Waived Tests and CPT Codes This list is for informational purposes only and may not accurately represent current CMS CPT codes. Please verify your tests waived status and CPT code prior to implementing testing.

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Adenovirus AdenoPlus (human eye fluid) Rapid Pathogen Screening, Inc. 87809QW Quidel, AdenoPlus Test, Adeno Detector, Detecor Plus (Tear Fluid) Quidel Corporation 87809QW Quidel Corporation, QuickVue Adenoviral Conjunctivitis Test {Tear Quidel Corporation 87809QW Fluid} Rapid Pathogen Screening RPS Adeno Detector Rapid Pathogen Screening, Inc. 87809QW Aerobic/Anaerobic Organisms - Vaginal Genzyme Diagnostics OSOM BVBLUE Test Gryphus Diagnostics, LLC 87905QW Gryphus Diagnostics BVBlue Gryphus Diagnostics, LLC 87905QW OBGYN-Vph Vaginal Ph Screening Kit Teco Diagnostics Pending Aerobic/Anaerobic/Viral Panel - Respiratory FilmArray Respiratory Panel 2.0 EZ (RP EZ) (nasopharyngeal) Biofire Diagnostics, LLC Pending Albumin Abaxis Piccolo Blood Chem Analyzer WB (Chem 13, CMP, Renal) Abaxis, Inc 82040QW Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Abaxis, Inc. 82040QW Reagent Disc) Abaxis Piccolo xpress Chem Analyzer WB Abaxis, Inc 82040QW (Chem 13, CMP, Liver Panel Plus, Renal) Arkray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 82040QW Genzyme Diag OSOM ImmunoDip (urinary alb) Genzyme Diagnostics 82040QW HemoCue Albumin 201 System (urinary albumin) HemoCue AB 82040QW TECO Diagnostics, Albumin Rapid Test Stick and Card Teco Diagnotics 82040QW Alanine Aminotransferase (ALT) Abaxis Piccolo Blood Chem Analyzer WB (CMP, Chem 6, Chem Abaxis, Inc 84460QW 13) Abaxis Piccolo Point Of Care Chemistry Analyzer (Lipid Panel Abaxis, Inc. 84460QW Reagent Disc) ALT Abaxis Piccolo xpress Chem Analyzer WB(CMP, Lipid Panel Plus, Abaxis, Inc 84460QW Liver Panel Plus, Chem 6, Chem 13) Alere Cholestech LDX (ALT)(WB) Alere, Inc 84466QW Arkray SPOTCHEM EZ Chem Analyzer (WB) Arkray, Inc. / Polymedco, Inc 84460QW Cholestech LDX Alanine Aminotransferase (ALT) Cholestech Corporation 84460QW Alkaline Phosphatase (ALP) Abaxis Piccolo Blood Chem Analyzer WB (CMP, Chem 13) Abaxis, Inc 84075QW Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Abaxis, Inc. 84075QW Reagent Disc) (WB) Abaxis Piccolo xpress Chem Analyzer WB (CMP, Chem 13, Liver Abaxis, Inc 84075QW Panel Plus) Akray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 84075QW Amylase Abaxis Piccolo Blood Chem Analyzer WB (Chem 13) Abaxis, Inc 82150QW Abaxis Piccolo express Chemistry Analyzer WB (Liver Panel Plus, Abaxis, Inc 82150QW Chem 13) Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Abaxis, Inc. 82150QW Reagent Disc)(WB)

DOH 681-018 May 2020 Page 1 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Aspartate Aminotransferase (AST) Abaxis Piccolo Blood Chem Analyzer WB (Chem 6, Chem 13, Abaxis, Inc 84450QW CMP) Abaxis Piccolo Point Of Care Chemistry Analyzer (Liver Panel Abaxis, Inc. 84450QW Reagent Disc) AST (WB) Abaxis Piccolo xpress Chem Analyzer WB(Chem 6, Chem 13, Abaxis, Inc 84450QW CMP, Liver Panel Plus, Lipid Panel Plus) Arkray SPOTCHEM EZ Chem Analyzer (WB) Arkray, Inc. / Polymedco, Inc 84450QW Cholestech LDX Aspartate Aminotransferase Cholestech Corporation 84450QW B-Type Natriuretic Peptide (BNP) Biosite Triage Meter (WB) (BNP) Biosite Incorporated 83880QW Biosite Triage Meter Plus (WB)(BNP) Biosite Incorporated 83880QW Biosite Triage Meterpro (WB)(BNP) Biosite Incorporated 83880QW Basic Metabolic Panel (Calcium, Ionized) Abbott i-STAT CHEM8+ Cartridge WB I-STAT Corporation 80047QW Basic Metabolic Panel (Calcium, Total) Abaxis Piccolo Blood Chemistry Analyzer WB (Basic Metabolic Abaxis, Inc 80048QW Reagent Disc) Abaxis Piccolo xpress Chemistry Analyzer WB (Basic Metabolic Abaxis, Inc 80048QW Reagent Disc) Bilirubin, Total Abaxis Piccolo Blood Chem Analyzer WB (Chem 13, CMP) Abaxis, Inc 82247QW Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Abaxis, Inc. 82247QW Reagent Disc)(WB) Abaxis Piccolo xpress Chem Analyzer WB(Chem 13, CMP, Liver Abaxis, Inc 82247QW Panel Plus) Akray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 82247QW Bladder Tumor Associated Antigen Alere NMP22 BladderChek Test Alere 86386QW BTA stat Test (for home use) Bion Diagnostic Sciences 86294QW LifeScan Status BTA Polymedco, Inc 86294QW Maritech BladderCheck Maritech, Inc. 86386QW BUN (Blood Urea Nitrogen) Abaxis Piccolo Blood Chemistry Analyzer (Chem 6 and 13 Panels, Abaxis, Inc. 84520QW CMP, BMP, Metlyte 8, Renal) Abaxis Piccolo xpress Chemistry Analyzer WB (Chem 6, 13, Kidney Abaxis, Inc. 84520QW Panels, CMP, BMP, Metlyte 8, Renal) Abbott i-STAT 6+ Cartridge (WB) i-STAT Corporation 84520QW Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 84520QW Arkray SPOTCHEM EZ Chem Analyzer (WB) Arkray, Inc. 84520QW Calcium Abaxis Piccolo Blood Chemistry Analyzer WB (Chem 13 Panel, Abaxis, Inc. 82310QW CMP, BMP, Renal) Abaxis Piccolo xpress Chemistry Analyzer WB (Chem 13 Panel, Abaxis, Inc. 82310QW CMP, BMP, Renal) Arkray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 82310QW Calcium – Ionized Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 82330QW

DOH 681-018 May 2020 Page 2 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Carbon Dioxide (CO2) Abaxis Piccolo Blood Chemistry Analyzer (CMP, BMP, Electrolyte Abaxis, Inc 82374QW Discs, Metlyte 8, Renal) Abaxis Piccolo xpress Chemistry Analyzer (CMP, BMP, Electrolyte Abaxis, Inc 82374QW Discs, Metlyte 8, Renal) Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 82374QW Catalase Accutest Uriscreen Rapid UTI Screen Savyon Diagnostics 81007QW Uriscreen (for OTC use), urine Diatech Diagnostics 81007QW Chloride Abaxis Piccolo Blood Chemistry Analyzer (CMP, BMP, Electrolyte, Abaxis, Inc 82435QW Metlyte 8, Renal) Abaxis Piccolo xpress Chemistry Analyzer (CMP, BMP, Electrolyte, Abaxis, Inc 82435QW Metlyte 8, Renal) Abbott i-STAT 6+ Cartridge (WB) i-STAT Corporation 82435QW Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 82435QW Cholesterol Abaxis Piccolo xpress Chemistry Analyzer {capillary-finger stick} Abaxis, Inc 82465QW (Cholesterol) Abaxis Piccolo xpress Chemistry Analyzer WB (Lipid Panel, Lipid Abaxis, Inc 82465QW Panel Plus) Abaxis Piccolo Point of Care Chemistry Analyzer WB (Lipid Panel, Abaxis, Inc 82465QW Lipid Panel Plus) Accu-Check InstantPlus Cholesterol Test System Roche/Boehringer Mannheim 82465QW Accucheck Instant Plus Dual Testing System Roche Diagnostics 82465QW ACON Laboratories Inc., Mission Cholesterol Pro Monitoring ACON Laboratories, Inc. 82465QW System Advanced Care Cholesterol Measuring System Johnson & Johnson 82465QW Alere Cholestech LDX (cholesterol)(WB) Alere, Inc 82465QW Alere San Diego, Inc., Cholestech LDX {WB} Abbott 82465QW Arkray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 82465QW Biomedix Inc Q Steps Biometer G/C Dual Monitoring System Biomedix, Inc. 82465QW ChemTrak AccuMeter Cholesterol Test System ChemTrak 82465QW Cholestech LDX (Must have software version 1.40 or above) Cholestech 82465QW ENA.C.T. Total Cholesterol & PDU ActiMed Laboratories, Inc 82465QW Germaine Laboratories Inc. AimStrip Tandem Lipid Profile and OSANG Healthcare Co., Ltd. 82465QW Glucose Measuring System Infopia USA LipidPro Infopia Co Ltd 82465QW Infopia USA LipidPro Professional Lipid Profile and Glucose Infopia Co Ltd 82465QW Measuring System Jant Pharmacal LipidPlus Lipid Profile and Glucose Measuring Infopia Co, Ltd 82465QW System KPI Healthcare Co., Ltd. CURO L5 Lipid Profile and Glucose OSANG Healthcare Co., Ltd. 82465QW Measuring System/Test Strips Lifestream Plus Cholesterol Monitor Lifestream Technologies 82465QW Lifestream Technologies Cholesterol Monitor Lifestream Technologies 82465QW

DOH 681-018 May 2020 Page 3 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Lifestream Technologies Personal Cholesterol Monitor for Lifestream Technologies, Inc. 82465QW cholesterol Mission Cholesterol Monitoring System and Mission Cholesterol Pro ACON Laboratories, INC 82465QW Monitoring System Polymer Technology Systems Bioscanner, Bioscanner Plus, and Polymer Technology Systems, 82465QW Bioscanner 2000 PTS Inc Polymer Technology Systems, Polymer Technology Systems MTM BioScanner 1000 82465QW Inc Polymer Technology Systems Cardiochek Plus, Cardiochek Home Use, Home Test System, and Cardiochek PA Analyzer test strips. 82465QW CardioChek Home Chol+HDL+Glu Test strips Polymer Technology Systems, -PTS Panels Lipid Panel test strips Inc 82947QW -CardioChek Home Lipid Panel test strips 82947QW Roche Diagnostics Accutrend Plus System WB Roche Diagnostics 82465QW SD Biosensor USA, Inc., SD LipidoCare (BT) Home Lipid Panel SD BIOSENSOR Pending Test Strip) SD Biosensor USA, Inc., SD LipidoCare (BT) Professional System SD BIOSENSOR Pending (SD LipidoCare Professional Lipid Panel Test Strip) Wako APOLOWAKO Analyzer Wako Chemicals USA 82465QW Complete Blood Count XW-100 Automated Hematology Analyzer for CLIA Waived Use (Hematocrit, Hemoglobin, Platelet Count, Red blood cell (RBC) Sysmex America, Inc Pending count, White blood cell (WBC) count, White blood cell differential) Comprehensive Metabolic Panel Abaxis Piccolo Blood Chemistry Analyzer WB (Comprehensive Abaxis, Inc 80053QW Metabolic Reagent Disc) Abaxis Piccolo xpress Chemistry Analyzer WB (Comprehensive Abaxis, Inc 80053QW Metabolic Reagent Disc) Creatine Kinase (CK) Abaxis Piccolo Blood Chemistry Analyzer WB (Metlyte 8 Disc) Abaxis, Inc 82550QW Abaxis Piccolo xpress Chemistry Analyzer WB (Metlyte 8 Disc) Abaxis, Inc 82550QW Creatinine Abaxis Piccolo Blood Chem Analyzer WB (Chem 6 and 13 Panels, Abaxis, Inc. 82565QW CMP, BMP, Metlyte 8, Renal) Abaxis Piccolo xpress Chem Analyzer WB (Chem 6, 13, Kidney Abaxis, Inc. 82565QW Panels, CMP, BMP, Metlyte 8, Renal) Abbott i-STAT Crea Cartridge (WB) i-STAT Corporation 82565QW Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 82565QW Akray SPOTCHEM EX Chem Analyzer (WB) Polymedco, Inc 82565QW Siemens Clinitek 50 Urine Chemistry Analyzer (see also under Bayer 82570QW Urinalysis) Siemens MICROABLUSTIX Reagent Strips Bayer 82570QW Siemens MultiStix PRO 10LS, PRO 11 and PRO 7G Reagent Strips Bayer 82570QW (urine dipstick and urine creatinine nonautomated) Drugs of Abuse (Use G0477QW for visually read devices or G0478QW for instrument read devices) 1 Step Detect Associates DTX Drug Test Cup Integrated E-Z Split Key Cup II(amphetamines, cocaine metabolites, MDMA, Biosite Inc 80305QW methamphetamines, opiates, PCP, THC)

