| Flow Cytometry |
Policy Number |
Effective Date |
End Date |
| Flow Cytometry |
CPCPLAB001 |
11/1/2022 |
8/15/2023 |
| Flow Cytometry |
CPCPLAB001 |
5/1/2022 |
11/1/2022 |
| |
|
|
|
| Cervical Cancer Screening |
Policy Number |
Effective Date |
End Date |
| Cervical Cancer Screening |
CPCPLAB002 |
11/1/2023 |
02/29/2024 |
| Cervical Cancer Screening |
CPCPLAB002 |
11/1/2022 |
10/31/2023 |
| Cervical Cancer Screening |
CPCPLAB002 |
5/1/2022 |
11/1/2022 |
| |
|
|
|
| Vitamin D |
Policy Number |
Effective Date |
End Date |
| Vitamin D |
CPCPLAB003 |
11/1/2022 |
8/15/2023 |
| Vitamin D |
CPCPLAB003 |
5/1/2022 |
11/1/2022 |
| |
|
|
|
| Diabetes Mellitus Testing |
Policy Number |
Effective Date |
End Date |
| Diabetes Mellitus Testing |
CPCPLAB004 |
8/15/2023 |
4/14/2024 |
| Hemoglobin A1c |
CPCPLAB004 |
11/1/2022 |
8/15/2023 |
| Hemoglobin A1c |
CPCPLAB004 |
5/1/2022 |
11/1/2022 |
| |
|
|
|
| Prostate Biopsies |
Policy Number |
Effective Date |
End Date |
| Prostate Biopsies |
CPCPLAB005 |
11/1/2023 |
01/31/2024 |
| Prostate Biopsies |
CPCPLAB005 |
11/1/2022 |
8/31/2023 |
| Prostate Biopsies |
CPCPLAB005 |
5/1/2022 |
11/1/2022 |
| |
|
|
|
| Prostate Specific Antigen Testing |
Policy Number |
Effective Date |
End Date |
| Prostate Specific Antigen Testing |
CPCPLAB006 |
11/1/2022 |
8/15/2023 |
| |
|
|
|
| Preventative Screenings in Adults |
Policy Number |
Effective Date |
End Date |
| Preventive Screening in Adults |
CPCPLAB007 |
8/22/2022 |
8/14/2023 |
| |
|
|
|
| Diagnostic Testng of Iron Homeostasis & Metabolism |
Policy Number |
Effective Date |
End Date |
| Diagnostic Testing of Iron Homeostasis & Metabolism |
CPCPLAB008 |
6/15/2023 |
3/14/2024 |
| Diagnostic Testing of Iron Homeostasis & Metabolism |
CPCPLAB008 |
11/1/2022 |
8/15/2023 |
| Testosterone Testing |
Policy Number |
Effective Date |
End Date |
| Testosterone Testing |
CPCPLAB009 |
11/1/2023 |
3/14/2024 |
| Testosterone Testing |
CPCPLAB009 |
11/1/2022 |
8/15/2023 |
| Vitamin B12 and Methylmalonic Acid Testing |
Policy Number |
Effective Date |
End Date |
| Vitamin B12 and Methylmalonic Acid Testing |
CPCPLAB010 |
11/1/2023 |
3/14/2024 |
| Vitamin B12 and Methylmalonic Acid Testing |
CPCPLAB010 |
11/1/2022 |
8/31/2023 |
| ANA/ENA Testing |
Policy Number |
Effective Date |
End Date |
| ANA/ENA Testing |
CPCPLAB011 |
11/1/2022 |
8/15/2023 |
| ANA/ENA Testing |
CPCPLAB011 |
5/1/2022 |
11/1/2022 |
| |
| Pre-Operative Testing |
Policy Number |
Effective Date |
End Date |
| Pre-Operative Testing |
CPCPLAB012 |
11/1/2022 |
5/30/2023 |
| |
| Allergen Testing |
Policy Number |
Effective Date |
End Date |
| Allergen Testing |
CPCPLAB013 |
11/1/2022 |
8/15/2023 |
| |
|
|
|
| Prenatal Screening |
Policy Number |
Effective Date |
End Date |
| Prenatal Screening |
CPCPLAB014 |
11/1/2023 |
11/1/2023 |
| Prenatal Screening |
CPCPLAB014 |
11/1/2022 |
8/15/2023 |
| Hepatitis C |
Policy Number |
Effective Date |
End Date |
| Hepatitis C |
CPCPLAB015 |
2/1/2024 |
3/14/2024 |
| Hepatitis C |
CPCPLAB015 |
11/1/2023 |
1/31/2024 |
| Hepatitis C |
CPCPLAB015 |
11/1/2022 |
8/15/2023 |
| |
| Pediatric Preventive Screening |
Policy Number |
Effective Date |
End Date |
| Pediatric Preventative Screening |
CPCPLAB016 |
11/1/2022 |
8/15/2023 |
| |
| Celiac Disease Testing |
Policy Number |
Effective Date |
End Date |
| Celiac Disease Testing |
CPCPLAB017 |
11/1/2023 |
02/29/2024 |
| Celiac Disease Testing |
CPCPLAB017 |
11/1/2022 |
8/15/2023 |
| |
| Helicobacter pylori Testing |
Policy Number |
