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Test Menu With 2022 Medicare Fee ScheduleClick the link below to see the respective 2022 Medicare Rates00165B00165U00167B00167U00168U00169 or 00169i00188OB00195U00197U or 00197iU00199U0002100023204000080100802CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 1 of 39
Test Menu With 2022 Medicare Fee 4030651006520065300656006710A La Carte TestingCONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 2 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00165BCPT CodePresumptive Testing*2022 Medicare RateAmphetaminesBarbituratesCannabinoids (Marijuana)Carisoprodol/Meprobamate (SkeletalMuscle Relaxants CPT Drug Class)Cocaine80307 62.14FentanylMeperidine (Opioids & Opiate AnalogsCPT Drug Class)MethadoneMethamphetamineDefinitive Testing**BenzodiazepinesOpiatesG0480 114.43OxycodoneDefinitive Testing** Tiers1-7 Drug Class(es)G0480 114.438-14 Drug ClassesG0481 156.5915-21 Drug ClassesG0482 198.7422 Drug ClassesG0483 binoids MeperidineMethadoneOpiatesOxycodoneMDA, MDEA, MDMA (Methylenedioxyamphetamines CPT Drug Class)*Presumptive testing results will reflex to definitive testing via mass spectrometry. Only onepresumptive testing code may be billed per day. This code will not be billed if presumptive testing isalready performed for same date of service.**Definitive testing charges will be determined based upon total number of definitive testsperformed. Only one CPT/G code will be utilized for definitive testing.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 3 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00165UCPT CodePresumptive nabinoids (Marijuana)Cocaine80307HeroinMethadone Metabolite (EDDP)MethadoneOpiatesOxycodoneDefinitive Testing** Tiers1-7 Drug Class(es)G04808-14 Drug ClassesG048115-21 Drug ClassesG048222 Drug s2022 Medicare Rate 62.14 114.43 156.59 198.74 246.92Cannabinoids (Marijuana)CocaineHeroinMethadoneMDA, MDEA, MDMA (Methylenedioxyamphetamines CPT Drug Class)OpiatesOxycodone*Presumptive testing results will reflex to definitive testing via mass spectrometry. Only onepresumptive testing code may be billed per day. This code will not be billed if presumptive testing isalready performed for same date of service.**Definitive testing charges will be determined based upon total number of definitive testsperformed. Only one CPT/G code will be utilized for definitive testing.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 4 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00167BCPT CodePresumptive Testing*2022 Medicare te (SkeletalMuscle Relaxants CPT Drug Class)Cocaine80307 62.14FentanylMeperidine (Opioids & Opiate AnalogsCPT Drug Class)MethadoneMethamphetamineDefinitive Testing**BenzodiazepinesG0480 114.43OpiatesOxycodoneDefinitive Testing** Tiers1-7 Drug Class(es)G0480 114.438-14 Drug ClassesG0481 156.5915-21 Drug ClassesG0482 198.7422 Drug ClassesG0483 oneMDA, MDEA, MDMA (Methylenedioxyamphetamines CPT Drug Class)OpiatesOxycodone*Presumptive testing results will reflex to definitive testing via mass spectrometry. Only onepresumptive testing code may be billed per day. This code will not be billed if presumptive testing isalready performed for same date of service.**Definitive testing charges will be determined based upon total number of definitive testsperformed. Only one CPT/G code will be utilized for definitive testing.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 5 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00167UCPT CodePresumptive Testing*2022 Medicare Heroin80307 62.14Methadone Metabolite (EDDP)MethadoneOpiatesOxycodoneDefinitive Testing** Tiers1-7 Drug Class(es)G0480 114.438-14 Drug ClassesG0481 156.5915-21 Drug ClassesG0482 198.7422 Drug ClassesG0483 neHeroinMethadoneMDA, MDEA, MDMA (Methylenedioxyamphetamines CPT Drug Class)OpiatesOxycodone*Presumptive testing results will reflex to definitive testing via mass spectrometry. Only onepresumptive testing code may be billed per day. This code will not be billed if presumptive testing isalready performed for same date of service.