Did you know that laboratory billing mistakes cost healthcare providers over $68 billion every year? A big reason for those losses is outdated lab CPT codes. The codes change regularly, and using old ones leads to claim denials faster than you can say “reimbursement.”
Here’s the problem: you’re busy treating patients, not memorizing coding updates. But insurance companies don’t care. They want current codes with the right modifiers, or they’ll reject your claim. That means delayed payments and extra work for your billing team. We’ve put together an updated list of the most top laboratory CPT codes you actually use in daily practice. Everything’s organized by category, from basic metabolic panels to genetic testing. Use this as your go-to reference when ordering labs, and you’ll save yourself from those frustrating denials.
Blood components or body fluid tests are included in this category. This consists of glucose, electrolytes, liver enzymes, lipids, and hormone tests. The tests are administered to test the metabolic fitness, functionality of organs, and the endocrine balance. CPT code of blood work also has such modifiers as QW, CLIA-waived tests, and 91, repeat testing.
| CPT Code | Description | Clinical Usage/Purpose | Modifiers |
|---|---|---|---|
| 80048 | Basic Metabolic Panel (BMP) – measures ~8 analytes (glucose, Ca, Na, K, Cl, HCO₃, BUN, creatinine) | Routine screening of metabolic/endocrine function (electrolytes, kidney function, blood sugar) during check-ups or hospital admission | QW (CLIA-waived versions), 90 (referral lab), 91 (repeat test) |
| 80053 | Comprehensive Metabolic Panel (CMP) – includes BMP analytes plus liver enzymes (ALT, AST, ALP), protein, albumin, and bilirubin | Monitors liver/kidney health, electrolytes, and blood glucose; often ordered in annual physicals and to evaluate general health | QW, 90, 91 |
| 80061 | Lipid Panel – measures total cholesterol, HDL, LDL, and triglycerides | Cardiovascular risk assessment screens for hyperlipidemia | 90, 91 |
| 82570 | Urine Creatinine – creatinine concentration in urine (e.g., 24h urine creatinine) | Assesses kidney function; used to normalize urine analytes (e.g., in drug testing or proteinuria evaluation) | 90, 91 |
| 83036 | Hemoglobin A1c (HbA1c) – glycosylated hemoglobin | Monitors long-term (2–3 mo) blood glucose control in diabetes | 90, 91 |
| 84443 | Thyroid Stimulating Hormone (TSH) | Assesses thyroid function; screens for hypo- or hyperthyroidism | 90, 91 |
| 82306 | Vitamin D, 25-Hydroxy (total) | Evaluates vitamin D status (bone health, metabolic disorders) | 90, 91 |
Hematology lab CPT codes cover tests that examine blood cells and coagulation, including complete blood counts (CBC) and clotting times like PT/INR. These are critical for diagnosing anemia, infections, and clotting disorders. Blood test CPT code includes modifiers like 90 (reference lab) and 91 (repeat tests).
| CPT Code | Description | Clinical Usage/Purpose | Modifiers |
|---|---|---|---|
| 85025 | Complete Blood Count (CBC) with automated differential | Counts and categorizes RBCs, WBCs, and platelets; screens/monitors anemia, infection, leukemia, and other blood disorders | 90, 91 |
| 85027 | Complete Blood Count (CBC) without differential | Similar to 85025 but without WBC differential; used when only total cell counts are needed (often when differential is done separately) | 90, 91 |
| 85610 | Prothrombin Time (PT/INR) | Measures blood clotting time (extrinsic pathway); monitors warfarin (Coumadin) therapy and evaluates bleeding or clotting disorders | 90, 91 |
| 85730 | Activated Partial Thromboplastin Time (aPTT/PTT) | Measures clotting time (intrinsic pathway); monitors heparin therapy and investigates unexplained bleeding | 90, 91 |
| 85378 | D-Dimer | Detects fibrin degradation product; screens for thromboembolic events (e.g., DVT, pulmonary embolism) when a clot is suspected | 90, 91 |
These lab CPTs involve the diagnosis of infectious organisms by culture, stains, or rapid antigen tests. They are applied to identify infections like UTI, strep throat, or STIs. Several in-office rapid tests can be subject to QW modifiers because they can be CLIA-waived, and 26/TC might be used when the technical or professional service will be billed separately.