DOH 681-018 May 2020 Page 4 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) 12 Panel Now (DBA) Hospital Connect Inc, 12 Panel Dip/Cup Tests (amphetamines, barbiturates, buprenorphine, benzodiazepines, Assure Tech (Hangzhou) Co., cocaine metabolites, EDDP, MDMA, methamphetamines, 80305QW Ltd. morphine, methadone, oxycodone, PCP, propoxyphene, tricyclic antidepressants, THC) Abbott Diagnostics Signify ER Drug Screen Test(amphetamines, barbiturates, benzodiazepines,cocaine metabolites, MDMA, opiates, Innovacon, Inc 80305QW oxycodone, PCP, propoxyphene, THC, tricyclic antidepressants) Acon iCassette Multi-Drug, Multi-Line Screen Test Device (amphetamines, cocaine metabolites, methamphetamines, opiates , Acon Laboratories, Inc. 80305QW PCP, THC) Acon Multi-Drug, Multi-Line Screen Test Card with Integrated Cup {professional use}(amphetamines, cocaine metabolites, MDMA Acon Laboratories, Inc. 80305QW methamphetamines, opiates, PCP, THC) Acon On Call Multi Drug Home Test/Test Cup(amphetamines, Acon Laboratories, Inc. 80305QW cocaine metabolites, methamphetamines, opiates, PCP,THC) Acon One Step Multi-Drug, Multi-Line Screen Test Device P{professional use}(amphetamines, cocaine metabolites, Acon Laboratories, Inc. 80305QW methamphetamines, opiates, PCP, THC) Acon Redi-Test Cassette Multi-Drug, Multi-Line Screen Test Device (amphetamines, cocaine metabolites, methamphetamines, opiates, Acon Laboratories, Inc. 80305QW PCP, THC) Accu-Stat Drugs of abuse Home Test amphetamines, cocaine Accu-Stat Diagnostics, Inc. 80305QW metabolites, methamphetamines, opiates, PCP,THC) Accu-Stat Home Drug Test -Cocaine -Marijuana -Marijuana and Cocaine Accu-Stat Diagnostics, Inc. 80305QW -Marijuana, cocaine, amphetamine, -Methamphetamine, opiates, PCP -Marijuana, cocaine, amphetamine, -Methamphetamine, opiates, ecstasy, PCP ACCU News Drug Screening Test Card/Urine Cup (Amphetamines, Coretests, Inc 80305QW Methamphetamines, Opiates, Cocaine Metabolites, Cannabinoids) ADC Multiple Drug Test Card (opiates, methamphetamines, Advantage Diagnostics Corp 80305QW cocaine metabolites, THC, PCP) Accutest Multi-Drug, Multi Line Screen Test Device (amphetamines, Acon Laboratories, Inc. 80305QW THC, cocaine metabolites, methamphetamines. Opiates, (PCP) Advin Multi-Drug Screen Test (amphetamines, barbiturates, buprenorphine, benzodiazepines, cocaine, metabolites, EDDP, Advin Biotech 80305QW methamphetamines, morphine, methadone, opiates, oxycodone, PCP, tricyclic antidepressants, THC, MDMA) Aeon Multi-Drug Urine Test Cup and DipCard (amphetamines, barbituates, benzodiapzepines, buprenorphine, THC, cocaine Healgen Scientific Limited 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants, EDDP) AimScreen Multi-Drug Urine Dip Card, Dip Device CLIA Waived and Test Cup (Amphetamines, Benzodiazepines, Cocaine Healgen Scientific Limitied 80305QW metaboities, Cannabinoids, Methamphetamines, Oxycodone, Morphine, Barbituates, Buprenorphine, MDMA, PCP, Methadone) Alatex Scientific Peace of Mind Marijuana Home Drug Test Advantage Diagnostics Corp 80305QW

DOH 681-018 May 2020 Page 5 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Alere Toxicology Service Alere iCup DxPro2 Multi-Drug Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Benzodiazepines, Guanhzhou Wondfo Biotech., Cocaine metabolities, Cannabinoids (THC), Methamphtamines, 80305QW LTD. MDMA, Morphine, PCP, Oxycodone, Buprenorphine, Methadone, Tricyclic antidepressants) Marijuana & Cocaine Home Drug Test (OTC) Alatex Scientific 80305QW Multiple Drugs of Abuse Test Advantage Diagnostics Corp 80305QW Alere iCassette Drug Screen (amphetamines, cocaine metabolites, Biosite Inc 80305QW Methamphetamines, Opiates, PCP, THC) Alere Toxicology Services Alere iCassette Dx Drug Screen (barbiturates, amphetamines, benzodiazepines, cocaine Alere 80305QW metabolites, morphine, oxycodone, propoxyphene, PCP, tricyclic antidepressants, THC, MDMA) Alere iCUP DX Drug Screen Cup (barbiturates, amphetamines, benzodiazepines, cocaine metabolites methadone, Alere 80305QW methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants, THC) Alere iCUP Dx Pro Urine Drug Screening Device (amphetamines, barbiturates, , benzodiazepines, cocaine metabolites methadone, Amedica Biotech, Inc 80305QW methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants, THC) Alere iCup DX-14 Drug Screen Cassette Dip Card (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites Branan Medical Corp 80305QW methadone, methamphetamines, MDMA, morphine, oxycodone, propoxyphene, PCP, tricyclic antidepressants, THC) Alere iScreen DX Multi-Drug of Abuse Dip Test (barbiturates, amphetamines, benzodiazepines, buprenorphine, cocaine Branan Medical Corp 80305QW metabolites, methadone, methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants, THC) Alere iScreen DX Single Dip Card (barbiturates, amphetamines, benzodiazepines, buprenorphine, cocaine metabolites, methadone, Branan Medical Corp 80305QW methamphetamines, MDMA, opiates, PCP, tricyclic antidepressants, THC) Alere iCup Rx Mutli-Drug Urine Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine Guangzhou Wondfo Biotech 80305QW metabolities, MDMA, Methadone, Methamphetamines, Morphine, Co., LtD. Oxycodone, PCP, THC, Tricyclic anitdepressants) Alere Toxicology Services, Alere T-Cup Compact Multi-Drug Urine Guangzhou Wondfo Biotech 80305QW Test Cup (EDDP, Propoxyphene) Co., Ltd. Alere Toxicology Services, Alere T-Cup Compact Multi-Drug Urine Test Cup (Amphetamines, Cocaine metabolities, Guangzhou Wondfo Biotech Methamphetamines, THC, MDMA, Morphine, PCP, Oxycodone, 80305QW Co., Ltd Buprenorphine, Methadone, Barbiturates, Benzodiazepines, Tricyclic anitdepressants) Alere Toxicology Services Drugs of Abuse Cup (amphetamines, cocaine metabolites, THC, methamphetamines, MDM A, opiates, Alere San Diego, Inc 80305QW PCP) Alere Toxicology Services, UScreen Drug Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, EDDP, methadone, methamphetamines, Wondfo Biotech Co., Ltd. 80305QW MDMA, morphine, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants)

DOH 681-018 May 2020 Page 6 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Alere Tox Screen Drugs of Abuse Test Cup(amphetamines, cannabinoids, cocaine metabolites, methamphetamines, opiates, Alere, Inc 80305QW PCP, MDMA) Alfa Scientific Designs, Inc Confidential Drug Test-Multi Drugs of Abuse Urine (amphetamines, cocaine metabolites, morphine, THC, Alfa Scientific Designs, Inc 80305QW MDMA) Alfa Scientific Designs, Inc Instant View Multi Drug of Abuse Urine Test (barbiturates, amphetamines, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methamphetamines, morphine, methadone, PCP, tricyclic antidepressants, THC, MDMA) Alfa Scientific Designs, Inc Instant View Multi Drug of Abuse Urine Cup Test (barbiturates, amphetamines, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, morphine, methadone, PCP, tricyclic antidepressants, THC, MDMA) Alfa Scientific Designs, Inc Instant Verdict Multi Drug of Abuse Urine Test (barbiturates, amphetamines, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methamphetamines, morphine, methadone, PCP, tricyclic antidepressants, THC, MDMA) Alfa Scientific Designs, Inc Instant Verdict Multi Drug of Abuse Urine Cup Test (barbiturates, amphetamines, benzodiazepines, Alfa Scientific Designs, Inc 80305QW cocaine metabolites, methamphetamines, morphine, methadone, PCP, tricyclic antidepressants, THC, MDMA) Alfa Scientific Designs, Inc. Instant-View Drug of Abuse Urine Cup Alfa Scientific Designs, Inc 80305QW Test (morphine, Oxycodone) Alfa Scientific Designs, Inc. Instant-View Multi Drug of Abuse Urine Test Cup(amphetamines, barbiturates, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, MDMA, methamphetamines, methadone, morphine, opiates, PCP, tricyclic antidepressants, THC) Alfa Scientific Designs, Inc. Instant-View Multi Drug of Abuse Urine Test Panel(amphetamines, barbiturates, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, MDMA, methamphetamines, methadone, morphine, opiates, PCP, tricyclic antidepressants, THC) Alfa Scientific Designs, Inc., INSTANT-VIEW plus Multi-Drug of Abuse Urine Test – Simple Cup (OTC Use) (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Alfa Scientific Designs, Inc 80305QW methadone, methamphetamines, MDMA, morphine, PCP, tricyclic antidepressants, buprenorphine, oxycodone) Alfa Scientific Designs Instant-View Drug of Abuse Urine Cassette Alfa Scientific Designs, Inc 80305QW Test (morphine, Oxycodone) Alfa Scientific Designs, Inc Multi Drug of Abuse Urine Test (barbiturates, amphetamines, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methamphetamines, morphine, methadone, PCP, tricyclic antidepressants, THC, MDMA) Alfa Scientific Designs, Inc Multi Drug of Abuse Urine Cup Test (barbiturates, amphetamines, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methamphetamines, morphine, methadone, PCP, tricyclic antidepressants, THC, MDM) AM Diagnostic, LLC, Helse Multiple Drug Cup Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Tianjin New Bay Bioresearch 80305QW methadone, methamphetamines, morphine, oxycodone, PCP, Co., Ltd. tricyclic antidepressants)

DOH 681-018 May 2020 Page 7 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Amedica Biotech Amedica Drug Test Cup (barbiturates, amphetamines, benzodiazepines, cocaine metabolites, Amedica Biotech Inc. 80305QW methamphetamines, methadone, opiates, oxycodone, PCP, tricyclic antidepressants, THC, MDMA) Amedica Biotech The Amedica Home Drug Test Cup (barbiturates, amphetamines, benzodiazepines, cocaine metabolites, Amedica Biotech Inc. 80305QW methamphetamines, methadone, opiates, oxycodone, PCP, tricyclic antidepressants, THC, MDMA) Amedica Biotech AmediCheck Instant Test Cup: (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, MDMA, Amedica Biotech Inc. 80305QW methamphetamines, methadone, opiates, oxycodone, PCP, tricyclic antidepressants, THC) Amedica Biotech Instant Test Cup (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, MDMA, Amedica Biotech Inc. 80305QW methamphetamines, methadone, opiates, oxycodone, PCP, tricyclic antidepressants, THC) Ameditech Inc ImmuTest Drug Screen Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Biosite Inc 80305QW methadone, MDMA, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) American Bio Medica Rapid TOX (barbiturates, amphetamines, benzodiazepines, buprenorphine, cocaine metabolites, American Bio Medica Corp 80305QW methamphetamines, methadone, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants, THC, MDMA) American Bio Medica Rapid Tox Cup II (barbiturates, amphetamines, benzodiazepines, buprenorphine, cocaine American Bio Medica Corp. 80305QW metabolites, methamphetamines, methadone, opiates, oxycodone, PCP, tricyclic antidepressants, THC, MDMA) American Institute of Toxicology, Inc., AIT Laboratories Drug of Abuse Card (amphetamines, barbiturates, benzodiazepines, Guangzhou Wondfo Biotech Co 80305QW cocaine metabolites, THC, methamphetamines MDMA, morphine, methadone, PCP, tricyclic antidepressants, oxycodone) American Institute of Toxicology, Inc., AIT Laboratories Drug of Abuse Cup (amphetamines, barbiturates, benzodiazepines, Guangzhou Wondfo Biotech Co 80305QW cocaine metabolites, THC, methamphetamines MDMA, morphine, methadone, PCP, tricyclic antidepressants, oxycodone) American Institute of Toxicology, Inc., AIT Laboratories Drug of Abuse Card (amphetamines, barbiturates, benzodiazepines, Guangzhou Wondfo Biotech Co 80305QW cocaine metabolites, THC, methamphetamines, MDMA, morphine, opiates, PCP, oxycodone, buprenorphine) American Screening Corp Discover Drug Test Cups/Cards (amphetamines, barbiturates, benzodiazepines, buprenorphine, EDDP, THC, cocaine metabolites, methadone, MDMA, UCP Biosciences, Inc 80305QW methamphetamines, morphine, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) American Screening Corporation, Inc. Precision DX Panel Dip M300/Dip M2000/Quick Cup M300/Quick Cup M2000 (amphetamines, benzodiazepines, cocaine metabolites, THC, Assure Tech (Hangzhou) Co., 80305QW methamphetamines, morphine, oxycodone, barbiturates, Ltd. buprenorphine, MDMA, PCP, EDDP, tricyclic antidepressants, propoxyphene, methadone)