Effective Date |
End Date |
| Helicobacter pylori Testing |
CPCPLAB018 |
11/1/2022 |
8/15/2023 |
| |
|
|
|
| Cardiovascular Disease Risk Assessment |
Policy Number |
Effective Date |
End Date |
| Cardiovascular Disease Risk Assessment |
CPCPLAB019 |
11/1/2022 |
8/15/2023 |
| |
|
|
|
| Cardiovascular Disease Risk Assessment |
Policy Number |
Effective Date |
End Date |
| Cardiovascular Disease Risk Assessment |
CPCPLAB020 |
11/1/2023 |
02/29/2024 |
| Thyroid Disease Testing |
CPCPLAB020 |
11/1/2022 |
8/15/2023 |
| |
|
|
|
| Diagnosis of Idiopathic Environmental Intolerance |
Policy Number |
Effective Date |
End Date |
| Diagnosis of Idiopathic Environmental Intolerance |
CPCPLAB023 |
11/1/2022 |
8/15/2023 |
|
|
|
| |
|
|
|
| Epithelial Cell Cytology in Breast Cancer Risk Assessment |
Policy Number |
Effective Date |
End Date |
| Epithelial Cell Cytology in Breast Cancer Risk Assessment |
CPCPLAB024 |
11/1/2023 |
02/29/2024 |
| Epithelial Cell Cytology in Breast Cancer Risk Assessment |
CPCPLAB024 |
11/1/2022 |
8/15/2023 |
|
|
|
| |
|
|
|
| Fecal Analysis in the Diagnosis of Intestinal Dysbiosis |
Policy Number |
Effective Date |
End Date |
| Fecal Analysis in the Diagnosis of Intestinal Dysbiosis |
CPCPLAB025 |
11/1/2023 |
02/29/2024 |
| Fecal Analysis in the Diagnosis of Intestinal Dysbiosis |
CPCPLAB025 |
11/1/2022 |
8/15/2023 |
|
|
|
| |
|
|
|
Fecal Calprotectin Testing in Adults
|
Policy Number |
Effective Date |
End Date |
Fecal Calprotectin Testing in Adults
|
CPCPLAB026 |
11/01/2023 |
01/31/2024 |
Fecal Calprotectin Testing in Adults
|
CPCPLAB026 |
11/1/2022 |
8/31/2023 |
|
|
|
| |
|
|
|
Testing for Diagnosis of Active or Latent Tuberculosis
|
Policy Number |
Effective Date |
End Date |
| Testing for Diagnosis of Active or Latent Tuberculosis |
CPCPLAB027 |
11/01/2023 |
01/31/2024 |
| Testing for Diagnosis of Active or Latent Tuberculosis |
CPCPLAB027 |
11/1/2022 |
8/31/2023 |
|
|
|
| |
|
|
|
Immune Cell Function Assay
|
Policy Number |
Effective Date |
End Date |
| Immune Cell Function Assay |
CPCPLAB028 |
11/01/2023 |
01/31/2024 |
| Immune Cell Function Assay |
CPCPLAB028 |
11/1/2022 |
8/31/2023 |
|
|
|
| |
|
|
|
| Intracellular Micronutrient Analysis |
Policy Number |
Effective Date |
End Date |
| Intracellular Micronutrient Analysis |
CPCPLAB029 |
11/1/2022 |
8/15/2023 |
| |
| In Vitro Chemoresistance and Chemosensitivities Assays |
Policy Number |
Effective Date |
End Date |
| In Vitro Chemoresistance and Chemosensitivities Assays |
CPCPLAB030 |
11/01/2023 |
01/31/2024 |
| In Vitro Chemoresistance and Chemosensitivities Assays |
CPCPLAB030 |
11/1/2022 |
8/15/2023 |
| |
| Measurement of Thromboxane Metabolites for ASA Resistance |
Policy Number |
Effective Date |
End Date |
| Measurement of Thromboxane Metabolites for ASA Resistance |
CPCPLAB031 |
11/1/2022 |
8/31/2023 |
| Measurement of Thromboxane Metabolites for ASA Resistance |
CPCPLAB031 |
11/1/2022 |
8/31/2023 |
| |
| Oral Screening Lesion Identification Systems and Genetic Screening |
Policy Number |
Effective Date |
End Date |
| Oral Screening Lesion Identification Systems and Genetic Screening |
CPCPLAB032 |
11/1/2022 |
8/15/2023 |
| |
| Diagnostic Testing of Influenza |
Policy Number |
Effective Date |
End Date |
| Diagnostic Testing of Influenza |
CPCPLAB033 |
11/01/2023 |
01/31/2024 |
| Diagnostic Testing of Influenza |
CPCPLAB033 |
11/1/2022 |
8/31/2023 |
| |
| Salivary Hormone Testing |
Policy Number |
Effective Date |
End Date |
