Lab Benefit Management Program - Avalon CPCP Archives

 

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

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