DOH 681-018 May 2020 Page 8 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) American Screening Corporation Discover Multi-Drug Key Cups(amphetamines, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, methadone, UCP Biosciences, Inc 80305QW methamphetamines, MDMA, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) American Screening Corporation Discover Plus Multi-Drug Key Cups and Cards (amphetamines, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, methadone, UCP Biosciences, Inc 80305QW methamphetamines, MDMA, morphine, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) American Screening Corp Multi-Drug Test Cups/Cards (amphetamines, barbiturates, benzodiazepines, THC, cocaine UCP Biosciences, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) American Screening Corp OneScreen Drug Test Cards (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, methadone, MDMA, UCP Biosciences, Inc 80305QW methamphetamines, morphine, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) American Screening Corp OneScreen Drug Test Cups (amphetamines, barbiturates, benzodiazepines, THC, cocaine UCP Biosciences, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) American Screening Corporation Precision DX Panel Dip M300/Quick Cup M300/Panel Dip M2000/Quick Cup M2000 (amphetamines, barbiturates, benzodiazepines, THC, cocaine AmericanScreening 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, oxycodone, PCP) American Screening Corp Reveal Multi- Drug Testing Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, methadone, MDMA, UCP Biosciences, Inc 80305QW methamphetamines, morphine, opiates, oxycodone, propoxyphene, PCP, tricyclic antidepressants) American Screening Corp Reveal Mini Drug Testing Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, methadone, MDMA, UCP Biosciences, Inc 80305QW methamphetamines, morphine, opiates, oxycodone, propoxyphene, PCP, tricyclic antidepressants) American Screening LLC, Precision Plus/DX Quick Cup/Panel Dip Tests (amphetamines, barbiturates, buprenorphine, American Screening benzodiazepines, cocaine metabolites, EDDP, MDMA, 80305QW Corporation, Inc. methamphetamines, morphine, methadone, oxycodone, PCP, propoxyphene, tricyclic antidepressants, THC) APC Work Force solutions ZeroChaos Multi Drug Screen Cup – professional (amphetamines, barbiturates, benzodiazepines, THC, Tianjin New Bay Bioresearch 80305QW cocaine metabolites, methadone, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants) Applied Biotech Drug Free @Home:THC (OTC) Applied Biotech, Inc 80305QW Applied Biotech Drug Free @Home:Cocaine Test (OTC) Applied Biotech, Inc 80305QW Assure Tech. Co., Ltd. AssureTech Panel Dip Test, Quick Cup Test (Ampethamines, Barbituates, Benzodiazepines, Buprenorphine, AssureTech (Hangzhou) 80305QW Cocaine metaboities, MDMA, Methamphetamines, Methadone, CO.,Ltd Morphine, Oxycodone, PCP, THC)

DOH 681-018 May 2020 Page 9 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Assure Tech Co., Ltd. AssureTech Quick Cup/Panel Dip Tests

(Propoxyphene, Tricyclic antidepressants, EDDP) AssureTech Strip, Dip Card, Quick Cup, Turn-Key Split Cup AssureTech (Hangzhou) Co., (Amphetamine, Cocaine, Marijuana, Methamphetamine, Morphine, 80305QW Ltd. PCP) AssureTech Buprenorphine Strip, Panel Dip, Quick Cup, Turn Key- AssureTech. CO.,Ltd 80305QW Split Cup AssureTech Methadone Strip, Panel Dip, Quick Cup, Turn Key-Split AssureTech. CO.,Ltd 80305QW Cup AssureTech Oxycodone Strip, Panel Dip, Quick Cup, Turn Key-Split AssureTech. CO.,Ltd 80305QW Cup (Barbiturates, Oxycodone) {OTC} AssureTech Panel Dip Test, Assure Quick Cup Test (Ampethamines, Barbituates, Benzodiazepines, Buprenorphine, AssureTech (Hangzhou) 80305QW Cocaine metaboities, MDMA, Methamphetamines, Methadone, CO.,Ltd Morphine, Oxycodone, PCP, THC) AssureTech Secobarbital Strip, Panel Dip, Quick Cup, Turn Key- AssureTech. CO.,Ltd 80305QW Split Cup {OTC} (Barbiturates , Oxycodone) Assured THC One step Marijuana Test Strip and Test Cassette Healgen Scientific 80305QW ATTEST (Amphetamines, Barbiturates, Benzodiapzepines, Buprenorphine, Cannabinoids, Cocaine metabolites, Methadone Advin Biotech, Inc 80305QW metabolites, Methamphetamines, MDMA, Morphine, Opiates, Oxycodone, PCP, Tricyclic antidepressants) Aventir Biotech LLC Home Check Multiple Drug Cup Test (barbiturates, amphetamines, benzodiazepines, cocaine Tianjin New Bay Bioresearch Co 80305QW metabolites, methamphetamines, morphine, methadone, oxycodone, PCP, tricyclic antidepressants, THC) Azure Biotech, Inc., Azure Bio-Panel Dip/Quick Cup Tests (morphine, amphetamines, barbiturates, buprenorphine, cocaine metabolites, benzodiazepines, EDDP, MDMA, methamphetamines, Azure Biotech Inc. 80305QW methadone, oxycodone, PCP, propoxyphene, tricyclic antidepressants, THC) Azure Biotech Inc., Azure Bio-Sensitivity Plus Panel Dip/Quick Cup Tests (EDDP, amphetamines, barbiturates, buprenorphine, benzodiazepines, cocaine metabolites, MDMA, methamphetamines, Azure Biotech Inc. 80305QW morphine, oxycodone, PCP, propoxyphene, tricyclic antidepressants, THC, methadone) Best Value Medical, Best Value Medical Multi Drug Testing Cup (Amphetamines, Oxazepam, Cocaine metabolites, THC, LSI Consulting 80305QW Methamphetamines, Morphine, Secobarbital, Methadone, MDMA, Oxycodone, Buprenorphine, PCP, Nortriptyline, Propoxyphene) Biotech Screening Correction Cup- Cup format ( amphetamines, barbiturates, benzodiazepines, cocaine metabolites, Guangzhou Wondfo Biotech 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, THC, Co., Ltd tricyclic antidepressants) Biotech Screening Correction Cup-Cup format (amphetamines, Guangzhou Wondfo Biotech 80305QW barbiturates, benzodiazepines, cannabinoids, oxycodone) Co., Ltd Biotech Screening Correction Cup (cocaine metabolites, Guangzhou Wondfo Biotech methamphetamines, MDMA, morphine, PCP, tricyclic 80305QW Co., Ltd antidepressants, methadone) Biotech Screening, LLC, Biotech Screening Corrections Cup, Cup format (buprenorphine, amphetamines, barbiturates, Guangzhou Wondfo Biotech 80305QW benzodiazepines, cocaine metabolites, cannabinoids, MDMA, Co., Ltd morphine, opiates, PCP, oxycodone)

DOH 681-018 May 2020 Page 10 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Biotech Screening, LLC Corrections Cup Multi-Drug Urine Test Cup (amphetamines, buprenorphine, cannabinoids, cocaine metabolites, Guangzhou Wondfo Biotech 80305QW methadone, methamphetamines, MDMA, tricyclic antidepressants, Co., Ltd oxycodone, morphine, benzodiazepines, PCP, barbiturates) Biotechnostix Rapid Response Multi-Drug, Multi-Line Screen Test Card with Integrated Cup (amphetamines, cocaine metabolites, Acon Laboratories, Inc. 80305QW THC, methamphetamines, MDMA, opiates, PCP) Biotechnostix Rapid Response One Step Multi-Drug, Multi-Line Screen Test Device (amphetamines, cocaine metabolites, THC, Acon Laboratories, Inc. 80305QW methamphetamines, opiates, PCP) Branan Medical Corp Fastect II Drug Screen Dipstick Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Branan Medical Corporation 80305QW metabolites, methadone, methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants Branan Medical Corp Fastect II BUP Dipcard (buprenorphine) Branan Medical Corporation 80305QW Branan Medical Corp Fastect II BUP Dipstsick (buprenorphine) Branan Medical Corporation 80305QW Branan Medical Corp FasTox Drug Dipcard (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Branan Medical Corporation 80305QW methadone, methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants) Branan Medical Corp QuickTox Drug Screen (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Branan Medical Corporation 80305QW methadone, methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants) Branan Medical Corp QuickTox Dipcard (buprenorphine) Branan Medical Corporation 80305QW Branan Medical Corp ToxCup Drug Screen Cup/Cassette Dip Card (amphetamines, barbiturates, benzodiazepines, THC, cocaine Branan Medical Corporation 80305QW metabolites, methadone, methamphetamines, MDMA, opiates, oxycodone, PCP) BTNX Inc Know Multi-Drug One Step Screen Test Panel (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methadone, methamphetamines, morphine, MDMA, PCP, tricyclic antidepressants) BTNX Inc. Rapid Response Drug Screening Cup-OTC/Panel- OTC/Test Strip-OTC (amphetamines, barbiturates, Hangzhou AllTest Biotech Co., benzodiazepines, buprenorphrine, cocaine metabolites, THC, 80305QW Ltd methadone, methamphetamines, MDMA, morphine, PCP, tricyclic antidepressants, oxycodone, EDDP) BTNX Inc. Rapid Response Drug Screening Cup/Panel/Strip w/wo Adulteration (amphetamines, barbiturates, benzodiazepines, Hangzhou AllTest Biotech Co., buprenorphrine, cocaine metabolites, THC, methadone, 80305QW Ltd methamphetamines, MDMA, morphine, PCP, tricyclic antidepressants, oxycodone, EDDP) BTNX, Inc. Rapid Response Drug Screening Panel/Cup (Amphetamines, Barbiturates, Buprenorphine, Benzodiazepines, Cocaine metabolites, EDDP, MDMA, Methamphetamines, BTNX, Inc. 80305QW Morphine, Methadone, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants, THC) BTNX Inc. Rapid Response Drugs of Abuse Test Cup and Test Panel (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine metabolites, EDDP, MDMA, Methadone, Healgen Scientific 80305QW Methamphetamines, Morphine, Oxycodone, PCP, THC, Tricyclic antidepressants)

