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Medicare Laboratory Payment Policy: Now and in the Future
TABLE E.1 1998 Medicare Carrier Denial Rates for Top 100 CPT Codes
Obs. No.
CPT
Description
Total Claims
Allowed Services
Denied Claims
Percent Denied
1
G0001
Venipuncture
54,308,311
50,522,357
3,785,954
7
2
80061
Lipid panel
10,012,394
8,112,908
1,899,486
19
3
85025
Automated hemogram
13,484,091
10,641,281
2,842,810
21
4
84443
Assay TSH
5,871,658
4,579,775
1,291,883
22
5
80054
Comp metabolic panel
10,290,202
9,491,333
798,869
8
6
85024
Automated hemogram
8,662,269
7,358,832
1,303,437
15
7
84153
Assay of PSA, total
4,756,531
3,284,409
1,472,122
31
8
80092
Thyroid panel w/TSH
2,534,185
1,974,563
559,622
22
9
85610
Prothombin time
14,291,139
12,574,088
1,717,051
12
10
83036
Glycated hemoglobin test
5,066,357
4,162,652
903,705
18
11
80049
Metabolic panel, basic
5,828,554
5,468,084
360,470
6
12
81000
Urinalysis, nonauto w/scope
10,333,195
9,197,005
1,136,190
11
13
87086
Urine culture/colony count
3,470,828
2,977,871
492,957
14
14
83970
Assay of parathormone
607,387
563,481
43,906
7
15
88342
Immunocytochemistry
773,537
679,395
94,142
12
16
80162
Assay of digoxin
2,217,224
1,719,286
497,938
22
17
82607
Vitamin B-12
1,293,984
1,148,163
145,821
11
18
82728
Assay of ferritin
1,676,425
1,206,352
470,073
28
19
82947
Assay of glucose, quant
6,808,196
5,095,476
1,712,720
25
20
83718
Assay of lipoprotein
2,735,590
1,971,582
764,008
28
21
80058
Hepatic function panel
3,257,316
2,793,817
463,499
14
22
83550
Iron-binding test
2,222,641
1,672,426
550,215
25
23
83540
Assay of iron
3,125,180
2,065,183
1,059,997
34
24
85023
Automated hemogram
1,679,112
1,482,497
196,615
12
25
87186
Antibiotic sensitivity, mic
1,541,216
1,423,826
117,380
8
26
88312
Special stains
750,231
691,029
59,202
8
27
82746
Blood folic acid serum
912,478
791,881
120,597
13
28
80185
Assay of phenytoin, total
839,618
778,174
61,444
7