Purpose
Detection of in utero exposure to drugs of abuse consistent with maternal use during the second and third trimesters of pregnancy; Newborn (neonatal) toxicology
Method(s)
High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS)
Suggested CPT Code(s)
80307
New York State Approval Status

Approved

Turnaround Time

1 days (If Positive: 3 days)

Test Includes
1 6-Monoacetylmorphine - Free 6-MAM; Heroin Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.2 Drug Metabolite
2 7-Amino Clonazepam Clonazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Hypnotic, Sedative
3 Acetyl Fentanyl High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 1 NPS, Synthetic Opioid
4 alpha-PVP (RS)-1-phenyl-2-(1-pyrrolidinyl)-1-pentanone; alpha-Pyrrolidinovalerophenone High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 NPS, Stimulant
5 Alprazolam Xanax® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
6 Amphetamine Adderall; Benzphetamine Metabolite; Methamphetamine Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Anorexigenic, Stimulant
7 Benzoylecgonine Cocaine Degradation Product High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Stimulant
8 Buprenorphine - Free Buprenex® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 1 Narcotic Analgesic
9 Butalbital High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Hypnotic, Sedative
10 Carisoprodol Soma® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Muscle Relaxant
11 Chlordiazepoxide Librium® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
12 Clonazepam Klonopin® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anticonvulsant, Antiepileptic
13 Cocaethylene Cocaine/Ethanol By-Product High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Stimulant
14 Cocaine High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Stimulant
15 Codeine - Free High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
16 Delta-9 Carboxy THC Inactive Metabolite of Delta-9 THC High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.1 Cannabinoid
17 Delta-9 THC Active Ingredient of Marijuana High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Cannabinoid
18 Desalkylflurazepam Flurazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
19 Dextro / Levo Methorphan High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Antitussive
20 Diazepam Valium® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
21 Dihydrocodeine / Hydrocodol - Free High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
22 EDDP Methadone Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Narcotic Analgesic
23 Ethylone 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)propan-1-one High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 NPS, Stimulant
24 Fentanyl Duragesic®; Sublimaze® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Anesthetic, Opioid Analgesic
25 Flunitrazepam Rohypnol® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Hypnotic, Sedative
26 Flurazepam Dalmane® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
27 Hydrocodone - Free Vicodin®; Zohydro® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
28 Hydromorphone - Free Dilaudid®; Hydrocodone Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
29 Hydroxytriazolam Triazolam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
30 Lorazepam Ativan® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Tranquilizer
31 MDA 3,4-Methylenedioxyamphetamine; Adam; MDMA Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Stimulant
32 MDEA 3,4-methylenedioxyethylamphetamine; Eve High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Stimulant
33 MDMA 3,4-Methylenedioxymethamphetamine; Ecstasy High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Stimulant
34 Meperidine Demerol® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Analgesic, Anesthetic
35 Meprobamate Carisoprodol Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Muscle Relaxant
36 Methadone Dolophine® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Narcotic Analgesic
37 Methamphetamine Benzphetamine Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Stimulant
38 Methylone 3,4-methylenedioxy-N-methylcathinone; bk-MDMA High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 NPS, Stimulant
39 Midazolam Versed® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
40 Morphine - Free High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
41 Norbuprenorphine - Free High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 1 Narcotic Analgesic
42 Nordiazepam Chlordiazepoxide Metabolite; Diazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
43 Norfentanyl Fentanyl Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Anesthetic, Opioid Analgesic
44 Norhydrocodone High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
45 Normeperidine Meperidine Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Analgesic, Anesthetic
46 Noroxycodone Oxycodone Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
47 O-Desmethyltramadol Tramadol Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Analgesic, Anti-Inflammatory
48 Oxazepam Diazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
49 Oxycodone - Free OxyContin®; Roxicodone® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
50 Oxymorphone - Free Numorphan®; Opana®; Oxycodone Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.2 Narcotic Analgesic
51 Phencyclidine Angel Dust; Sherm; PCP High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 1.0 Hallucinogen
52 Phenobarbital Luminal® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Anticonvulsant, Sedative
53 Tapentadol Nucynta® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Centrally Acting Analgesic
54 Temazepam Diazepam Metabolite; Normison® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
55 Tramadol Ultram®; Ultrex® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Analgesic, Anti-Inflammatory
56 Triazolam Halcion® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
57 Zolpidem Ambien® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Hypnotic, Sedative

