Pregnancy: Comprehensive Perinatal Servicespreg com los
Program (CPSP) – Los Angeles County Waiver Facilities1
Los Angeles (LA) County Waiver Facilities approved for comprehensive perinatal services should use the following CPT-4 codes when billing Medi-Cal.
CPT-4 CodeDescription
Reimbursable Codes59025Fetal non-stress test
71045Radiologic examination, chest; single view
71046two views
76801Transabdominal ultrasound, pregnant uterus, first trimester; single or first gestation
76802each additional gestation
76805Transabdominal ultrasound, pregnant uterus, single or first gestation
76810each additional gestation
76811Transabdominal ultrasound, pregnant uterus, fetal and maternal evaluation, single or first gestation
76812each additional gestation
76813Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation
76814each additional gestation
76815Ultrasound, pregnant uterus, real time with image documentation, limited, 1 or more fetuses
76816Transabdominal ultrasound, pregnant uterus,
follow-up, per fetus
76817Ultrasound, pregnant uterus, real time with image documentation, transvaginal
2 – Pregnancy: Comprehensive Perinatal ServicesOutpatient Services – Clinics and Hospitals 519
Program (CPSP) – Los Angeles County Waiver FacilitiesJanuary 2018
Pregnancy: Comprehensive Perinatal Servicespreg com los
Program (CPSP) – Los Angeles County Waiver Facilities1
CPT-4 CodeDescription
80055Obstetric panel
82382Catecholamines; total urine
82570Creatinine; other source
82575Creatinine; clearance
82746Folic acid; serum
82947Glucose; quantitative, blood (except reagent strip)
82950post glucose dose
82951GTT
83020Hemoglobin fractionation and quantitation; electrophoresis
83540Iron
83550Iron binding capacity
84479 *Thyroid hormone (T3 or T4) uptake or thyroidhormone binding ratio (THBR)
84540Urea nitrogen, urine
84545Urea nitrogen, clearance
84702Gonadotropin, chorionic; quantitative
84703qualitative
85018Blood count; hemoglobin
85025complete, automated and automated differential WBC count
85027complete, automated
86280Hemagglutination inhibition test (HAI)
86580Skin test; TB intradermal
86592Syphilis test; qualitative
*Refer to the Pathology: Chemistry section in this manual for code 84479 billing restrictions.
2 – Pregnancy: Comprehensive Perinatal ServicesOutpatient Services – Clinics and Hospitals 519
Program (CPSP) – Los Angeles County Waiver FacilitiesJanuary 2018
preg com los
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CPT-4 CodeDescription
87070Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates
87086Culture, bacterial; quantitative colony count, urine
87177Ova and parasites, direct smears, concentration and identification
87205Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types
87210wet mount for infectious agents
87252Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect
88150Cytopathology, slides, cervical or vaginal; manual screening under physician supervision
99000Handling and/or conveyance of specimen
2 – Pregnancy: Comprehensive Perinatal ServicesOutpatient Services – Clinics and Hospitals 405
Program (CPSP) – Los Angeles County Waiver FacilitiesJune 2008