| CPT Code | Description | Clinical Usage/Purpose | Modifiers |
|---|---|---|---|
| 87086 | Culture, bacterial; quantitative colony count for urine | Diagnoses urinary tract infection by identifying bacteria in urine; yields organism count and speciation | TC (lab processing), 26 (interpretation, if separate), 90, 91 |
| 87070 | Culture, bacterial, any source (except urine) | Identifies pathogens (bacteria, fungi) in clinical specimens (e.g., throat, wound swabs); guides antibiotic therapy | TC, 26, 90, 91 |
| 87491 | Chlamydia trachomatis, amplified probe (NAAT) | Nucleic acid amplification test for Chlamydia in genital or urine samples; used to detect common STD (often paired with GC test) | TC, 26, 90, 91 |
| 87591 | Neisseria gonorrhoeae, amplified probe (NAAT) | Nucleic acid amplification test for gonorrhea in genital or urine samples; used for STD diagnosis | TC, 26, 90, 91 |
| 87880 | Streptococcus, Group A antigen; rapid immunoassay (throat swab) | Rapid screen for group A strep in pharyngitis (strep throat); CLIA-waived point-of-care test | QW (waived test), 90, 91 |
| 87260 | Wet mount preparation, any source | Microscopic examination of the specimen (e.g., vaginal discharge) for organisms/cells | 90, 91 |
The category of tests in this category identifies genetic mutations or infectious agents by detecting DNA or RNA. This category includes COVID-19 and cancer-related genes. These are complicated tests that are normally highly certified by CLIA. Repeat testing of a medical necessity can be done with modifier 91.
| CPT Code | Description | Clinical Usage/Purpose | Modifiers |
|---|---|---|---|
| 81270 | JAK2 V617F Mutation Analysis | Detects the JAK2 V617F mutation associated with myeloproliferative neoplasms (polycythemia vera, essential thrombocythemia, myelofibrosis) | 90, 91 |
| 81479 | Unlisted molecular pathology procedure | Placeholder for a genetic test without a specific CPT code (used for novel or proprietary assays) | 90, 91 |
| 87635 | SARS-CoV-2 (COVID-19) RNA detection by amplified probe | Qualitative RT-PCR for COVID-19 diagnosis | 90, 91 |
| 81405 | Multigene cancer panel (sequencing) | Simultaneously sequences multiple oncogenes/tumor suppressors (e.g., KRAS, EGFR); used in cancer diagnosis and therapy planning | 90, 91 |
| 87901 | HIV-1 drug resistance genotyping | Identifies HIV mutations conferring antiviral resistance; guides therapy in HIV patients | 90, 91 |
This category contains screening (presumptive) and confirmation (definitive) tests of drugs of abuse or therapeutic testing. These tests are commonly used in a clinical, forensic, or occupational setting and are often required to have the modifiers QW,91, and must comply with stringent frequency and medical necessity requirements.
| CPT Code | Description | Clinical Usage/Purpose | Modifiers |
|---|---|---|---|
| 80305 | Drug test(s), presumptive, any number of drug classes (read by visual inspection) | Qualitative point-of-care drug screen (e.g., urine dipstick or card) for drugs of abuse; positive screens often reflex to a definitive test | TC, QW (for waived POC kits), 90, 91 |
| 80306 | Drug test(s), presumptive, instrument-read (qualitative) | Automated laboratory drug screen by immunoassay; e.g., chemistry analyzer–based multi-drug panel screening | TC, 90, 91 |
| 80307 | Drug test(s), presumptive, instrument chemistry (e.g., GC, MS) | Laboratory definitive drug screen (e.g., GC/MS, LC/MS); can detect/confirm specific drugs and metabolites | TC, 90, 91 |
| 83992 | Phencyclidine (PCP) assay, urine; qualitative or quantitative | Definitive test (e.g,. GC/MS) for PCP (hallucinogen) in urine after a presumptive screen | TC, 90, 91 |
| 82075 | Alcohol, breath | Breath ethanol level measurement for DUI/intoxication evaluation | 90, 91 |
Surgical pathology is a branch of pathology, includes the study of samples of tissues (e.g., biopsies) using gross and microscopic analysis to identify cancer or other pathological conditions. The Lab CPT code for pathology and laboratory often uses 26 for professional interpretation, TC for the technical component, and 59 when more than one specimen is submitted.