DOH 681-018 May 2020 Page 11 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) BTNX Inc Rapid Response Multi-Drug One Step Screen Test Panel (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methamphetamines, morphine, MDMA, PCP, tricyclic antidepressants) BTNX Inc Rapid Response Multi-Drug Urine Test Panel {Dip Card format} (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, methamphetamines, morphine, Guangzhou Wondfo Biotech Co 80305QW MDMA, oxycodone, PCP, tricyclic antidepressants, buprenorphrine) BTNX Inc Rapid Response Multi-Drug Urine Test Cup{Cup format} (amphetamines, barbiturates, benzodiazepines, THC, cocaine Guangzhou Wondfo Biotech Co 80305QW metabolites, methadone, methamphetamines, morphine, MDMA, oxycodone, PCP, tricyclic antidepressants, buprenorphines) BTNX Inc. Rapid Response Multi-Drug Urine Test Cup (Morphine 300) {cup format}(amphetamines, burenorphine, THC, cocaine Guangzhou Wondo Biotech Co., 80305QW metabolities, methadone, methamphetamines, MDMA, morphine, Ltd tricyclic antidepressants, benzopdiazepines, PCP, barbituates) BTNX Inc. Rapid Response Multi-Drug Urine Test Panel (Morphine 300) {Dip Card format} (oxycodone, amphetamines, Guangzhou Wondo Biotech Co., buprenorphrine, THC, cocaine metabolites, methadone, 80305QW Ltd methamphetamines, MDMA, morphine, tricyclic antidepressants, benzodiazepines, PCP, barbituates) BTNX Inc. Rapid Response Multi-Drug Integrated Split Spec. Cup (Ampetamine, Barbiturates, Buprenorphine, Cocaine, BTNX Inc. 80305QW Methamphetamine, Morphine, Oxycodone, PCP, THC) BTNX Inc. Rapid Response Multi-Drug One-Step Cup (Ampetamine, Barbiturates, Buprenorphine, Cocaine, BTNX Inc. 80305QW Methamphetamine, Morphine, Oxycodone, PCP, THC) BTNX Inc. Rapid Response Single-Drug Test Strip, Single/Multi- Drug Test Panel (Amphetamines, Barbirurates, Buprenorphine, BTNX Inc. 80305QW Cocaine metabolites, Morphine, Methadone, Methamphetamines, PCP, Oxycodone, THC) BTNX Inc. Rapid Response Single/Multi DOA Panel MOR 300/Panel MOR 2000/Cup MOR 300/Cup MOR 2000 (Urine) (Amphetamines, Barbirurates, Buprenorphine, Benzodiazepines, Assure Tech (Hangzhou) Co., 80305QW Cocaine metabolites, EDDP, Methadone, MDMA, Ltd. Methamphetamines, Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants, THC) BTNX Inc. Rapid Response Single/Multi-Drug Test Panel (Amphetamines, Barbirurates, Buprenorphine, Cocaine metabolites, BTNX Inc. 80305QW Morphine, Methamphetamines, PCP, Oxycodone, THC) BTNX Inc. Rapid Response Multi-Drug Urine Test Cup and Dip Card (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine metabolites, MDMA, Methamphetamines, Healgen Scientific Limited 80305QW Methadone, Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) BTNX Rapid Response X-Press Drug Test Strip or Cassette BTNX, Inc 80305QW (AMP/Amphetamine)(amphetamines) BTNX Rapid Response X-Press Drug Test (COC/Cocaine) Dip BTNX, Inc 80305QW Card or Cup format (Cocaine metabolites) BTNX Rapid Response X-Press Drug Test(MDMA/Methylenedioxymethaphetamines) Dip Card or Cup BTNX, Inc 80305QW format (MDMA)

DOH 681-018 May 2020 Page 12 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) BTNX Rapid Response X-Press Drug Test (MET/Methamphetamine) Dip Card or Cup format BTNX, Inc 80305QW (methamphetamines) BTNX Rapid Response X-Press Drug Test (MOP/Morphine) Dip BTNX, Inc 80305QW Card or Cup format (morphine) BTNX Rapid Response X-Press Drug Test Morphine (2000) Dip BTNX, Inc 80305QW Card or Cup format (Cocaine metabolites) BTNX Rapid Response X-Press Drug Test (MTD/Methadone) Dip BTNX, Inc 80305QW Card or Cup format (methadone) BTNX Rapid Response X-Press Drug Test Nortriptyline Dip Card BTNX, Inc 80305QW and Cup format (tricyclic antidepressants) BTNX Rapid Response X-Press Drug Test Oxazepam Strip or BTNX, Inc 80305QW Cassette (Benzodiazepines) BTNX Rapid Response X-Press Drug Test (PCP/PCP) Dip Card or BTNX, Inc 80305QW Cup format (PCP) BTNX Rapid Response X-Press Drug Test Secobarbital Strip or BTNX, Inc 80305QW Cassette (Barbiturates) BTNX Rapid Response X-Press Drug Test Strip or Cassette (THC) BTNX, Inc 80305QW Budpak THC One Step Marujuana, Test Cassette, Test Dip card, Healgen Scientific Limited 80305QW Test Strip Budpak Morphine Test DipCard, Test Cassette, Test Strip Healgen Scientific Limited 80305QW Chemtron Biotech Inc, Chemtrue Multi-Panel DOA Dip Card Tests (amphetamines, THC, cocaine meatbolites, methanphetamines, Chemtron Biotech, Inc 80305QW morphine, PCP,barbituates, benzodiadepines, methadone, MDMA, opiates, oxycodone, tricyclic antidepressants, buprenorphrine) Chemtron Biotech Inc, Chemtrue Multi-Panel DOA Dip Card with OPI 2000 Tests (amphetamines, THC, cocaine metabolites, methamphetamines, morphine, PCP, barbiturates, Chemtron Biotech, Inc 80305QW benzodiadepines, methadone, MDMA, opiates, oxycodone, tricyclic antidepressants, buprenorphrine) Chemtron Biotech Inc, Chemtrue Single/Multi-Panel Drug Screen Cassette Tests (benzodiazepines, barbiturates, buprenorphrine, Chemtron Biotech, Inc 80305QW tricyclic antidepressants, MDMA, methadone, opiates, oxycodone) Chemtron Biotech Chemtrue Single/Multi-Panel Drug Screen Cup tests: (buprenorphrine, tricyclic antidepressants, amphetamines, Chemtron Biotech, Inc 80305QW barbiturates, benzodiazepines, cocaine metabolites, MDMA, methamphetamines, methadone, morphine, oxycodone, PCP, THC) Chemtron Biotech Chemtrue Screen Cup tests with OPI 2000 (buprenorphrine, tricyclic antidepressants, amphetamines, Chemtron Biotech, Inc 80305QW barbiturates, benzodiazepines, cocaine metabolites, MDMA, methamphetamines, methadone, opiates, oxycodone, PCP, THC) Chemtron Biotech Inc, Chemtrue Single/Multi-Panel Drug Screen Dip Card Tests (buprenorphine, tricyclic antidepressants, Chemtron Biotech, Inc 80305QW amphetamines, THC, cocaine metabolites, methamphetamines, Morphine, PCP) Chemtrue Multi-Panel Drug Screen Dip Card/Cup Tests (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cannabinoids, Cocaine metabolites, Methodone, Chemtrom Biotech, Inc. 80305QW Methamphetamines, MDMA, Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants)

DOH 681-018 May 2020 Page 13 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Chemtrue Multi-Panel Dip Card with OPI 2000 Tests (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cannabinoids, Cocaine metabolites, Methodone, Chemtron Biotech, Inc. 80305QW Methamphetamines, MDMA, Morphine, Opiates, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) Clarity Diagnostics, Multi-Drug Home Rapid Test Cup/Panel (Urine) (Amphetamines, Barbiturates, Buprenorphine, Benzodiazepines, Hangzhou AllTest Biotech Co., Cocaine metabolites, Methamphetamines, Methadone, PCP, 80305QW Ltd Tricyclic antidepressants, THC, MDMA, Morphine, Oxycodone, EDDP) Clarity Diagnostics LLC., Clarity CLIA Waived Multi-Drug Urine Test Cup and Test Panel (Amphetamines, Cocaine metabolites, THC, Guangzhou Wondfo Biotech Methamphetamines, MDMA, Morphine, PCP, Oxycodone, 80305QW Co., LTD Buprenorphine, Methadone, Tricyclic antidepressants, Benzodiazepines, Phenobarbital) Clarity Diagnostics Multi-Panel Drug Screen Dip Card Tests (amphetamines, barbiturates, benzodiazepines, buprenorphine, Chemtron Biotech, Inc 80305QW cocaine metabolites, MDMA, methamphetamines, methadone, morphine, oxycodone, PCP, THC, tricyclic antidepressants) Clarity Diagnostics Multi-Panel Drug Screen Dip Card with OPI 2000 Tests (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, MDMA, methamphetamines, Chemtron Biotech, Inc 80305QW methadone, opiates, oxycodone, PCP, THC, tricyclic antidepressants) CLIA Screen In-Vitro Multi-Drug Urine Test Dip Card and Test Cup (amphetamines, cocaine metabolites, barbituates, benzodiazepines, MDMA, buprenorphine, EDDP, methadone, Healgen Scientific 80305QW methamphetamines, morphine, oxycodone, PCP, THC, tricycylic antidepressants) CLIA-X Multiple Drug Cup Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, Tianjin New Bay Bioresearch Co 80305QW methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants) CLIAwaived, Drug Test Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, Guangzhou Wondfo Biotech 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) CLIAwaived, Instant Drug Test Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, Guangzhou Wondfo Biotech 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) CLIA wavied Inc, Instant Drug Test Cup/Card II (IDTC II) (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine metabolities, EDDP, MDMA, Methadone, Advin Biotech, Inc. 80305QW Methamphetamines, Morphine, Opiates, Oxycodone, PCP, THC, Tricyclic antidepressants) CLIAwaived Inc. Multi-Drug Screen Test CUP (Amphetamines, Barbiturates, Tricyclic antidepressants, PCP, Oxycodone, Opiates, Advin Biotech, Inc. 80305QW Morphine, MDMA, Methamphetamines, EDDP, Methadone, Cocaine metabolities, THC, Buprenorphine, Benzodiazepines) CLIAwaived Rapid Dip Drug Test (buprenorphine) Branan Medical Corp 80305QW

DOH 681-018 May 2020 Page 14 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) CLIAwaived Rapid Drug Test Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, Biosite, Inc / Alere 80305QW methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants) CLIAwaived Inc. Rapid Drug Test Cup Cassette Dip Card format (amphetamines, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, methadone, MDMA, Branan Medical Corp 80305QW methamphetamines, morphine, oxycodone, PCP, propoxyphene, tricyclic antidepressants) CLIAwaived Rapid Drug Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, Branan Medical Corp 80305QW methamphetamines, MDMA, opiates, oxycodone, PCP) CLIAwaived Single Drug Dipstick Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Branan Medical Corp 80305QW methadone, methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants) CLIAwaived Single Drug Dipstick Test (buprenorphine) Branan Medical Corp 80305QW Clinical Reference Intelligent Transport Cup (OTC) (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Biosite Inc. / Alere 80305QW methadone, methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants) Clungene Split Key Cup, Test Cup, Dip Card, Cassette Hangzhou Clongene Biotech., (Amphetamines, Benzodiazapines, Cocaine metabolites, 80305QW LTD Methamphetamine, Morphine, Marijuana) Coastline Medical Management Coastline Expolorer Cup (Cassette Dip Card Format) (amphetamines, barbituates, benzodiazepines, buprenorphine, THC, cocaine metabolites, methadone, Branan Medical Corp 80305QW methamphetamines, MDMA, morphine, Oxycodone, PCP, proxyphene, tricyclic anitdepressants) Co-Innovation Biotech Co., Ltd Single/Multi-drug Test Cup (amphetamines, barbiturates, benzodiazepines, cocaine metaboiltes, EDDP, MDMA, methamphetamines, methadone, Co-Innovation Biotech Co., Ltd 80305QW morphine, oxycodone, PCP, propoxyphene, THC, tricyclic antidepressants, buprenorphine) Co-Innovation Biotech Co., Ltd Single/Multi-drug Test Dipcard (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, EDDP, MDMA, methamphetamines, methadone, Co-Innovation Biotech Co., Ltd 80305QW morphine, oxycodone, PCP, propoxyphene, THC, tricyclic antidepressants, buprenorphine) Confirm Bioscience, DrugConfirm Multi Drug Urine Test Cup (amphetamines, benzodiazepines, barbiturates, buprenorphine, THC, cocaine metabolites, EDDP, methadone, methamphetamines, Healstone Biotech Inc 80305QW MDMA, morphine, oxycodone, PCP, propoxyphene, tricyclic antidepressants, opiates) Confirm Bioscience, DrugConfirm Multi-Drug Urine Test Cup/Dip Card II (amphetamines, benzodiazepines, barbiturates, buprenorphine, THC, cocaine metabolites, EDDP, methadone, Healgen Scientific 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) Confirm Bioscience, DrugConfirm Multi-Drug Urine Test DipCard/Test Cup (amphetamines, benzodiazepines, barbiturates, buprenorphine, THC, cocaine metabolites, methadone, Healgen Scientific 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, propoxyphene, tricyclic antidepressants)

