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 |