| CPT Code | Description | Clinical Usage/Purpose | Modifiers |
|---|---|---|---|
| 88305 | Surgical pathology, Level IV – gross and microscopic examination (moderate complexity) | Biopsy/tissue examination (e.g., colon polyp, skin lesion) for diagnosis of cancer, inflammation, infection | 26 (interpretation), TC (technical prep), 59 (multiple specimens), 91 |
| 88307 | Surgical pathology, Level V – more complex tissue exam | Larger or complex specimens (e.g., entire organ, extensive biopsy) requiring detailed histologic analysis | 26, TC, 59, 91 |
| 88309 | Surgical pathology, Level VI – highest complexity | Very complex specimens (e.g., radical tumor resections) with extensive analysis | 26, TC, 59, 91 |
| 88312 | Special stain, Group I (e.g., Gram, PAS on tissue) | Histochemical stains on slides for identifying organisms or tissue elements; often performed adjunctively | 26, TC |
| 88342 | Immunohistochemistry stain (per antibody) | IHC for tumor markers (e.g., hormone receptors, keratins) on tissue specimens | 26, TC |
They are simple tests that are conducted on the urine to identify evidence of infection, metabolic complications, or pregnancy. Run on a regular check-up or ER visit, a large number of these tests are CLIA-waived and coded with modifier QW. Modifier 91 can also be used in repeat testing of urine.
| CPT Code | Description | Clinical Usage/Purpose | Modifiers |
|---|---|---|---|
| 81001 | Urinalysis, automated (multistix with instrumentation) | Chemical and microscopic analysis of urine (glucose, protein, blood, cells, etc.); screens for UTIs, kidney disease, and diabetes | QW (dipstick), 90, 91 |
| 81003 | Urinalysis, manual (dipstick only) | Rapid bedside urine screen (glucose, protein, etc.) without instrumentation | QW, 90, 91 |
| 81025 | Urine pregnancy test (hCG) | Detects human chorionic gonadotropin in urine to confirm pregnancy (CLIA-waived) | QW, 90, 91 |
Immunology codes capture tests that detect immune response, e.g., autoimmune antibodies (e.g., ANA), CRP when there is inflammation, or when testing HIV or syphilis. Tests can be reused with time to monitor the disease, which should include the modifier 91, and others can qualify to be QW in case they are CLIA-waived.
| CPT Code | Description | Clinical Usage/Purpose | Modifiers |
|---|---|---|---|
| 86039 | Antinuclear Antibody (ANA), by immunofluorescence | Screens for autoimmune diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis) | 90, 91 |
| 86140 | C-Reactive Protein (CRP), quantitative | Marker of acute inflammation/infection; elevated in sepsis, autoimmune disease, etc. | 90, 91 |
| 86592 | Syphilis (RPR) – rapid plasma reagin | Non-treponemal syphilis screen; used to detect active Treponema pallidum infection | 90, 91 |
| 86703 | HIV-1 antibody (single) | Screening for HIV-1 infection (antibody test) | 90, 91 |
| 86677 | Helicobacter pylori antibody, serologic | Detects H. pylori infection; used in the evaluation of peptic ulcer or chronic gastritis | 90, 91 |
Now that you’ve got the top lab CPT codes, here’s what actually matters: documentation. The right lab CPT codes are of no use when your notes do not prove medical necessity. Specific details that insurance auditors seek to find are why you ordered the test, what the symptoms caused you to order the test, and how the results altered your treatment plan.
Monitor your denial behavior, as well. When you are receiving repeatedly rejected CPT codes on labs, then more often than not, you are missing a payer-specific rule. A few insurers demand pre-authorization on genetic testing, and some have varying packages for specific chemistry. This is time-saving knowledge of these quirks before you place an order.
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