**Definitive testing charges will be determined based upon total number of definitive testsperformed. Only one CPT/G code will be utilized for definitive testing.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 6 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00168UCPT CodeDefinitive probamate (SkeletalMuscle Relaxants CPT Drug Class)FentanylGabapentinHeroinMeperidine (Opioids & Opiate AnalogsCPT Drug 04812022 Medicare Rate 156.59CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 7 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00169 or 00169iCPT CodeDefinitive TestingAmphetamines-Methamphetamine D/L probamate (SkeletalMuscle Relaxants CPT Drug Class)CocaineFentanylHeroinMethadoneMDA and MDMA(Methylenedioxyamphetamines CPTDrug Class)OpiatesOxycodoneTramadolG04812022 Medicare Rate 156.59*Positive methamphetamine results will reflex to methamphetamine D/L Isomer testing for 00169i.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 8 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00188OBCPT CodeDefinitive TestingAlcohol Biomarkers (Ethyl Glucuronide,Ethyl Sulfate)Amphetamines-Methamphetamine D/L probamate (SkeletalMuscle Relaxants CPT Drug Class)CocaineCotinine (Nicotine)G0482FentanylHeroinMeperidine (Opioids & Opiate AnalogsCPT Drug Class)MethadoneMDA, MDEA, MDMA(Methylenedioxyamphetamines CPTDrug Class)OpiatesOxycodoneTramadol2022 Medicare Rate 198.74*Positive methamphetamine results will reflex to methamphetamine D/L Isomer testing.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 9 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00195UCPT CodeDefinitive probamate (SkeletalMuscle Relaxants CPT Drug Class)FentanylHeroinMethadoneMeperidine (Opioids & Opiate AnalogsCPT Drug Class)OpiatesOxycodoneTramadolG04812022 Medicare Rate 156.59CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 10 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00197iU or 00197UCPT CodeDefinitive TestingAmphetamines-Methamphetamine D/L probamate (SkeletalMuscle Relaxants CPT Drug Class)CocaineFentanylGabapentinHeroinMeperidine (Opioids & Opiate AnalogsCPT Drug Class)MethadoneMDA, MDEA, MDMA(Methylenedioxyamphetamines CPTDrug Class)OpiatesOxycodonePregabalinTramadolG04822022 Medicare Rate 198.74*Positive methamphetamine results will reflex to methamphetamine D/L Isomer testing for 00197iU.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 11 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00199UCPT CodeDefinitive TestingAlcohol Biomarkers (EthylGlucuronide, Ethyl Sulfate)Amphetamines-Methamphetamine D/L probamate (SkeletalMuscle Relaxants CPT Drug Class)CocaineCotinine (Nicotine)FentanylGabapentinHeroinMeperidine (Opioids & Opiate AnalogsCPT Drug Class)MethadoneMDA, MDEA, MDMA(Methylenedioxyamphetamines CPTDrug 2022 Medicare RateG0482 198.74*Positive methamphetamine results will reflex to methamphetamine D/L Isomer testingCONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 12 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00021CPT CodeDefinitive Testing*Quinine84228Column Chromatography, non-drug82542Antidepressants, not otherwise specifiedAntidepressants, serotonergic classAntidepressants, Tricyclic and othercyclicalsAntiepileptics, not otherwise specifiedAntipsychotics, not otherwise specifiedG0481BarbituratesMethadoneAlkaloids, not otherwise specifiedSkeletal Muscle Relaxants drugDrug(s) or substance(s), definitive,qualitative or quantitative, not otherwisespecifiedDefinitive Testing* Tiers†1-7 Drug Class(es)G04808-14 Drug ClassesG048115-21 Drug ClassesG048222 Drug ClassesG04832022 Medicare Rate 11.63 24.09 156.59 114.43 156.59 198.74 246.92*Definitive testing charges will be determined based upon total number of definitive tests performed.Only one CPT/G code will be utilized for definitive testing.