DOH 681-018 May 2020 Page 15 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Confirm Biosciences Drugconfirm Instant Multi-Drug Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Confirm Biosciences Reli On Multi-Drug Urine Cup Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Confirm Biosciences Reli On Urine Screening Test (THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methamphetamines, morphine) Confirm BioSciences, Smart Choice Multi Panel DOA Test Cup/Dip Card (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, methadone, EDDP, Healgen Scientific 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) Continental Pharmaceuticals, New Choice Home Drug Test Healgen Scientific 80305QW Marijuana {Test Strip} (THC) CR3 Keyless Split Sample Cup Morphine-Oxazepam-Cup System ( Guangzhou Wondfo Biotech 80305QW benzodiazepines, morphine) Co., Ltd CVS/Pharmacy Inc. CVS Home Drug Test (amphetamines,barbituates, benzodiapines, THC, cocaine First Check Diagnostics, LLC 80305QW metabolites, methadone, methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants) Detector Drug Cup Multi-Drug Urine Test Cup (Amphetamines, Barbiturates, Bezodiazepines, Buprenorphine, Cocaine Metabolites, Healgen Scientific 80305QW EDDP, Methadone, Methamphetamines, MDMA, Morphine, Oxycodone, PCP, THC, Tricyclic antidepressants) Devon Medical CentralCheck Multiple Drug Cup Test (professional use) (amphetamines, barbiturates, benzodiazepines, THC, cocaine Tianjin New Bay Bioresearch 80305QW metabolites, methadone, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants) Diagnostic Test Group Clarity Multiple Drug Screen Cups (amphetamines, barbiturates, benzodiazepines, THC, cocaine UCP Biosciences, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) Diagnostic Test Group Clarity Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Diagnostic Test Group Clarity Multi-Drug Test Cards (amphetamines, barbiturates, benzodiazepines, THC, cocaine UCP Biosciences, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) Diagnostic Test Group Clarity Simple Drug Screening Cups (amphetamines, barbiturates, benzodiazepines, THC, cocaine UCP Biosciences, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) Discover Plus Multi-Panel Drug Test Cups and Cards (EDDP) UCP Biosciences, Inc 80305QW Drug Detection Devices Ltd Screeners AutoCup Clinical (OTC) (amphetamines, barbiturates, benzodiazepines, THC, cocaine Biosite, Inc. 80305QW metabolites, methadone, MDMA, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants)

DOH 681-018 May 2020 Page 16 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) DrugSmart Multi-Panel Drug Screen Cup Tests (Amphetamines, Barbiturates, Benzodiazepines, Cocaine metabolites, MDMA, Chemtron Biotech, Inc. 80305QW Methamphetamines, Methadone, Morphine, Oxycodone, PCP, Propoxyphene Propoxyphene, THC, Tricyclic antidepressants) DrugSmart Multi-Panel Drug Screen Cup with OPI 2000 Test (Amphetamines, Barbiturates, Benzodiazepines, Burprenorphine, Cocanie metabolities, MDMA, Methamphetamines, Methadone, Chemtron Biotech, Inc. 80305QW Opiates, Oxycodone, Propoxyphene, Cannabinoids, Tricyclic antidepressants, Propoxyphene) Drug Test City Inc., Multi-Panel Cup/Dip Tests - High sensitivity (Amphetamines, barbiturates, benzodiazepines, buprenorphine, Assure Tech. (Hangzhou) Co., cannabinoids, cocaine metabolites, methadone, EDDP, 80305QW Ltd methamphetamines, MDMA, morphine, oxycodone, PCP, propoxyphene, tricyclic antidepressants) Easy At Home Medical, LLC Easy@Home Multi Drug-Urine Test Cup (amphetamines, barbiturates, benzodiazepines, Guangzhou Wondfo Biotech 80305QW buprenorphine, cannabinoids, cocaine metabolites, Co., Ltd methamphetamines, MDMA, morphine, oxycodone, PCP) Easy At Home Medical, LLC Easy@Home Multi Drug-Urine Test Guangzhou Wondfo Biotech 80305QW Cup (methadone, tricyclic antidepressants) Co., Ltd Easy At Home Medical, LLC Easy@Home Multi Drug-Urine Test Panel(amphetamines, barbiturates, benzodiazepines, Guangzhou Wondfo Biotech 80305QW buprenorphine, cannabinoids, cocaine metabolites, Co., Ltd methamphetamines, MDMA, morphine, oxycodone, PCP) Easy @ Home Cannabinoids Single Panel Easy at Home Medical, LLC 80305QW Easy At Home Medical, LLC Easy@Home Multi Drug-Urine Test Guangzhou Wondfo Biotech 80305QW Panel (methadone, tricyclic antidepressants) Co., Ltd Easy Healthcare Corporation, Areta Drug Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine Guangzhou Wondfo Biotech 80305QW metabolites, methadone, methamphetamines, MDMA, morphine, Co., Ltd opiates, PCP, Tricyclic antidepressants) Easy Healthcare Corporation, Areta Multi-Drug Test Cup/Screen Test (MOR 2000/MOR300) (Amphetamines, Barbiturates, Assure Tech (Hangzhou) Co., Benzodiazepines, Buprenorphine, THC, Cocaine metabolites, 80305QW Ltd Methadone, EDDP, Methamphetamines, MDMA, Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) Assure Tech (Hangzhou) Co., Easy Healthcare Corporation, Areta Single Drug Screen Test (THC) 80305QW Ltd. Easy Healthcare Corporation, Easy@Home Single Drug Screen Wondfo Biotech Co., Ltd. 80305QW Test (THC) Easy Healthcare Corporation, easy @ Home Multi Drug Screen Test Card/Cup (amphetamines, tricyclic antidepressants, PCP, Huangzhou Wondfo Biotech opiates, morphine, MDMA, methamphetamines, methadone, 80305QW Co., Ltd. cocaine metabolites, THC, buprenorphine, benzodiazepines, barbituates) EGENS Biotechnology Urine Test Cup (Methamphetamine Nantong Egens Biotech Co., 80305QW /amphetamine, and Morphine) LTD. EGENS Biotechnology Co., Ltd,. EGENS Urine Test Marijuana Nantong Egens Biotech Co., 80305QW (THC) Cup, DipCard, and Cassette LTD. EGENS Biotechonology Co., Ltd,. EGENS Urine Test MDMA Cup, Nantong Egens Biotech Co., 80305QW and DipCard LTD. Ekla Corporation NOVAPLUS Buprenorphine Drug Test Cup S.D. Biotek, Llc 80305QW

DOH 681-018 May 2020 Page 17 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Elka Corporation NOVAPLUS Drug Test Cup(amphetamines, barbiturates, benozodiazepines, cocaine metabolites, methadone, S.D. Bioteck, Llc 80305QW methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants, THC) ELKA Corporation NOVAPLUS MDMA and OPI Drug Test Cup Tianjin New Bay Bioresearch 80305QW Urine, Cup format(MDMA, opiates) Co., Ltd eScreen, Inc. mCheck Multi-Line Screen Test Device: cocaine metabolites, methamphetamines, THC, opiates, PCP, Innovacon, Inc. 80305QW amphetamines Express Diagnostics International DrugCheck Multi Panel Drug Test Cups/DipCards (amphetamines, benozodiazepines, cocaine metabolites, THC, methamphetamines, morphine, oxycodone, Healgen Scientific 80305QW barbiturates, buprenorphine, MDMA, methadone, PCP, tricyclic antidepressants, propoxyphene) Express Diagnostics International Inc DrugCheck Waive Drug Test Cards (amphetamines, barbiturates, benzodiazepines, THC, UCP Biosciences Inc 80305QW cocaine metabolites, methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) Express Diagnostics DrugCheck Waive Multiple Drug Screen Cups (amphetamines, barbiturates, benzodiazepines, THC, cocaine UCP Biosciences, Inc. 80305QW metabolites, methadone, MDMA, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) Express Diagnostics DRUGCHECK Waive Drug Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine Biosite, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) Express Diagnostics DrugCheck Waive RT (Model 9380z) (amphetamines, barbiturates, benzodiazepines, THC, cocaine Phamatech, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, opiates, oxycodone, PCP) Express Diagnostics DrugCheck Waive TC Multiple Drug Cup Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Tianjin New Bay Bioresearch co 80305QW metabolites, methadone, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants) EZ Testing Solutions, Inc., EZ Test Cup/Panel (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, THC, Cocaine Assure Tech (Hangzhou) Co., metabolites, Methadone, EDDP, Methamphetamines, MDMA, 80305QW Ltd. Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) EZ Testing Solutions, Inc., EZ Test Cup/Panel (MOR 2000/300) (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Assure Tech (Hangzhou) Co., THC, Cocaine metabolites, Methadone, EDDP, 80305QW Ltd. Methamphetamines, MDMA, Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) First Check 12 Drug Cup Test(amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, First Check Diagnostics, LLC 80305QW methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants) First Check Diagnostics – First Check home Drug Test (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine metaboloites, MDMA, Methadone, Methamphetamines, Ameditech, Inc. 80305QW Morphines, Oxycodone, PCP, Propoxphene, THC, Tricyclic antidepressants)

DOH 681-018 May 2020 Page 18 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) First Check Diagnostics LLC, Home Drug Test(amphetamines, cannabinoids, tricyclic antidepressants, cocaine metabolites, Amedica Biotech, Inc 80305QW methamphetamines, opiates, PCP, barbiturates, benzodiazepines, methadone, oxycodone, MDMA First Check Home Drug Test for Marijuana Acon Laboratories 80305QW First Check Multi Drug Cup (amphetamines, THC, Cocaine Worldwide Medical, LLC 80305QW metabolites, MDMA, methamphetamines, opiates, PCP) First Check Multi Drug Cup 12 (OTC)(amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, First Check Diagnostics, LLC 80305QW methamphetamines, MDMA, opiates, oxycodone, PCP, tricyclic antidepressants) First Sign Drug of Abuse Dip Card and Cup Test (MDMA, EDDP, W.H.P.M., INC 80305QW Nortriptyline) Foodhold USA, LLC, CAREONE Drug Screen Tests Home Ttest Kit (OTC Use) (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, methadone, Alfa Scientific Designs, Inc. 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) Forefront Diagnostics: DrugFree Home THC and COC Test Kit Forefront Diagnostics, Inc 80305QW Fourstar Froup USA Inc., VeriQuick At Home Marijuana Test Healgen 80305QW Instacheck Drug Screen THC Applied Biotech, Inc. 80305QW Instacheck Multi-Drug Screen Panel (THC/COC) Forefront Diagnostics, Inc 80305QW Germaine Laboratories, Inc., SafeCup 14 Multi-Drug Urine test Cup (EDDP, Tricyclic antidepressants, Amphetamines, Cociane metabolites, THC, Methamphetamines, Morphine, Oxycodone, Healgen Scientific 80305QW Buprenorphine, MDMA, PCP, Methadone, Benzodiazepines, Barbiturates) GreenBrier Intn’l EasyScreen Marijuana Test Strip Guangzhou Wondro Biotech 80305QW Guangzhou Wondfo Biotech Co., Ltd CR3 Keyless Split Sample Cup (Amphetamines, MDMA, Methamphetamines, Cocaine Guangzhou Wondfo Biotech 80305QW metabolites, THC, Morphine, PCP, Oxycodone, Buprenorphine, Co., Ltd Methadone, Barbiturates, Opiates) Guangzhou Wondfo Biotech Co Ltd CR3 Keyless Split Sample Cup Guangzhou Wondfo Biotech Nortriptyline-Buprenorphine (tricyclic antidepressants, 80305QW Co., Ltd buprenorphine) Guangzhou Wondfo Biotech Co., Ltd CR3 Keyless Split Sample Lsi International Inc. 80305QW Cup(MDMA, PCP) Guangzhou Wondfo Biotech Co., Ltd CR3 Keyless Split Sample Guangzhou Wondfo Biotech 80305QW Cup(Morphine-Methamphetamines) Co., Ltd Guangzhou Wondfo Biotech Co, Ltd CR3 Keyless Split Sample Cup Guangzhou Wondfo Biotech 80305QW Oxycodone-Cannabinoids (oxycodone, THC) Co., Ltd Guangzhou Wondfo Biotech Co., Ltd CR3 Keyless Split Sample Guangzhou Wondfo Biotech 80305QW Cup Secobarbital-Methadone (methadone, barbituates) Co., Ltd Guangzhou Wondfo Biotech Co., Wondfo T-Cup Multi-Drug Urine Test Cup (amphetamines, barbiturates, benzodiazepines, THC, Guangzhou Wondfo Biotech cocaine metabolites, methadone, methamphetamines, opiates, 80305QW Co., Ltd. tricyclic antidepressants, propoxyphene, PCP, oxycodone, morphine, MDMA, buprenorphine, EDDP) Guangzhou Wondfo Biotech Co., Wondfo VacuLid Multi-Drug Urine Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Guangzhou Wondfo Biotech Buprenorphine, THC, Cocaine metabolites, EDDP, Methadone, 80305QW Co., Ltd Methamphetamines, MDMA, Morphine, Opiates, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants)

