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Reflex Testing

Reflex testing plays an integral part of patient care, allowing additional testing to be done automatically, provided criteria established for the test are met.   Reflex tests are billed only when performed.  If the criteria were not met, no further charges will be generated. 

Tests listed under "Reflex Order Options" can be ordered so that the reflex testing will be done automatically if indicated.  To order without reflex, order the individual test.  The next section of the chart represents what is considered by the Medical Executive Committees of York Hospital and Gettysburg Hospital to be “Standard of Practice” and, as such, will be routinely performed and billed as outlined above. 

Reflex Order Options

Initial TestCPT CodePriceReflex CriteriaReflex Test(s)CPT CodePrice
Electrophoresis
Serum Plus

84165
84155

$70.50 Presence of monoclonal paraprotein Serum IFE 86334 $109.50
Electrophoresis
Urine Plus
84166
84156
$105.25 Presence of monoclonal paraprotein Urine IFE 86335 $143.75
PAP Plus

G0123
88142
P3000
88164
G0145
88175

$90.00
$90.00
$45.00
$45.00
$99.00
$99.00

ASCUS positive

HPV

If HPV detected the HPV Genotype will be done at no additional charge.

87621 $140.00
Pernicious Anemia Panel (Vitamin B 12) 82607 $73.75

Vit B12 150-300 pg/mL
 
Vit B12 <150 pg/mL
 
IFBA >0.4 umol/L

Methylmalonic Acid

Intrinsic Factor

Blocking Ab
Gastrin

83921 
 
86340
 
82941

$80.50 
 
$73.75 
 
$86.50

TSH Progressive 84443 $82.25

TSH   1-30 days
Male: <0.44 or >13.68
Female:<0.62 or >11.20

TSH   30 days-5years
Male: <0.47 or >6.07
Female: <0.39 or >6.92

TSH   5 years-adult
<0.30 or >5.00

Free T4 84439 $44.25
UACX 81003 $11.00

>28 WBC/uL (automated); or >358/uL bacteria; or positive nitrate. 
>6 WBC/uL (manual)

Urine Culture 87086 $39.50

Standards of Practice

Initial TestCPT CodePriceReflex CriteriaReflex Test(s)CPT CodePrice
Initial Test CPT Code Price Reflex Criteria Reflex Test(s) CPT Code Price

Ab Screen
Blood Bank

86850 $83.00 Screen Positive

Antibody ID

Patient Antigen

Direct Coombs

86870

86905

86880

$159.00

$108.00

$44.75

      DAT Positive DAT Eval 86880x2 $89.50
      Anti IgG Positive Poss. Elution 86860 $114.50
      Pregnant + Antibody Poss. Ab titer 86886 $186.75
ADAMTS13 Activity Progressive 85397 $156.25

Result < or = 30%

ADAMTS13 Inhibitor Screen Positive

ADAMTS13 Inhibitor Screen

ADAMTS13 Inhibitor Titer

85335

85335

$68.75

$68.75

Antibody Identification
Blood Bank

86870 $159.00 Anti-M or Anti-P detected Antibody Screen Tube Discrepancy 86850 $83.00
ANA Screen 86038 $59.25 Screen Positive ANA Titer 86039 $54.75
Anti-dsDNA Ab Screen (Native DNA) 86225 $67.25 Screen Positive dsDNA Titer 86039 $54.75
Breast Biopsy 88305 $450.00

All Invasive Breast Cancer (New, metastatic, recurrence)

If ER Positive
Her2Neu Not Amplified;
Node Negative;
No more than micrometastasis;
Primary Tumor >0.5cm;
Age <76 

ER, PR, Ki67
Her2Neu FISH

Oncotype DX
S3854

88360x3; 88367x2


84999

$1245.00
$612.50

Approx $4000.00

Breast Biopsy 88305 $450.00 Newly Diagnosed DCIS ER, PR 88360x2 $830.00
Cord Blood to Hold n/a n/a Mother Type O, or Rho(D) negative Cord Blood Workup (YH)

86900
86901
86880

$35.75
$35.75
$47.25

     

Mother Type O (D) negative
Baby Rho(D) positive

RhIG Workup on Mother

85461
J2790

$32.50
$274.75

Crossmatch

86920
86922
86923

$191.50 Ab ID Positive Poss. Ag Typing (unit) 86902 $108.00
Dilute Russel Viper Venom Time 85613 $47.00