†If test #00021 (Drug-Drug Interaction) is requested with additional and separate definitive drug testing, thedefinitive testing charges will be determined based upon total number of definitive tests performed (drugclasses are only counted once).CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 13 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00023 – Oral FluidCPT CodeDefinitive Testing*Quinine84228Column Chromatography, non-drug82542Antidepressants, not otherwise specifiedAntidepressants, serotonergic classAntidepressants, Tricyclic and othercyclicalsAntiepileptics, not otherwise specifiedG0481Antipsychotics, not otherwise specifiedBarbituratesMethadoneAlkaloids, not otherwise specifiedSkeletal Muscle RelaxantsDrug(s) or substance(s), definitive,qualitative or quantitative, not otherwisespecifiedDefinitive Testing* Tiers†1-7 Drug Class(es)G04808-14 Drug ClassesG048115-21 Drug ClassesG048222 Drug ClassesG04832022 Medicare Rate 11.63 24.09 156.59 114.43 156.59 198.74 246.92*Definitive testing charges will be determined based upon total number of definitive tests performed.Only one CPT/G code will be utilized for definitive testing.†If test #00023 (Drug-Drug Interaction) is requested with additional and separate definitive drug testing, thedefinitive testing charges will be determined based upon total number of definitive tests performed (drugclasses are only counted once).CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 14 of 39
Test Menu With 2022 Medicare Fee ScheduleTest20400 KardiAssureCPT CodeDefinitive TestingAnalgesics, non-opioid, 1-2Drug(s) or substances(s), definitive,qualitative or quantitative, not otherwisespecifiedG04802022 Medicare Rate 114.43CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 15 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00801CPT CodeDefinitive TestingAlcohol Biomarkers (Ethyl Glucuronide,Ethyl Sulfate)Amphetamines-Methamphetamine D/L Isomer*BenzodiazepinesBuprenorphineBupropion (Antidepressants, nototherwise specified)Carisoprodol/Meprobamate (SkeletalMuscle Relaxants CPT Drug nidateNaloxone (Opioids & Opiate Analogs)Naltrexone (Opioids & Opiate Analogs)MDA, MDEA, MDMA(Methylenedioxyamphetamines CPTDrug Class)OpiatesOxycodone2022 Medicare Rate 198.74*Positive methamphetamine results will reflex to methamphetamine D/L Isomer testing.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 16 of 39
Test Menu With 2022 Medicare Fee ScheduleTest00802CPT CodeDefinitive Testing*Antidepressants, not otherwise specifiedAntidepressants, serotonergic classAntidepressants, Tricyclic and othercyclicalsAntiepileptics, not otherwise specifiedG0481Antipsychotics, not otherwise specifiedDrug(s) or substance(s), definitive,qualitative or quantitative, not otherwisespecifiedOpiatesOxycodone2022 Medicare Rate 156.59CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 17 of 39
Test Menu With 2022 Medicare Fee ScheduleTest05700CPT CodeMolecular Diagnostic TestingCOVID19 Diagnostic Test (SARS-CoV-2, RTU0003PCR) U0005*2022 Medicare Rate 75.00 25.00 Pursuant to the CARES Act, Aegis has published its cash price for COVID-19 tests on its website. Aegis’s cash pricefor its COVID-19 diagnostic test (test #05700 (SARS-CoV-2, RT-PCR)) is 100.00.* Billed in conjunction with U0003 per CMS requirements when such requirements are met. CMS requirementsfor U0005 require the following elements to be met to bill this code: (1) the test is finalized and ready for releasewithin two calendar days from the date of specimen collection (e.g., a specimen collected on Monday must befinalized and ready for release by 11:59:59 PM on Wednesday); and (2) the laboratory must have completed themajority of all COVID-19 diagnostic tests performed in the prior month within two calendar days from the dateof specimen collection.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 18 of 39