Test Also Known As
Neonatal
Reflex Tests
Test Code Test Name
52341UC Opiates - Free (Unconjugated) Confirmation (Qualitative), Umbilical Cord Tissue
52342UC Barbiturates Confirmation (Qualitative), Umbilical Cord Tissue
52343UC Benzodiazepines Confirmation (Qualitative), Umbilical Cord Tissue
52344UC Cannabinoids Confirmation (Qualitative), Umbilical Cord Tissue
52345UC Amphetamines Confirmation (Qualitative), Umbilical Cord Tissue
52346UC Novel Psychoactive Substances Confirmation (Qualitative), Umbilical Cord Tissue
52347UC Tapentadol Confirmation (Qualitative), Umbilical Cord Tissue
52348UC Tramadol and Metabolite Confirmation (Qualitative), Umbilical Cord Tissue
52349UC Acetyl Fentanyl Confirmation (Qualitative), Umbilical Cord Tissue
52350UC Buprenorphine and Metabolite Confirmation (Qualitative), Umbilical Cord Tissue
52351UC Carisoprodol and Metabolite Confirmation (Qualitative), Umbilical Cord Tissue
52352UC Cocaine and Metabolites Confirmation (Qualitative), Umbilical Cord Tissue
52353UC Dextro / Levo Methorphan Confirmation (Qualitative), Umbilical Cord Tissue
52354UC Fentanyl and Metabolite Confirmation (Qualitative), Umbilical Cord Tissue
52355UC Meperidine and Metabolite Confirmation (Qualitative), Umbilical Cord Tissue
52356UC Methadone and Metabolite Confirmation (Qualitative), Umbilical Cord Tissue
52357UC Phencyclidine Confirmation (Qualitative), Umbilical Cord Tissue
52358UC Zolpidem Confirmation (Qualitative), Umbilical Cord Tissue
Compliance Statement
This test was developed and its performance characteristics determined by NMS Labs. It has not been cleared or approved by the US Food and Drug Administration.
Sample Type
Umbilical Cord
Requested Volume
10 g
Minimum Volume
10 g
Special Handling
Collect at least 6 inches of umbilical cord (approximately the length of an adult hand). Drain and discard any blood. Rinse the exterior of the cord segment with normal saline or sterile water. Pat the cord dry and place in container for transport. Store at refrigerated temperature.



Unacceptable Specimens: Cords soaking in blood or other fluid. Formalin fixed. Tissue that is obviously decomposed. Samples received without cold pack.
Sample Container
Plastic container (preservative-free)

Additional Collection Instructions

Transport Temperature
Refrigerated
Light Protection
Not Required
Rejection Criteria
None

Rejection criteria pertain to clinical sample submissions only.