DOH 681-018 May 2020 Page 19 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Hangzhou AllTest Biotech Co., Ltd, Single and Multi-Drug Home Rapid Test Panel/Cup/Dipstick (Amphetamines, Barbiturates, Hangzhou AllTest Biotech Co., Buprenorphine, Benzodiazepines, Cocaine metabolites, 80305QW Ltd, Methamphetamines, Methadone, PCP, Tricyclic antidepressants, THC, MDMA, Morphine, Oxycodone, EDDP) Hangzhou Biotest Biotech Co., Ltd. RightSign Drug Screen Test (Amphetamines, Barbiturates, Benzodiazepines, THC, Cocaine metabolites, Methadone, Methamphetamines, MDMA, Morphine, Advin Biotech, Inc. 80305QW Opiates, Oxycodone, PCP, Tricyclic antidepressants, Buprenorphine, EDDP) Hangzhou Clongene Biotech Co.,Ltd. CLUNGENE Multi-Drug Test Dip Card/Easy Cup (Amphetamines, Barbiturates, Hangzhou Clongene Biotech 80305QW Benzodiazepines, THC, Cocaine metabolites, Methadone, Co.,Ltd. Methamphetamines, Morphine, Oxycodone) Hangzhou Clongene Biotech Co.,Ltd. CLUNGENE Multi-Drug Test Hangzhou Clongene Biotech Dip Card/Easy Cup (Buprenorphine, MDMA, PCP, Tricyclic 80305QW Co.,Ltd. antidepressants) Hangzhou Clongene Biotech Co.,Ltd., CLUNGENE Multi-Drug Test Hangzhou Clongene Biotech 80305QW Dip Card/Easy Cup (EDDP, Propoxyphene) Co.,Ltd. Healgen Scientific, Healgen Accurate Multi Drug Urine Test Cup (Amphetamines, Morphine, Barbiturates, Benzodiazepines, Cocaine metabolites, Methadone, Methamphetamines, Propoxyphene, Healgen Scientific 80305QW Tricyclic antidepressants, PCP, THC, Oxycodone, Buprenorphine, EDDP, MDMA, Opiates) Healgen Scientific LLC, Invitro Pro. Multi-Drug Urine Test DipCard (Amphetamines, Benzodiazepines, Barbiturates, Buprenorphine, Cocaine metabolites, Cannabiniods, MDMA, Healgen Scientific, Llc 80305QW Methamphetamines/amphetamine, Morphine, Methadone, PCP, Oxycodone) Healgen Scientific LLC, Invitro Pro. Multi-Drug Urine Test Cup (Amphetamines, Benzodiazepines, Barbiturates, Buprenorphine, Healgen Scientific, Llc 80305QW Cocaine metabolites, Cannabiniods, MDMA, Methamphetamines, Morphine, Methadone, PCP, Opiates, Oxycodone) Healgen Scientific LLC, Multi-Drug Urine Test Cup (Amphetamines, Benzodiazepines, Barbiturates, Buprenorphine, Cocaine Healgen Scientific, Llc 80305QW metabolites, Cannabiniods, MDMA, Methamphetamines, Morphine, Methadone, PCP, Oxycodone) Healgen Scientific LLC, Multi-Drug Urine Test Dip Card (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Healgen Scientific, Llc 80305QW Cocaine metabolites, THC, Methamphetamines, Morphine, Oxycodone, MDMA, PCP, Methadone) Healgen Amphetamine Test Cassette Healgen Scientific, Llc 80305QW HealgenAmphetamine Test Cup Healgen Scientific, Llc 80305QW Healgen Amphetamine Test Dip Card Healgen Scientific, Llc 80305QW Healgen Amphetamine Test Strip Healgen Scientific, Llc 80305QW Healgen EDDP (Methadone Metabolite) Test Cassette Healgen Scientific, Llc 80305QW Healgen EDDP (Methadone Metabolite) Test Cup Healgen Scientific, Llc 80305QW Healgen EDDP (Methadone Metabolite) Test DipCard Healgen Scientific, Llc 80305QW Healgen EDDP (Methadone Metabolite) Test Strip Healgen Scientific, Llc 80305QW Healgen Oxazepam Test Cassette Healgen Scientific, Llc 80305QW Healgen Oxazepam Test Cup Healgen Scientific, Llc 80305QW Healgen Oxazepam Test Dip Card Healgen Scientific, Llc 80305QW Healgen Oxazepam Test Strip Healgen Scientific, Llc 80305QW Healgen Oxycodone Test Cassette Healgen Scientific, Llc 80305QW

DOH 681-018 May 2020 Page 20 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Healgen Oxycodone Test Cup Healgen Scientific, Llc 80305QW Healgen Oxycodone Test Dip Card Healgen Scientific, Llc 80305QW Healgen Oxycodone Test Strip Healgen Scientific, Llc 80305QW Healgen COC One Step CocaineTest Cassette Healgen Scientific, Llc 80305QW Healgen COC One Step Cocaine Test Cup Healgen Scientific, Llc 80305QW Healgen COC One Step Cocaine Test Dip Card Healgen Scientific, Llc 80305QW Healgen COC One Step Cocaine Test Strip Healgen Scientific, Llc 80305QW Healgen THC One Step Marijuana Test Cassette Healgen Scientific, Llc 80305QW Healgen THC One Step Marijuana Test Cup Healgen Scientific, Llc 80305QW Healgen THC One Step Marijuana Test Dip Card Healgen Scientific, Llc 80305QW Healgen THC One Step Marijuana Test Strip Healgen Scientific, Llc 80305QW Healgen mAMP One Step Methamphetamine Test Cassette Healgen Scientific, Llc 80305QW Healgen mAMP One Step Methamphetamine Test Cup Healgen Scientific, Llc 80305QW Healgen mAMP One Step Methamphetamine Test Dip Card Healgen Scientific, Llc 80305QW Healgen mAMP One Step Methamphetamines Test Strip Healgen Scientific, Llc 80305QW Healgen Methadone Test Cassette Healgen Scientific, Llc 80305QW Healgen Methadone Test Cup Healgen Scientific, Llc 80305QW Healgen Methadone Test Dip Card Healgen Scientific, Llc 80305QW Healgen Methadone Test Strip Healgen Scientific, Llc 80305QW Healgen MOP One Step MorphineTest Cassette Healgen Scientific, Llc 80305QW Healgen MOP One Step MorphineTest Cup Healgen Scientific, Llc 80305QW Healgen MOP One Step Morphine Test Dip Card Healgen Scientific, Llc 80305QW Healgen MOP One Step Morphine Test Strip Healgen Scientific, Llc 80305QW Healgen Morphine Test Cassette Healgen Scientific, Llc 80305QW Healgen Morphine Test Cup Healgen Scientific, Llc 80305QW Healgen Morphine Test Dip Card Healgen Scientific, Llc 80305QW Healgen Morphine Test Strip Healgen Scientific, Llc 80305QW Healgen MDMA Test Cassette LSI International Inc. 80305QW Healgen MDMA Test Cup LSI International Inc. 80305QW Healgen MDMA Test Dip Card LSI International Inc. 80305QW Healgen MDMA Test Strip LSI International Inc. 80305QW Healgen Multi-Drug Urine Test Cup and Dip Card (EDDP, Tricyclic Healgen Scientific LLC 80305QW anti-depressants) Healgen Nortriptyline Test Cassette (Tricyclic Anitdepressants) Healgen Scientific, Llc 80305QW Healgen Nortriptyline Test Cup (Tricyclic Anitdepressants) Healgen Scientific, Llc 80305QW Healgen Nortriptyline Test Dip Card (Tricyclic Anitdepressants) Healgen Scientific, Llc 80305QW Healgen Nortriptyline Test Strip (Tricyclic Anitdepressants) Healgen Scientific, Llc 80305QW Healgen Buprenorphine Test Cassette Healgen Scientific, Llc 80305QW Healgen Buprenorphine Test Cup Healgen Scientific, Llc 80305QW Healgen Buprenorphine Test Dip Card Healgen Scientific, Llc 80305QW Healgen Buprenorphine Test Strip Healgen Scientific, Llc 80305QW Healgen PCP Test Cassette LSI International Inc. 80305QW Healgen PCP Test Cup LSI International Inc. 80305QW Healgen PCP Test Dip Card LSI International Inc. 80305QW Healgen PCP Test Strip LSI International Inc. 80305QW Healgen Propoxyphene Test Cassette Healgen Scientific, Llc 80305QW Healgen Propoxyphene Test Dip Card Healgen Scientific, Llc 80305QW Healgen Propoxyphene Test Cup Healgen Scientific, Llc 80305QW Healgen Propoxyphene Test Strip Healgen Scientific, Llc 80305QW Healgen Secobarbital Test Cassette Healgen Scientific, Llc 80305QW Healgen Secobarbital Test Dip Card Healgen Scientific, Llc 80305QW Healgen Secobarbital Test Cup Healgen Scientific, Llc 80305QW Healgen Secobarbital Test Strip Healgen Scientific, Llc 80305QW

DOH 681-018 May 2020 Page 21 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Healstone Biotech Inc., Accurate Multi Panel Drug Urine Test Cup (Amphetamines, Opiates, Barbiturates, Benzodiazepines, Cocaine Healstone Biotech Inc 80305QW metabolites, Methadone, Methamphetamines, Propoxyphene, Tricyclic antidepressants, PCP, THC) Healstone Biotech Inc., Accurate Multi Panel Drug Urine Test Cup (Amphetamines, Opiates, Barbiturates, Benzodiazepines, Cocaine metabolites, Methadone, Methamphetamines, Propoxyphene, Healstone Biotech Inc 80305QW Tricyclic antidepressants, PCP, THC, Buprenorphine, EDDP, MDMA, Morphine, Oxycodone) Henry Schein, Inc., OneStep+ Drugs of Abuse Cup (Amphetamines, Barbituates, Benzodiazepines, Buprenophines, THC, Cocaines metabolites, Methadone, Methamphetamines, Ameditech, Inc. 80305QW MDMA, Morphine, Oxycodone, PCP, Propoxyphene, tricyclic antidepressants) Indentifi Biosciences, Inc., Identifi Multi-Panel (Amphetamines, Barbituates, Benzodiazepines, Cocaines metabolites, Methadone, Methamphetamines, MDMA, Morphine, Oxycodone, Opiates, PCP, UCP Biosciences, Inc 80305QW Ticyclic Anit-depressants, THC, Buprenophines, Propoxyphene, EDDP) IND Home Amphetamine Test (strip format) IND Diagnostic, Inc 80305QW IND Home Amphetamine, Marijuana, Cocaine, Methamphetamines, IND Diagnostic, Inc 80305QW Morphine Test (cassette format) IND Home Cocaine and Methamphetamines Test (strip format) IND Diagnostic, Inc 80305QW IND Home Marijuana Test (strip format) IND Diagnostic, Inc 80305QW IND Home Drug Test Multi-Panel Strip and lCassette Formats (amphetamines, cocaine metabolites, methamphetamines, IND Diagnostic, Inc 80305QW morphine, THC) Innovacon Integrated E-Z Split Key Cup II (amphetamines cocaine Innovacon 80305QW metabolites, THC, methamphetamines, MDMA, opiates, PCP) Innovacon Multi-Clin Drug Screen Test Device (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, MDMA, Innovacon, Inc 80305QW morphine, oxycodone, PCP, propoxyphene, tricyclic antidepressants) Innovative Laboratory Solutions, BEST TEST CUP Quick Cup, Panel Dip Tests (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cannabinoids, Cocaine metabolites, Methadone, Best Test Cups 80305QW EEDP, Methamphetamines, MDMA, Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) Innovative Laboratory Solutions, Multi Drug Panel Dip, Quick Cup M300 (Amphetamines, Barbiturates, Benzodiazepines, Assure Tech (Hangzhou) Co., 80305QW Buprenorphine, Cannabinoids, Cocaine metabolites, PCP, Ltd. Oxycodone, MDMA, Methadone, Methamphetamines, Morphine) Innovative Laboratory Solutions, Multi Drug Panel Dip, Quick Cup M2000 (Amphetamines, Barbiturates, Benzodiazepines, Assure Tech (Hangzhou) Co., 80305QW Buprenorphine, Cannabinoids, Cocaine metabolites, PCP, Ltd. Oxycodone, MDMA, Methadone, Methamphetamines, Morphine) Innovative Laboratory Solutions, EZ Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cannabinoids, Assure Tech (Hangzhou) Co., Cocaine metabolites, EDDP, Methadone, Methamphetamines, 80305QW Ltd. MDMA, Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) Insight Medical Drug of Abuse Cassette/Cup (morphine, Alfa Scientific Designs, Inc 80305QW oxycodone)