Test Menu With 2022 Medicare Fee ScheduleTestCOVID19 Antibody Test05701CPT CodeImmunologic Testing867692022 Medicare Rate 42.13CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 19 of 39
Test Menu With 2022 Medicare Fee ScheduleTestCOVID19 FLU A/B05702CPT CodeMolecular Diagnostic Testing876362022 Medicare Rate 142.63CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 20 of 39
Test Menu With 2022 Medicare Fee ScheduleTest05703CPT CodeMolecular Diagnostic TestingCOVID19 Saliva (SARS-CoV-2, RT-PCR) 2022 Medicare RateU0003 75.00U0005* 25.00 Pursuant to the CARES Act, Aegis has published its cash price for COVID-19 tests on its website. Aegis’s cash pricefor its COVID-19 diagnostic test (test #05700 (SARS-CoV-2, RT-PCR)) is 100.00.* Billed in conjunction with U0003 per CMS requirements when such requirements are met. CMS requirementsfor U0005 require the following elements to be met to bill this code: (1) the test is finalized and ready for releasewithin two calendar days from the date of specimen collection (e.g., a specimen collected on Monday must befinalized and ready for release by 11:59:59 PM on Wednesday); and (2) the laboratory must have completed themajority of all COVID-19 diagnostic tests performed in the prior month within two calendar days from the dateof specimen collection.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 21 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen TargetSapovirus (I,II,IV,V)AdenovirusEnterovirus (Pan)AstrovirusParechovirus06210CPT CodeGastrointestinal Virus Profile875062022 Medicare Rate 262.99CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 22 of 39
Test Menu With 2022 Medicare Fee Schedule06230Pathogen TargetCPT CodeGastrointestinal Bacteria ProfileShigellaShiga-like toxin producing E.coli (STEC)stx1/stx2E. coli O157SalmonellaCampylobacter jejuni875052022 Medicare Rate 128.29CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 23 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen TargetInfluenza A/BRSV A/BAdenovirusRhinovirus06400CPT CodeUpper RTI Profile876322022 Medicare Rate 218.06CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 24 of 39
Test Menu With 2022 Medicare Fee Schedule06401Pathogen TargetCPT Code2022 Medicare RateCommunity Acquired Pneumonia ProfileStaphylococcus aureus87640 35.09Streptococcus pneumoniae87798 35.0987486 35.09Chlamydophila pneumoniae87581 35.09Mycoplasma pneumoniaCONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 25 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen TargetHuman Metapneumovirus (hMPV)Parainfluenza Virus 1,2,3,4RSV A/B06403CPT CodeBronchitis Profile876322022 Medicare Rate 218.06CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 26 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen Target06510CPT CodeBacterial Vaginosis ProfileAtopobium vaginaeGardnerella vaginalisBVAB2Megasphaera 1, 2Lactobacillus species (includes crispatus,gasseri, iners, jensenii)Mycoplasma hominisTrichomonas vaginalis875118766187798 x 62022 Medicare Rate 35.09 35.09 35.09 x 6CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 27 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen TargetCandida albicansCandida glabrataCandida parapsilosisCandida tropicalisCandida kruseiCandida dubliniensis, lusitaniae06520CPT CodeCandidiasis87481 x 62022 Medicare Rate 35.09 x6CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 28 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen TargetChlamydia trachomatisNeisseria gonorrhoeaeTrichomonas vaginalisHSV 1/ HSV 206530CPT CodeSTI Profile HSV87491875918766187529 x 22022 Medicare Rate 35.09 35.09 35.09 35.09 x 2CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 29 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen TargetChlamydia trachomatisNeisseria gonorrhoeaeTrichomonas vaginalis06560CPT CodeSTI Profile8749187591876612022 Medicare Rate 35.09 35.09 35.09CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 30 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen Target06710CPT CodeUTI Standard ProfileKlebsiella aerogenesEnterobacter cloacae complexEnterococcus faecalisEnterococcus faeciumEscherichia coliKlebsiella pneumoniaeProteus mirabilisProteus vulgarisPseudomonas aeruginosaStaphylococcus (saprophyticus, xylosus)Streptococcus agalactiae (group B)8765387798 x 102022 Medicare Rate 35.09 35.09 x 10CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 31 of 39