If >45 sec

If dRVVT confirm Positive

dRVVT Confirm

dRVVT 1:1 Mix

85598

85613

$88.00

$47.00

Drugs of Abuse
Progressive
Random Urine
G0431 $356.25 Screen Positive Specific Drug
Confirmation
Various Varies
Electrolytes 80051 $34.50 ED or Inpatient >=12
yrs no Creatinine in
20 hrs
Creatinine 82565 $25.00
Endomysial IgA Ab 86255 $59.00 Screen Detected Endomysial IgA Titer 86256 $42.75
Fetal Cell Scrn 85461 $38.00 Screen Positive Fetal Hgb Stain 85460 $38.00
Glucose Tolerance Testing

82950
82951
82952

Various Initial fingerstick glucose >140 mg/dL Do not perform glucose tolerance, obtain lab glucose 82947 $19.25

Heparin Induced
Platelet Antibody
Progressive

86022 $100.00 Positive Serotonin Release
Assay
86022 $62.00
Herpes 1 & 2 IgM Ab

86695
86696

$159.25 Screen Positive

Herpes 1 IgM Titer
Herpes 2 IgM Titer

86695
86696

$64.50
$94.75

HIV Ag/Ab
Progressive

87389 $118.00 HIV Ag/Ab Positive HIV MultiSpot 86689 No Add'l Charge
HIV 1 Rapid 86701 $43.50 HIV 1 Positive HIV MultiSpot 86689 No Add'l Charge
HTLV1/2 Ab 86687 $41.00 HTLV 1/2 Positive HTLV 1/2 WB 86689 $94.75
Influenza A & B and RSV PCR 87631 $312.25 Positive Influenza A H1 Swine,
H1 Seasonal,
H3 Seasonal
87503
87502
87502
No Add'l Charge
Lamellar Body Count 83664 $92.75 Diabetic mother <45 yrs; or Non-Diabetic mother <30 yrs. %PG and L/S Ratio

83661
82489

$107.75
$90.50

Lipid Panel 80061 $61.50 Triglyceride >400 mg/dL Direct LDL 83721 $46.75
Lupus Anticoagulant 85730 $29.50 Screen Positive Hexagonal Phase Confirmation 85598 $88.00
Lyme Ab 86618 $83.50 Screen Positive Lyme WB IgG
Lyme WB IgM

86617
86617

$76.00
$76.00

Massive Transfusion Protocol-Fibrinogen 85384 $44.50 Massive Transfusion Protocol 3 pools of 6 cryoprecipitate

P9012
x18

$3568.50
Massive Transfusion Protocol-Platelet 85027 $31.75 Massive Transfusion Protocol Unit of platelets P9031x5 or P9035

$2083.75
$2376.75

Microbiology Culture Varies by source Varies by source Growth of Pathogen

Bacterial ID
MIC and/or KB Susceptibilities

87077
87186
87184

$31.50
$42.25
$33.75

Preg BHCG 84702 $71.00

Positive Preg result
ED patient

ABORh type if no previous ABORh

86900
86901

$71.50
Rapid Strep A Antigen 87880 $54.00 Rapid Strep Negative Throat culture screen 87081 $31.50
RPR (Serum VDRL) 86592 $21.00 Screen Positive

RPR Quant
Treponemal Ab

86953
86780

$21.50
$64.75

Tot Bilirubin 82247 $24.50 Total Bilirubin >1.2 mg/dL Direct Bilirubin 82248 $24.50
Transfusion Reaction workup

86880
86900
86901
86078

$44.75
$35.75
$35.75
$247.50

Post DAT Positive

If Pre DAT negative

Pre DAT

Transfusion Reaction workup extended



Possible Antigen Typing (unit)/each

86880 
 
86850x2
86900
86901 
86922x2

86902

$44.75

$166.00 
$35.75
$35.75
$383.00

$101.75

Type + Screen

86900
86901
86850

$35.75
$35.75
$83.00

Screen Positive
 
If Antibody ID positive
or Screen Negative
with history of
significant antibodies

Antibody ID
 
Antigen typing unit; and Crossmatch 2 units

86870
 
86902 ea 
 
86922x2

$159.00
 
$108.00 
 
$383.00

Urinalysis 81003 $11.00 Albumin, blood, nitrite, or leukocyte esterase positive Urine Microscopic 81015 $15.00
Urinalysis – Cath Urine 81003 $11.00 Age <9 Urine Culture 87086 $39.50
Von Willebrand Factor Protease Activity Progressive 85397 $156.25 If <=40 sec vWF Protease Inhibitor 85335 $156.25

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