DOH 681-018 May 2020 Page 22 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Insight Medical Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Alfa Scientific Designs, Inc 80305QW methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Insta-Screen Multi-Drug Urine Dip Card (amphetamines, benzodiazepines, THC, cocaine metabolities, methamphetamines, Healgen Scientif Limited 80305QW morphine, oxycodone, barbituates, buprenorphine, methadone, MDMA, PCP, EDDP tricycic antidepressants) Instant Technologies iCassette Dx Drug Screen Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, MDMA, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) Instant Technologies iCup Dx Drug Screen Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Alfa Scientific Designs, Inc 80305QW methadone, MDMA, methamphetamines, opiates, oxycodone,, PCP, tricyclic antidepressants) Instant Technologies iScreen Drug of Abuse Cassette and Cup Alfa Scientific Designs, Inc 80305QW (morphine, oxycodone) Instant Technologies iScreen Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Instant-View Multi-Drug Urine Test Cup and Panel (Home Use) (amphetamines, barbituates, benzodiazepines, buprenorphine, Alfa Scientific Designs, Inc. 80305QW THC, cocaine metabolites, methadone, methamphetamines, MDMA, morphine, opiates, PCP, tricylic antidepressants) Intrinsic Interventions, Inc., VistaFlow (Amphetamines, Barbiturates, Benzodiazepines, THC, Cocaine Metabolites, Methadone, Advin Biotech, Inc. 80305QW Methamphetamines, MDMA, Morphine, Opiates, Oxycodone, PCP, Tricyclic antidepressants, Propoxyphene, Buprenorphine, EDDP) iTest, iCassette for marijuana, cocaine, amphetamine, Accu-Stat Diagnostics, Inc. 80305QW methamphetamine, opiates, PCP iTest, iCup for marijuana, cocaine, amphetamine, Accu-Stat Diagnostics, Inc. 80305QW methamphetamine, ecstasy, opiates, PCP Inverness Med Innovations Signify ER Drug Screen(amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, MDMA, Biosite, Inc 80305QW opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) Jant Pharmacal Accutest Buprenorphine Drug Test Cup Tianjin New Bay Bioresearch Co 80305QW Jant Pharmacal Accutest Drug Test Cup (MDMA and opiates) Tianjin New Bay Bioresearch Co 80305QW Jant Parmacal AccutestDrug of Abuse Cassette and Cup Alfa Scientific Designs Inc 80305QW (morphine, oxycodone) Jant Pharmacal Accutest Drug Test Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, MDMA, Amedicda Biotech, Inc 80305QW methadone, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) Jant Pharmacal Accutest Drug Test Cup (professional use) (amphetamines, barbiturates, benzodiazepines, THC, cocaine Tianjin New Bay Bioresearch 80305QW metabolites, methadone, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants) Jant Pharmacal Corp. Accutest Value+ Drug Urine Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Healgen Scientific Limited 80305QW Cocaine metabolites, EDDP, Oxycodone, PCP, MDMA, Methadone, Methamphetamines, Morphines, THC, Tricyclic antidepressants)

DOH 681-018 May 2020 Page 23 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Jant Pharmacal Accutest MultiDrug ER11 Drug Screen (amphetamines, barbiturates, benzodiazepines, THC, cocaine Innovacon, Inc 80305QW metabolites, MDMA, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) Jant Pharmacal Accutest Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs Inc 80305QW metabolites, methadone, methamphetamines, MDMA, morphine, PCP, tricyclic antidepressants) Jant Pharmacal Accutest Multi-Drug Urine Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, Guangzhou Wondofu Biotech 80305QW THC, cocaine metabolites, methadone, methamphetamines, CO.,LTD. MDMA, morphine, opiates, PCP, tricyclic antidepressants) Jant Pharmacal Accutest Multi X Drug Cup Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Tianjin New Bay Bioresearch 80305QW methadone, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants) Jant Pharmacal Corp. Accutest VALUPAK Drug Screen Cup (amphetamines, cocaine metabolites, THC, methamphetamines, benzodiazepines, barbiturates, methadone, PCP, morphine, Healgen Scientific Limited 80305QW oxycodone, EDDP, buprenorphine, tricyclic antidepressants, MDMA) Jant Pharmaceutical Accutest SplitCup: (amphetamines, THC, Innovacon, Inc 80305QW cocaine metabolites, methamphetamines, MDMA, opiates, PCP) Jant Pharmaceutical Corporation Accutest Propoxyphene Urine Wondfo Biotech Co., LTD. 80305QW Test and Urine Test Cup Jant Pharmaceutical Accutest Value+Multi-Drug Urine Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Healgen Scientific 0305QW Cocaine metabolities, MDMA, Methadone, Methamphetamines, Morphine, Oxycodone, Propoxyphene, THC, Tricyclic depressants) Kasaac Laboratories Drug Test(amphetamines, barbiturates, benzodiazepines, cocaine metabolites, methadone, Tianjin New Bay Bioresearch 80305QW methamphetamines, oxycodone, PCP, tricyclic antidepressants, Co., Ltd cannabinoids, opiates) Kasaac Laboratories, Inc Kasaac Laboratories Buprenorphine Drug Tianjin New Bay Bioresearch 80305QW Test (opiates) Co., Ltd Kasaac Laboratories Multi (MDMA ands OPI) Drug Test Cup Urine, Tianjin New Bay Bioresearch 80305QW Cup format(MDMA, opiates) Co., Ltd LifeSign Home Drug Tests:Marijuana, Cocaine Metabolites Princeton Biomeditech Corp 80305QW LifeSign Home Drug Tests:Marijuana, Opiates, Cocaine Princeton Biomeditech Corp 80305QW Metabolites, and Methamphetamines LumiQuick Diagnostics Inc. Quick Profile Buprenorphine Drug Cup Tianjon New Bay Bioresearch 80305QW Test (buprenorphine) Co., Ltd. LumiQuick Diagnostics, Inc. Quick Profile Multi Drug Cup Test Tianjin New Bay Bioresearch 80305QW (MDMA, opiates) Co., Ltd. LumiQuick Diagnostics, Inc., Quick Profile Multiple Drug Cup Test (amphetamines, methamphetamines, cocaine metabolites, Tianjin New Bay Bioresearch 80305QW benzodiazepines, THC, morphine, PCP, methadone, oxycodone, Co., Ltd. tricyclic antidepressants, barbiturates) Magenta Technology Partners, LLC, Magenta Multi-Drug Urine Test Cup/Compact Cup (Amphetamines, Barbiturates, Benzodiazepines, Magenta Technology Partners, Buprenorphine, THC, Cocaine Metabolites, EDDP, Methadone, 80305QW LLC Methamphetamines, MDMA, Morphine, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants, Opiates)

DOH 681-018 May 2020 Page 24 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Magenta Technology Partners LLC, Magenta Multiple Panel Urine Dip Card (Amphetamines, Barbiturates, Benzodiazepines, Magenta Technology Partners, Buprenorphine, THC, Cocaine Metabolites, Methadone, 80305QW LLC Methamphetamines, MDMA, Morphine, Oxycodone, PCP, Tricyclic antidepressants) Tianjin Mew Bay Bioresearch Medi-Temp, LLC, Care One Buprenorphine Drug Screen Test Cup 80305QW Co., Ltd. McKesson Corporation, HealthMart At Home Drug Test (OTC Use) (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Alfa Scientific Designs, Inc. 80305QW THC, Cocaine Metabolites, Methadone, Methamphetamines, MDMA, Morphine, Oxycodone, PCP, Tricyclic antidepressants) McKesson Cosult Drugs of Abuse Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cociane Branan Medical Corp 80305QW Metabolites, MDMA, Methamphetamines, Methadone, Morphine, Oxycodone, PCP, Propoxyphene, THC, Tricyclic antidepressants) McKesson Medical-Surgical Inc, Mckesson Consult Drugs of Abuse Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Burprenorphine, Cocaine Metabolites, MDMA, Methadone, Branan Medical Corp 80305QW Methamphetamines, Morphine, Oxycodone, PCP, Propoxyphene, THC, Tricyclic antidepressants) McKesson Medical-Surgical Inc., McKesson Multi Panel Drugs of abuse Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, EDDP, methadone, Healgen Scientific Limited 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) McKesson Medical-Surgical, McKesson Drugs of abuse PPX Test Healgen Scientific 80305QW Cup (propoxyphene) MedDirect Inc ProXam Drug Test Cards(amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, UCP Biosceinces, Inc 80305QW methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) MedDirect Inc Multiple Drug Screen Cups(amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, UCP Biosceinces, Inc 80305QW methadone, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) Medical Disposables, MD Drug Screen MD Quick Cup Tests (Mor300/MOR2000) (amphetamines, barbiturates, buprenorphine, benzodiazepines, cocaine metabolites, methadone, MDMA, Medical Disposables Corp 80305QW methamphetamines, morphine, EDDP, oxycodone, PCP, Proxyphene, THC, tricyclic antidepressants) Medical Distribution Group Inc., Identify Diagnostics Home Drug Test Cards and Cups (Buprenorphine, Amphetamines, Cocaine metabolites, EDDP Methamphetamines, MDMA, Oxycodone, UCP Biosceinces, Inc 80305QW Opiates, Morphine, PCP, THC, Benzodiazepines, Methadone, Barbiturates, Tricyclic antidepressants, Propoxyphene) Medical Distribution Group Inc., Identify Diagnostics Drug Test UCP Biosciences, Inc 80305QW Cards and Cups (EDDP) Medical Distribution Group Inc., Identify Diagnostics USA Drug Screen Test (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine metabolites, EDDP, MDMA, Methadone, Advin Biotech, Inc. 80305QW Methamphetamines, Morphine, Opiates, Oxycodone, PCP, THC, Tricyclic antidepressants)

DOH 681-018 May 2020 Page 25 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Medical Distribution Group Inc., IDENTIFY HEALTH DRUG SCREEN TEST (amphetamines, barbiturates, buprenorphine, benzodiazepines, cocaine metabolites, EDDP, methamphetamines, Advin Biotech, Inc. 80305QW MDMA, morphine, methadone, opiates, oxycodone, PCP, tricyclic antidepressants,THC) Medimpex Q Test Buprenorphine Drug Cup Test (opiates) Tianjin New Bay Bioresearch Co 80305QW Medimpex Q Test Multi X Drug Cup Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Tianjin New Bay Bioresearch Co 80305QW methadone, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants) Mercedes Medical, BluRapids Concise Multi-Drug Test Cup and Test Panel (Amphetamines, Barbiturates, Benzodiazepines, Guangzhou Wondfo Biotech Buprenorphine, Cocaine metabolities, MDMA, Methadone, 80305QW Co., Ltd. Methamphetamies, Morphine, Opiates, PCP, THC, Tricyclic antidepressants) Mercedes Scientific Inc., ClearRapids Multi-Panel Drug Test Cup (Amphetamines, Oxycodone, Cocaine metabolities, Methamphetamies, MDMA, Opiates, Morphine, PCP, THC, UCP Biosciences Inc. 80305QW Benzodiaepines, Methadone, Barbiturates, Tricyclic antidepressants, Buprenorphine, Proxyphene) Mercedes Scientific Inc., Platinum+ Multi-Drug Urine Test Cup/Dip Card (Amphetamines, Barbiturates, Benzodiaepines, Buprenorphine, THC, Cocaine metabolites, Methadone, EDDP, Healgen Scientific 80305QW Methamphetamines, MDMA, Morphine, Oxycodone, PCP, Tricyclic antidepressants) Mergers Marketing Inc., Clear Scan Multi-Drug Urine Test Cup, PreScreen Plus Multi-Drug Urine Test Cup/Card (Amphetamines, Barbiturates, Benzodiaepines, Buprenorphine, Cocaine metabolites, Healgen Scientific 80305QW EDDP, MDMA, Methadone, Methamphetamines, Morphine, Oxycodone, PCP, THC, Tricyclic antidepressants) Micro Distributing II, Ltd., FASTEST LABS One Step Drug Test Cup (Amphetamines, Barbitrates, Benzodiazepines, Buprenorphine, Guangzhou Wondfo Biotech 80305QW Cocaine metabolites, Methamphetamines, MDMA, Methadone, Co., Ltd. Morphine, PCP, Oxycodone, THC, Tricyclic antidepressants) Micro Distributing II Ltd, FASTEST LABS Propoxyphene Urine Test Guangzhou Wondfo Biotech 80305QW Cup and Urine Test Co., Ltd. Micro Distributing II Ltd Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Micro Distributing II, Ltd, STAT Cup One Step Drug Test (amphetamines, barbiturates, benzodiazepines, buprenorphine, Guangzhou Wondfo Biotech THC, cocaine metabolites, EDDP, methadone, methamphetamines, 80305QW Co., Ltd. MDMA, morphine, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) Micro Distributing II Ltd STAT Cup3 One Step Drug Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, Guangzhou Wondfo Biotech 80305QW cocaine metabolites, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, THC) Micro Distributing II Ltd STATDIP One Step Multi-Drug Urine Test Panel (amphetamines, barbiturates, benzodiazepines, Guangzhou Wondfo Biotech 80305QW buprenorphine, cocaine metabolites, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, THC)