Test Menu With 2022 Medicare Fee SchedulePathogen Target06730CPT CodeUTI Expanded ProfileKlebsiella aerogenesEnterobacter cloacae complexEnterococcus faecalisEnterococcus faeciumEscherichia coliKlebsiella pneumoniaeProteus mirabilisProteus vulgarisPseudomonas aeruginosaStaphylococcus (saprophyticus, xylosus)Streptococcus agalactiae (group B)Acinetobacter baumanniiKlebsiella oxytocaCitrobacter freundiiMorganella morganiiProvidencia stuartii8765387798 x 152022 Medicare Rate 35.09 35.09 x 15CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 32 of 39
Test Menu With 2022 Medicare Fee ScheduleA La Carte TestingAnalysis Code04420 or 04420OF04440 or encyclidineTestPresumptive Testing*Definitive Testing** Tiers1-7 Drug Class(es)8-14 Drug Classes15-21 Drug Classes22 Drug ClassesCPT Code2022 Medicare Rate80307803078030780307 62.14 62.14 62.14 62.14G0480G0481G0482G0483 114.43 156.59 198.74 246.92Definitive 9601017B04496OF/04496iOF04801AcetaminophenAlcohol Biomarkers (Ethyl Glucuronide,Ethyl etamines- Methamphetamine D/L Isomer***MethylenedioxyamphetaminesAmphetamines – Oral FluidMethylenedioxyamphetamines – Oral FluidAmphetamines – Oral Fluid- Methamphetamine D/L Isomer ***MethylenedioxyamphetaminesAntipsychotics – Oral FluidAntipsychoticsAntipsychotics – Oral FluidArmodafinil/ModafinilAtomoxetineAtomoxetine – Oral FluidBaclofenBaclofen – Oral FluidBarbituratesBenzodiazepinesBenzodiazepines – Oral FluidBuprenorphineBuprenorphine – BloodBuprenorphine – Oral FluidBupropionCONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 33 of 39
Test Menu With 2022 Medicare Fee ScheduleAnalysis 04469iOF042000460004462coTestDefinitive Testing**CPT CodeBupropion – Oral FluidBuspironeBuspirone – Oral FluidButorphanolCaffeineCannabinoids ONLYCarbamazepineCarbamazepine – Oral ate – Oral FluidChlorzoxazoneClonidineClonidine – Oral FluidCocaineCocaine – Oral FluidCotinineCyclobenzaprineCyclobenzaprine – Oral FluidDantroleneDesigner BenzodiazepinesDesigner Benzodiazepines – Oral FluidDesigner OpioidsDesigner Opioids – Oral /Levorphanol – OralFluidDiphenhydramineDiphenhydramine – Oral FluidEthanolEthanol – Oral FluidEthanol - BloodFentanylFentanyl – Oral FluidHallucinogens/ DissociativesHallucinogens/ Dissociatives – OralFluidHeroinCONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 34 of 392022 Medicare Rate
Test Menu With 2022 Medicare Fee ScheduleAnalysis /04180i01630U01632/01632iTestDefinitive Testing**CPT CodeHeroin – Oral FluidGabapentin – BloodGabapentinGabapentin – Oral FluidGuanfacineGuanfacine – Oral FluidHydroxyzineHydroxyzine – Oral FluidKetamineKetamine – Oral FluidKratomKratom – Oral FluidLamotrigineLamotrigine – Oral FluidLevetiracetamLamotrigine – Oral FluidLevetiracetamLevetiracetam – Oral FluidLofexidine – Oral FluidLoperamide – Oral FluidLorcaserin – Oral FluidMeperidineMetaxaloneMetaxalone – Oral FluidMethadoneMethadone – Oral FluidMethamphetamine D/L Isomer – PCTOnlyMethamphetamine D/L Isomer – PCTOnly – Oral FluidMethamphetamine D/L IsomerMethocarbamolMethocarbamol – Oral FluidMethylphenidateMethylphenidate – Oral FluidMirtazapineMirtazapine – Oral FluidCONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 35 of 392022 Medicare Rate