| Salivary Hormone Testing |
CPCPLAB034 |
11/1/2022 |
8/15/2023 |
| |
| Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease |
Policy Number |
Effective Date |
End Date |
| Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease |
CPCPLAB035 |
11/01/2023 |
01/31/2024 |
| Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease |
CPCPLAB035 |
11/1/2022 |
8/15/2023 |
| |
| Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases |
Policy Number |
Effective Date |
End Date |
| Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases |
CPCPLAB036 |
11/01/2023 |
01/31/2024 |
| Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases |
CPCPLAB036 |
11/1/2022 |
8/15/2023 |
| |
| Serum Tumor Markers for Malignancies |
Policy Number |
Effective Date |
End Date |
| Serum Tumor Markers for Malignancies |
CPCPLAB037 |
03/01/2024 |
04/14/2024 |
| Serum Tumor Markers for Malignancies |
CPCPLAB037 |
11/01/2023 |
02/29/2024 |
| Serum Tumor Markers for Malignancies |
CPCPLAB037 |
11/1/2022 |
8/15/2023 |
| |
| Urinary Tumor Markers for Bladder Cancer |
Policy Number |
Effective Date |
End Date |
| Urinary Tumor Markers for Bladder Cancer |
CPCPLAB038 |
11/1/2022 |
8/15/2023 |
| |
| Vectra DA Blood Test for Rheumatoid Arthritis |
Policy Number |
Effective Date |
End Date |
| Vectra DA Blood Test for Rheumatoid Arthritis |
CPCPLAB039 |
11/1/2022 |
8/14/2023 |
| |
| Erectile Dysfunction |
Policy Number |
Effective Date |
End Date |
| Erectile Dysfunction |
CPCPLAB041 |
11/1/2022 |
8/31/2023 |
| Erectile Dysfunction |
CPCPLAB041 |
11/1/2022 |
8/31/2023 |
| |
| ZIKA Virus Risk Assessment |
Policy Number |
Effective Date |
End Date |
| ZIKA Virus Risk Assessment |
CPCPLAB042 |
11/1/2022 |
8/31/2023 |
| |
| Evaluation of Dry Eyes |
Policy Number |
Effective Date |
End Date |
| Evaluation of Dry Eyes |
CPCPLAB043 |
11/1/2022 |
8/15/2023 |
| |
| Lyme Disease |
Policy Number |
Effective Date |
End Date |
| Lyme Disease |
CPCPLAB044 |
11/1/2022 |
8/15/2023 |
| |
| Pathogen Panel Testing |
Policy Number |
Effective Date |
End Date |
| Pathogen Panel Testing |
CPCPLAB045 |
11/01/2023 |
02/29/2024 |
| Pathogen Panel Testing |
CPCPLAB045 |
11/1/2022 |
8/15/2023 |
| |
| Biomarkers for Myocardial Infarction and Chronic Heart Failure |
Policy Number |
Effective Date |
End Date |
| Biomarkers for Myocardial Infarction and Chronic Heart Failure |
CPCPLAB046 |
11/01/2023 |
02/29/2024 |
| Cardiac Biomarkers for Myocardial Infarction |
CPCPLAB046 |
11/1/2022 |
8/15/2023 |
| |
| Pancreatic Enzyme Testing for Acute Pancreatitis |
Policy Number |
Effective Date |
End Date |
| Pancreatic Enzyme Testing for Acute Pancreatitis |
CPCPLAB047 |
11/1/2022 |
8/15/2023 |
| |
| Folate Testing |
Policy Number |
Effective Date |
End Date |
| Folate Testing |
CPCPLAB048 |
11/1/2022 |
8/15/2023 |
| |
General Inflammation Testing
|
Policy Number |
Effective Date |
End Date |
| General Inflammation Testing |
CPCPLAB049 |
11/1/2022 |
8/15/2023 |
| |
| Urine Culture Testing for Bacteria |
Policy Number |
Effective Date |
End Date |
| Urine Culture Testing for Bacteria |
CPCPLAB050 |
11/1/2022 |
8/15/2023 |
| |
| Diagnostic Testing of Common Sexually Transmitted Infections |
Policy Number |
Effective Date |
End Date |
| Diagnostic Testing of Common Sexually Transmitted Infections |
CPCPLAB051 |
11/1/2023 |
11/1/2023 |
| Diagnostic Testing of Common Sexually Transmitted Infections |
CPCPLAB051 |
11/1/2022 |
8/15/2023 |
| |
| Testing for Mosquito- or Tick-Related Infections |
Policy Number |
