		$3.30
83030		$11.56
83033		$8.33
83036		$13.56
83036	QW	$13.56
83037		$13.56
83037	QW	$13.56
83045		$6.93
83050		$10.23
83051		$10.21
83055		$6.87
83060		$11.56
83065		$9.62
83068		$11.83
83069		$2.98
83070		$6.64
83071		$9.61
83080		$14.94
83088		$41.26
83090		$23.57
83150		$27.04
83491		$24.47
83497		$18.01
83498		$37.95
83499		$35.22
83500		$31.65
83505		$33.96
83516		$16.01
83518		$11.85
83518	QW	$11.85
83519		$18.88
83520		$18.09
83525		$15.98
83527		$18.09
83528		$22.22
83540		$9.05
83550		$12.21
83570		$10.67
83582		$19.80
83586		$17.89
83593		$36.75
83605		$14.92
83605	QW	$14.92
83615		$8.44
83625		$17.88
83630		$26.91
83631		$26.91
83632		$28.24
83633		$6.11
83634		$16.10
83655		$16.91
83655	QW	$16.91
83661		$30.71
83662		$26.43
83663		$26.43
83664		$26.43
83670		$12.80
83690		$8.97
83695		$18.09
83698		$43.81
83700		$15.73
83701		$34.68
83704		$44.08
83718		$11.44
83718	QW	$11.44
83719		$16.26
83721		$12.81
83721	QW	$12.81
83727		$24.02
83735		$9.36
83775		$9.11
83785		$34.36
83788		$25.23
83789		$25.23
83805		$24.63
83825		$22.72
83835		$23.67
83840		$22.81
83857		$15.01
83858		$20.71
83864		$27.82
83866		$13.76
83872		$6.50
83873		$24.04
83874		$15.86
83880		$43.81
83880	QW	$43.81
83883		$15.86
83885		$27.42
83887		$33.09
83890		$5.60
83891		$5.60
83892		$5.60
83893		$5.60
83894		$5.60
83896		$5.60
83897		$5.60
83898		$23.42
83900		$46.84
83901		$23.42
83902		$19.83
83903		$23.42
83904		$23.42
83905		$23.42
83906		$23.42
83907		$4.92
83908		$23.42
83909		$23.42
83912		$5.60
83913		$4.92
83914		$23.42
83915		$15.58
83916		$27.42
83918		$23.00
83919		$23.00
83921		$23.00
83925		$27.19
83930		$9.24
83935		$9.52
83937		$41.71
83945		$17.99
83950		$40.56
83970		$57.67
83986		$3.12
83986	QW	$3.12
83992		$20.54
83993		$26.91

HCPCS	MODIFIER	FEE
84022		$21.76
84030		$7.69
84035		$5.11
84060		$10.32
84061		$10.39
84066		$13.50
84075		$7.23
84078		$10.20
84080		$20.66
84081		$23.09
84085		$9.42
84087		$9.77
84100		$6.63
84105		$7.16
84106		$5.99
84110		$11.80
84119		$7.78
84120		$20.55
84126		$35.59
84127		$7.78
84132		$6.42
84133		$6.01
84134		$20.38
84135		$26.73
84138		$26.46
84140		$28.89
84143		$31.20
84144		$29.15
84146		$27.08
84150		$34.88
84152		$25.70
84153		$25.70
84154		$25.70
84155		$5.12
84156		$5.12
84157		$5.12
84160		$2.73
84163		$21.03
84165		$15.01
84166		$20.30
84181		$23.80
84182		$25.15
84202		$16.89
84203		$12.03
84206		$24.89
84207		$39.25
84210		$15.17
84220		$13.18
84228		$16.26
84233		$40.56
84234		$40.56
84235		$40.56
84238		$51.09
84244		$30.73
84252		$28.28
84255		$35.67
84260		$43.28
84270		$30.36
84275		$18.77
84285		$32.90
84295		$6.72
84300		$6.79
84302		$6.79
84305		$25.53
84307		$25.53
84311		$9.77
84315		$2.73
84375		$27.39
84376		$6.11
84377		$6.11
84378		$16.10
84379		$16.10
84392		$6.64
84402		$35.57
84403		$36.08
84425		$29.67
84430		$9.23
84432		$11.45
84436		$9.61
84437		$9.04
84439		$12.60
84442		$20.66
84443		$23.47
84443	QW	$23.47
84445		$40.56
84446		$19.81
84449		$24.57
84450		$7.22
84450	QW	$7.22
84460		$7.40
84460	QW	$7.40
84466		$17.84
84478		$8.04
84478	QW	$8.04
84479		$8.97
84480		$19.81
84481		$23.67
84482		$8.97
84484		$13.75
84485		$10.49
84488		$10.20
84490		$10.63
84510		$14.53
84512		$10.76
84520		$5.51
84525		$5.25
84540		$5.73
84545		$5.73
84550		$6.27
84560		$6.64
84577		$16.77
84578		$4.54
84580		$9.92
84583		$7.02
84585		$21.66
84586		$26.68
84588		$43.81
84590		$16.20
84591		$16.20
84597		$19.15
84600		$22.45
84620		$15.86
84630		$13.78
84681		$29.07
84702		$21.03
84703		$10.49
84703	QW	$10.49
84704		$21.03
84830		$14.02

HCPCS	MODIFIER	FEE
85002		$6.29
85004		$9.04
85007		$4.81
85008		$3.64
85009		$5.19
85013		$3.31
85014		$3.31
85014	QW	$3.31
85018		$3.31
85018	QW	$3.31
85025		$10.79
85027		$9.04
85032		$6.01
85041		$4.20
85044		$6.01
85045		$5.59
85046		$7.80
85048		$3.55
85049		$6.25
85055		$37.41
85130		$10.68
85170		$5.05
85175		$6.11
85210		$18.14
85220		$24.66
85230		$25.02
85240		$25.02
85244		$28.53
85245		$32.06
85246		$32.06
85247		$32.06
85250		$26.60
85260		$25.02
85270		$25.02
85280		$27.04
85290		$22.83
85291		$9.23
85292		$26.46
85293		$26.46
85300		$16.55
85301		$15.11
85302		$16.80
85303		$17.81
85305		$16.20
85306	&n