Exhibit #8 Clinical Laboratory Fees Effective for Dates of Service on and after 1/1/2018 Maximum HCPCS Modifier SHORTDESC Fees 290.67 Chromosome analysis 20-25 88267 419.24 Chromosome analys placenta 88269 387.87 Chromosome analys amniotic 88271 49.95 Cytogenetics dna 88272 62.44 Cytogenetics 3-5 74.92 Cytogenetics 10-30 88274 81.18 Cytogenetics 25-99 88275 93.65 Cytogenetics 100-300 88280 58.51 Chromosome karyotype study 88283 159.97 Chromosome banding study 44.30 Chromosome additional 88289 80.29 Chromosome study additional 88371 51.78 Protein western blot tissue 46.07 Protein analysis w/probe 11.70 Bilirubin total transcut 88738 11.70 Hgb quant transcutaneous 11.70 Transcutaneous carboxyhb 11.70 Transcutaneous methb 89050 9.91 Body fluid cell count 89051 12.84 Body fluid cell count 89055 9.96 Leukocyte assessment fecal 89060 16.68 Exam synovial crystals 10.08 Specimen fat 89160 8.30 Exam feces for meat fibers 89190 8.30 Nasal smear for eosinophils 89300 20.83 Semen analysis w/huhner 89300 QW 20.83 analysis w/huhner 14.82 Semen analysis w/count 28.10 Semen anal vol/count/mot 89321 28.10 Semen anal sperm detection 89321 QW 28.10 Semen anal sperm detection 89322 36.14 Semen anal strict criteria 89325 18.17 Sperm antibody test 89329 48.89 Sperm evaluation test 89330 23.07 Evaluation cervical mucus 89331 45.68 Retrograde ejaculation anal 0006M 0.00 Onc hep gene risk classifier 0007M 0.00 Onc gastro 51 gene nomogram
Exhibit #8 Clinical Laboratory Fees Effective for Dates of Service on and after 1/1/2018 HCPCS Modifier Maximum Fees SHORTDESC 290.67 Chromosome analysis 20-25 88267 419.24 Chromosome analys placenta 88269 387.87 Chromosome analys amniotic 88271 49.95 Cytogenetics dna 88272 62.44 Cytogenetics 3-5 74.92 Cytogenetics 10-30 88274 81.18 Cytogenetics 25-99 88275 93.65 Cytogenetics 100-300 88280 58.51 Chromosome karyotype study 88283 159.97 Chromosome banding study 44.30 Chromosome additional 88289 80.29 Chromosome study additional 88371 51.78 Protein western blot tissue 46.07 Protein analysis w/probe 11.70 Bilirubin total transcut 88738 11.70 Hgb quant transcutaneous 11.70 Transcutaneous carboxyhb 11.70 Transcutaneous methb 89050 9.91 Body fluid cell count 89051 12.84 Body fluid cell count 89055 9.96 Leukocyte assessment fecal 89060 16.68 Exam synovial crystals 10.08 Specimen fat 89160 8.30 Exam feces for meat fibers 89190 8.30 Nasal smear for eosinophils 89300 20.83 Semen analysis w/huhner 89300 QW 20.83 analysis w/huhner 14.82 Semen analysis w/count 28.10 Semen anal vol/count/mot 89321 28.10 Semen anal sperm detection 89321 QW 28.10 Semen anal sperm detection 89322 36.14 Semen anal strict criteria 89325 18.17 Sperm antibody test 89329 48.89 Sperm evaluation test 89330 23.07 Evaluation cervical mucus 89331 45.68 Retrograde ejaculation anal 0006M 0.00 Onc hep gene risk classifier 0007M 0.00 Onc gastro 51 gene nomogram
Rule_18_2018_Exhibit_8_2018.docx