Stability
Room Temperature: Undetermined
Refrigerated: 7 day(s)
Frozen (-20 °C): 14 day(s)
1 6-Monoacetylmorphine - Free 6-MAM; Heroin Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.2 Drug Metabolite
2 7-Amino Clonazepam Clonazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Hypnotic, Sedative
3 Acetyl Fentanyl High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 1 NPS, Synthetic Opioid
4 alpha-PVP (RS)-1-phenyl-2-(1-pyrrolidinyl)-1-pentanone; alpha-Pyrrolidinovalerophenone High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 NPS, Stimulant
5 Alprazolam Xanax® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
6 Amphetamine Adderall; Benzphetamine Metabolite; Methamphetamine Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Anorexigenic, Stimulant
7 Benzoylecgonine Cocaine Degradation Product High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Stimulant
8 Buprenorphine - Free Buprenex® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 1 Narcotic Analgesic
9 Butalbital High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Hypnotic, Sedative
10 Carisoprodol Soma® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Muscle Relaxant
11 Chlordiazepoxide Librium® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
12 Clonazepam Klonopin® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anticonvulsant, Antiepileptic
13 Cocaethylene Cocaine/Ethanol By-Product High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Stimulant
14 Cocaine High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Stimulant
15 Codeine - Free High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
16 Delta-9 Carboxy THC Inactive Metabolite of Delta-9 THC High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.1 Cannabinoid
17 Delta-9 THC Active Ingredient of Marijuana High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Cannabinoid
18 Desalkylflurazepam Flurazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
19 Dextro / Levo Methorphan High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Antitussive
20 Diazepam Valium® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
21 Dihydrocodeine / Hydrocodol - Free High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
22 EDDP Methadone Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Narcotic Analgesic
23 Ethylone 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)propan-1-one High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 NPS, Stimulant
24 Fentanyl Duragesic®; Sublimaze® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Anesthetic, Opioid Analgesic
25 Flunitrazepam Rohypnol® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Hypnotic, Sedative
26 Flurazepam Dalmane® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
27 Hydrocodone - Free Vicodin®; Zohydro® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
28 Hydromorphone - Free Dilaudid®; Hydrocodone Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
29 Hydroxytriazolam Triazolam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
30 Lorazepam Ativan® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Tranquilizer
31 MDA 3,4-Methylenedioxyamphetamine; Adam; MDMA Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Stimulant
32 MDEA 3,4-methylenedioxyethylamphetamine; Eve High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Stimulant
33 MDMA 3,4-Methylenedioxymethamphetamine; Ecstasy High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Stimulant
34 Meperidine Demerol® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Analgesic, Anesthetic
35 Meprobamate Carisoprodol Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Muscle Relaxant
36 Methadone Dolophine® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Narcotic Analgesic
37 Methamphetamine Benzphetamine Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Stimulant
38 Methylone 3,4-methylenedioxy-N-methylcathinone; bk-MDMA High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 NPS, Stimulant
39 Midazolam Versed® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
40 Morphine - Free High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
41 Norbuprenorphine - Free High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 1 Narcotic Analgesic
42 Nordiazepam Chlordiazepoxide Metabolite; Diazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
43 Norfentanyl Fentanyl Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Anesthetic, Opioid Analgesic
44 Norhydrocodone High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
45 Normeperidine Meperidine Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Analgesic, Anesthetic
46 Noroxycodone Oxycodone Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
47 O-Desmethyltramadol Tramadol Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Analgesic, Anti-Inflammatory
48 Oxazepam Diazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
49 Oxycodone - Free OxyContin®; Roxicodone® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.5 Narcotic Analgesic
50 Oxymorphone - Free Numorphan®; Opana®; Oxycodone Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 0.2 Narcotic Analgesic
51 Phencyclidine Angel Dust; Sherm; PCP High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 1.0 Hallucinogen
52 Phenobarbital Luminal® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 5 Anticonvulsant, Sedative
53 Tapentadol Nucynta® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Centrally Acting Analgesic
54 Temazepam Diazepam Metabolite; Normison® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
55 Tramadol Ultram®; Ultrex® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Analgesic, Anti-Inflammatory
56 Triazolam Halcion® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Anxiolytic, Sedative
57 Zolpidem Ambien® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/g 2 Hypnotic, Sedative

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LOINC® Information

The CPT Codes provided in this document are based on AMA Guidelines and are for informational purposes only. NMS Labs Does not assume responsibility for billing errors due to Reliance on the CPT Codes listed in this document.

*The information contained in this document represents database configurations, as they will appear on the effective date listed above.