Effective Date |
End Date |
| Testing for Mosquito- or Tick-Related Infections |
CPCPLAB052 |
11/1/2022 |
8/15/2023 |
| |
| β-Hemolytic Streptococcus Testing |
Policy Number |
Effective Date |
End Date |
| β-Hemolytic Streptococcus Testing |
CPCPLAB053 |
11/01/2023 |
02/29/2024 |
| β-Hemolytic Streptococcus Testing |
CPCPLAB053 |
11/1/2022 |
8/31/2023 |
| |
| Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing |
Policy Number |
Effective Date |
End Date |
| Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing |
CPCPLAB055 |
11/1/2022 |
8/15/2023 |
| |
| Gamma-glutamyl Transferase |
Policy Number |
Effective Date |
End Date |
Gamma-glutamyl Transferase
|
CPCPLAB056 |
11/1/2022 |
8/31/2023 |
| |
| Coronavirus Testing in the Outpatient Setting |
Policy Number |
Effective Date |
End Date |
| Coronavirus Testing in the Outpatient Setting |
CPCPLAB057 |
03/01/2024 |
03/15/2024 |
| Coronavirus Testing in the Outpatient Setting |
CPCPLAB057 |
11/01/2023 |
02/29/2024 |
| Coronavirus Testing in the Outpatient Setting |
CPCPLAB057 |
11/1/2022 |
8/15/2023 |
| |
| Diagnosis of Vaginitis Including Multi-target PCR Testing |
Policy Number |
Effective Date |
End Date |
| Diagnosis of Vaginitis Including Multi-target PCR Testing |
CPCPLAB059 |
11/1/2023 |
3/14/2024 |
| Diagnosis of Vaginitis Including Multi-target PCR Testing |
CPCPLAB059 |
8/15/2023 |
10/31/2023 |
| Diagnosis of Vaginitis Including Multi-target PCR Testing |
CPCPLAB059 |
11/1/2022 |
8/15/2023 |
| |
| Genetic Testing for Adolescent Idiopathic Scoliosis |
Policy Number |
Effective Date |
End Date |
| Genetic Testing for Adolescent Idiopathic Scoliosis |
CPCPLAB060 |
11/1/2022 |
8/31/2023 |
| |
| Testing for Alpha-1 Antitrypsin Deficiency |
Policy Number |
Effective Date |
End Date |
| Testing for Alpha-1 Antitrypsin Deficiency |
CPCPLAB061 |
11/1/2022 |
8/31/2023 |
| |
| Identification of Microorganisms using Nucleic Acid Probes |
Policy Number |
Effective Date |
End Date |
| Identification of Microorganisms using Nucleic Acid Probes |
CPCPLAB063 |
11/1/2022 |
8/15/2023 |
| |
| Nerve Fiber Density Testing |
Policy Number |
Effective Date |
End Date |
| Nerve Fiber Density Testing |
CPCPLAB064 |
11/01/2023 |
3/1/2024 |
| Nerve Fiber Density Testing |
CPCPLAB064 |
11/1/2022 |
8/15/2023 |
| |
| Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection |
Policy Number |
Effective Date |
End Date |
| Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection |
CPCPLAB065 |
11/1/2022 |
8/15/2023 |
| |
| DNA Ploidy Cell Cycle Analysis |
Policy Number |
Effective Date |
End Date |
| DNA Ploidy Cell Cycle Analysis |
CPCPLAB066 |
11/1/2022 |
8/15/2023 |
| |
| Testing of Homocysteine Metabolism-Related Conditions |
Policy Number |
Effective Date |
End Date |
| Testing of Homocysteine Metabolism-Related Conditions |
CPCPLAB067 |
11/1/2023 |
3/14/2023 |
| |
| Onychomycosis Testing |
Policy Number |
Effective Date |
End Date |
| Onychomycosis Testing |
CPCPLAB068 |
11/1/2022 |
8/15/2023 |
| |
| Immunohistochemistry |
Policy Number |
Effective Date |
End Date |
| Immunohistochemistry |
CPCPLAB069 |
6/15/2023 |
3/14/2024 |
| Immunohistochemistry |
CPCPLAB069 |
11/1/2022 |
8/15/2023 |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting |
Policy Number |
Effective Date |
End Date |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting |
CPCPLAB070 |
11/1/2022 |
8/15/2023 |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting |
CPCPLAB070 |
8/15/2023 |
10/31/2023 |
