US · guidance
CMS Pub. 100-04, ch. 16, § 100.2
Laboratory Tests Never Subject to the Fee Schedule
Some CPT codes in the 80000 series are not clinical laboratory tests and are therefore
never subject to fee schedule limitations. Some of these codes are exempted because
they are not clinical laboratory services. They include codes for procedures, services,
blood products and auto-transfusions. They include codes such as whole blood, various
red blood cell products, platelets, plasma, and cryoprecipitate. Other codes for tests
primarily associated with the provision of blood products are also not considered to be
clinical tests. Such tests identify various characteristics of blood products, but are not
diagnostic in nature. These include various blood cross matching techniques. If they are
covered, Medicare pays exclusion codes under the MPFS, reasonable charges, reasonable
costs, or OPPS as applicable.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7443bc7b552699ac6f705b8166a63177627618342056014a65856f26ef20d83e
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