Test Menu With 2022 Medicare Fee ScheduleAnalysis 02123/02123i02125U02125B02125U, 04125, 04125co04125OF, 04125iOFTestDefinitive Testing**CPT CodeNaloxone – Oral FluidNaltrexoneOpiatesOpiates – Oral FluidOther (phenibut, tianeptine, andxylazine, 4-OH-Xylazine)Other – Oral Fluid (phenibut,tianeptine, and xylazine, 4-OHXylazine)OxcarbazepineOxcarbazepine – Oral FluidPentazocinePregabalin – BloodPregabalinPregabalin – Oral FluidPromethazineSNRISNRI – Oral FluidSSRISSRI – Oral FluidSedative HypnoticsSynthetic CannabinoidsSynthetic Cannabinoids – Oral FluidSynthetic StimulantsSynthetic Stimulants – Oral FluidSuvorexant – Oral FluidTapentadol – Oral FluidTapentadolTapentadol - BloodTizanidineTopiramateTopiramate – Oral FluidTramadolTramadol – BloodTramadolTramadol – Oral FluidCONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 36 of 392022 Medicare Rate
Test Menu With 2022 Medicare Fee ScheduleAnalysis Code02128, 04855/04855iTestDefinitive Testing**CPT Code2022 Medicare RateTrazodone – Oral FluidTrazodoneTricyclic AntidepressantsTricyclic Antidepressants – Oral FluidVilazodoneVilazodone – Oral FluidVorioxetineVorioxetine – Oral Fluid*Presumptive testing results will reflex to definitive testing via mass spectrometry. Only one presumptive testing code may bebilled per day. This code will not be billed if presumptive testing is already performed for same date of service.**Definitive testing charges will be determined based upon total number of definitive tests performed. Only one CPT/G codewill be utilized for definitive testing.***Positive methamphetamine results will reflex to methamphetamine D/L Isomer testing.CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 37 of 39
Test Menu With 2022 Medicare Fee ScheduleAnalysis 6455064570645906461065400654206546A La Carte – Pathogen TestingTestCPT CodeGastrointestinal Pathogen Targets*Norovirus87798Rotavirus A87998Entamoeba histolytica87798Cyclospora cayetanensis87798Cryptosporidium87798Giardia lamblia87798Vibrio cholera87798Vibrio parahaemolyticus87798Vibrio vulnificus87798Escherichia EHEC/Intimin87798Escherichia EIEC87798Escherichia EPEC87798Escherichia ETEC87798Plesiomonas shigelloides87798Aeromonas hydrophila87798Yersinia enterocolitica87798Clostridiodes difficile87798Respiratory Tract Infection Pathogen Targets**Human Metapneumovirus (hMPV)87798Parainfluenza Virus 1,2,3,487631RSV A/B87634Influenza ophilus influenza (B)87798Moraxella catarrhalis (B)87798Whopping Cough/Bordetella (B)87798Bocavirus87798Coronavirus 229E, HKU1, NL63, OC4387631Enterovirus87798Staphylococcus aureus (B)87640Streptococcus pneumoniae (B)87798Chlamydophila pneumoniae (B)87486Mycoplasma pneumonia (B)87581GH/STI Pathogen TargetHPV High Risk (16,18)87625HPV High Risk Expanded(31,33,35,39,45.52,58)Mycoplasma genitalium2022 Medicare Rate 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 35.09 142.63 70.20 95.80/ 29.22 x2 35.09 35.09 35.09 35.09 35.09 35.09 142.63 35.09 35.09 35.09 35.09 35.09 40.5587624 35.0987563 35.09CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 38 of 39
Test Menu With 2022 Medicare Fee ScheduleAnalysis Code06548065500655206554TestMycoplasma hominisUreaplasma urealyticumStreptococcus agalactiae (group B)Treponema pallidum (Syphilis)CPT Code877988779887653877982022 Medicare Rate 35.09 35.09 35.09 35.09*Gastrointestinal Infection:CPT code will be determined based on total number of pathogen targets tested.87505 (3-5 targets)87506 (6-11 targets)87507 (12 targets)**Respiratory Tract Infections:CPT code will be determined based on total number of pathogen viral targets tested.87631 (3-5 targets)87632 (6-11 targets)87366 (12 targets)(Targets notated with a (B) are bacterial and excluded from the total count)CONFIDENTIAL – FOR INTERNAL AEGIS USE ONLY – DO NOT REPRODUCEPage 39 of 39
Test CPT Code 2022 Medicare Rate Presumptive Testing* Amphetamines 80307 62.14 Barbiturates Benzodiazepines Cocaine Heroin Methadone Metabolite (EDDP) Methadone Opiates Oxycodone Definitive Testing** Tiers 1-7 Drug Class(es) G0480 114.43 8-14 Drug Classes G0481 156.59 15-21 Drug Classes G0482 198.74