DOH 681-018 May 2020 Page 26 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Micro Distributing II Ltd STATDIP One Step Multi-Drug Urine Test Panel and Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, MDMA, Wondfo Biotech Co., Ltd. 80305QW methamphetamines, methadone, morphine, opiates, PCP, THC, Tricyclic antidepressants) Micro Distributing II, Ltd STATDIP and STATCUP II Propoxphene Wondfo Biotech Co., Ltd. 80305QW Urine Test Micro Distributing II Ltd STAT Cup One Step Drug Test Dip Care/Cup (amphetamines, barbiturates, benzodiazepines, THC, Guangzhou Wondfo Biotech 80305QW oxycodone) Millennium Laboratories INSTA-SCREEN Multi-Drug Urine Test Cup (amphetamines, buprenorphine, cannabinoids, cocaine Guangzhou Wondo Biotech Co., metabolites, methadone, methamphetamines, MDMA, morphine, 80305QW Ltd tricyclic antidepressants, benzodiadepines, PCP, barbiturates, oxycodone) Millennium Laboratories INSTA-SCREEN Multi-Drug Urine Test Panel (amphetamines, buprenorphine, cannabinoids, cocaine Guangzhou Wondo Biotech Co., metabolites, methadone, methamphetamines, MDMA, morphine, 80305QW Ltd tricyclic antidepressants, benzodiadepines, PCP, barbiturates, oxycodone) Millennium Lab Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Alfa Scientific Designs, Inc 80305QW methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Millennium Lab Multi-Drug Pain Med Screen Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Biosite, Inc 80305QW methadone, MDMA, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) Tianjin New Bay Bioresearch MP Biomedical MP On-site Buprenorphine Drug of Abuse Test Cup 80305QW Co., Ltd MP Biomedical, LLC MP-On-Site Drugs of Abuse Test Cup (amphetamines, PCP, methamphetamines, morphine, cocaine Tianjin New Bay Bioresearch 80305QW metabolites, barbiturates, benzodiazepines, cannabinoids, Co., Ltd methadone, oxycodone, tricyclic antidepressants) National Test Systems, DrugSure DOT One Step Rapid Test Cup/DipCard (amphetamines, barbituates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, EDDP, Healgen Scientific Ltd 80305QW methadone, methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) National Test Systems DrugSure One Step Rapid Test Cup/Dip Card (amphetamines, barbituates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, EDDP, Healgen Scientific Ltd 80305QW methadone, methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) Native Diagnostics Alcosmart Saliva Alcohol Test Teco Diagnostics 80305QW Native Diagnostics International, DrugSmart Drug Screen Cup Tests (amphetamines, barbituates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, methadone, Chemtron Biotech, Inc 80305QW methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants)

DOH 681-018 May 2020 Page 27 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Native Diagnostics International, DrugSmart Drug Screen Cup Tests with OPI 2000 (amphetamines, barbituates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, methadone, Chemtron Biotech, Inc 80305QW methamphetamines, MDMA, morphine, opiates oxycodone, PCP, tricyclic antidepressants) Native Diagnostics International, DrugSmart Dip Single/Multi-Panel Drug Screen Cassette Tests(amphetamines, cannabinoids, cocaine metabolites, methamphetamines, morphine, PCP, Chemtron Biotech, Inc 80305QW barbituates,benzodiazepines,methadone,MDMA, opiates,oxycodone) Native Diagnostics International, DrugSmart Dip Single/Multi- Panel Drug Screen Dip Card Tests(amphetamines, cannabinoids, cocaine metabolites, methamphetamines, morphine, PCP, buprenorphine, Chemtron Biotech, Inc 80305QW tricyclic antidpressants,barbituates,benzodiazepines,methadone, MDMA, opiates,oxycodone) ) Native Diagnostics International DrugSmart Dip Multi-Panel Drug Screen Dip Card Tests (buprenorphine, tricyclic antidepressants, amphetamines, barbituates, benzodiazepines, cocaine metabolites, Chemtron Biotech, Inc 80305QW MDMA, methamphetamines, methadone, morphine, oxycodone, PCP, THC) Native Diagnostics International DrugSmart Dip Multi-Panel Drug Screen Dip Card with OPI 2000 Tests (Buprenorphine, tricyclic antidepressants, amphetamines, barbituates, benzodiazepines, Chemtron Biotech, Inc 80305QW cocaine metabolites, MDMA, methamphetamines, methadone, morphine, opiates,oxycodone, PCP, THC) Native Diagnostics International, DrugSmart Dip Single/Multi-Panel Drug Screen Cassette Tests (barbiturates, benzodiazepines, Chemtron Biotech, Inc 80305QW methadone, MDMA, opiates, oxycodone) Native Diagnostics International, DrugSmart Dip Single/Multi-Panel Drug Screen Dip Card Tests (barbiturates, benzodiazepines, Chemtron Biotech, Inc 80305QW methadone, MDMA, opiates, oxycodone) NexScreen LLC, NexScreen Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, methadone, MDMA, Amedica Biotech, Inc 80305QW methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) NexScreen Multi-Drug Test Cup and Dip Card (amphetamines, benzodiazepines, THC, cocaine metabolites, methamphetamines, Healgen Scientific 80305QW morphine, oxycodone, barbituates, buprenorphine, methadone, MDMA, PCP,NE EDDP, tricyclic antidepressants) NexScreen LLC, NexScreen Drug Screen Screen Cup (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine metabolites, EDDP, MDMA, Methadone, Advin Biotech, Inc. 80305QW Methamphetamines, Morphine, Opiates, Oxycodone, PCP, THC, Tricyclic antidepressants) Noble Medical Inc., INSTA-SCREEN-2 Cup (tricyclic antidepressants, PCP, oxycodone, opiates, morphine, MDMA, amphetamines, barbiturates, benzodiazepines, THC, cocaine Advin Biotech, Inc. 80305QW metabolites, methadone, methamphetamines, buprenorphine, EDDP) Noble Medical Inc NOBLE1 Step Cup (OTC) (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Biosite / Alere 80305QW methadone, MDMA, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants)

DOH 681-018 May 2020 Page 28 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Noble Medical Inc. Noble 1 Step + Cup (Buprenorphine, Morphine, Propoxyphene, Amphetamines, Barbiturates, Benzpdiazepines, Branan Medical Corp. 80305QW THC, Cocaine metabolites, Methamphetamines, Methadone, MDMA, Oxycodone, PCP, Tricyclic antidepressants) Noble Medical, Inc INSTA-SCREEN Multi-Drug Urine Test Cup Guangzhou Wondo Biotech Co., 80305QW (oxycodone) Ltd Noble Medical, Inc INSTA-SCREEN Multi-Drug Urine Test Cup(amphetamines, buprenorphine, cannabinoids, cocaine Guangzhou Wondo Biotech Co., metabolites, methadone, methamphetamines, MDMA, morphine, 80305QW Ltd tricyclic antidepressants, benzodiazepines, PCP, barbiturates, oxycodone) Noble Medical, Inc INSTA-SCREEN Multi-Drug Urine Test Panel Guangzhou Wondo Biotech Co., 80305QW (oxycodone) Ltd Noble Medical, Inc INSTA-SCREEN Multi-Drug Urine Test Panel (amphetamines, buprenorphine, cannabinoids, cocaine metabolites, Guangzhou Wondo Biotech Co., 80305QW methadone, methamphetamines, MDMA, morphine, tricyclic Ltd antidepressants, benzodiazepines, PCP, barbiturates, oxycodone) Noble Medical Inc INSTA-SCREEN Multi-Drug Urine Test Cup (cocaine metabolites, methadone, MDMA, methamphetamines, Guangzhou Wondfo Biotech 80305QW morphine, opiates, PCP, tricyclic antidepressants) Noble Medical Inc INSTA-SCREEN Multi-Drug Urine Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, Guangzhou Wondfo Biotech 80305QW cocaine metabolites, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, THC) Noble Medical Inc., INSTA-SCREEN Multi-Drug Test Cup II (Amphetamines, Cocaine metabolites, EDDP, Tricyclic antidepressants, THC, Methamphetamines, Morphine, Oxycodone, Healgen Scientifc Limited 80305QW Buprenorphine, MDMA, PCP, Methadone, Benzodiazepines, Barbiturates) Nobel Medical Split-Specimen Cup (amphetamines, THC, cocaine Nobel Medical 80305QW metabolites, methamphetamines, MDMA, opiates, PCP) On the Spot Drug Testing Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) On-Site Testing Specialists Inc. On-Site Testing Specialist Multi- Panel Drug Screen Cup and Dip Card Tests (amphetamines, barbituates, benzodiapines, buprenorphine, cocaine metabolites, Chemtron Biotech, Inc. 80305QW MDMA, methamphetamines, methadone, morphine, oxycodone, PCP, propoxyphene, THC, tricyclic antidepressants) On-Site Testing Specialists Inc. On-Site Testing Specialist Multi- Panel Drug Screen Cup and Dip Card with OPI2000 Tests (amphetamines, barbituates, benzodiapines, buprenorphine, Chemtron Biotech, Inc 80305QW cocaine metabolites, MDMA, methamphetamines, methadone, morphine, oxycodone, opiates, PCP, propoxyphene, THC, tricyclic antidepressants) On-Site Testing Specialists Inc. On-Site Testing Specialist Drug Screen Cup Tests (amphetamines, barbituates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, MDMA, Chemtron Biotech, Inc. 80305QW methadone, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants)

DOH 681-018 May 2020 Page 29 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) On-Site Testing Specialists Inc. On-Site Testing Specialist Drug Screen Cup Tests with OPI 2000 (amphetamines, barbituates, benzodiazepines, buprenorphine, cannabinoids, cocaine Chemtron Biotech, Inc. 80305QW metabolites, MDMA, methadone, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) On-Site Testing Specialists Inc. On-Site Testing Specialist Single/Multi-Panel Drug Screen Dip Card Tests (amphetamines, barbituates, benzodiazepines, buprenorphine, cocaine metabolites, Chemtron Biotech, Inc 80305QW MDMA, methadone, methamphetamines, morphine, oxycodone, PCP, THC, tricyclic antidepressants) On-Site Testing Specialists Inc. On-Site Testing Specialist Single/Multi-Panel Drug Screen Dip Card with OPI 2000 Tests (amphetamines, barbiturates, benzodiazepines, buprenorphone, Chemtron Biotech, Inc 80305QW cocaine metabolites, methadone, methamphetamines, opaites, oxycodone, PCP, THC, Tricyclic antidepressants, MDMA) Origin Diagnostics Origin Instant Drug Test (Amphetamines, THC, Cocaine metabolites, Benzodiazepines, Morphine, W.H.P.M., INC. 80305QW Methamphetamines, PCP, Methadone, Oxycodone, Buprenorphine, Barbiturates, Morphine, EDDP, MDMA, Tricyclic antidepressants) Phamatech At Home Drug Test Model: -9063/9063T (Amphetamine) -9064 (amphetamines) -9068/9068T (Methamphetamines) -9069 (methamphetamines) -9073/9073T (Cocaine Metabolites) -9074 (cocaine metabolites) -9078/9078T (THC) Phamatech, Inc. 80305QW -9079 (THC) -9083/9083T (Opiates) -9084 (opiates) -9133/9133T (PCP) -9150/9150T (THC, Opiates, Cocaine Metabolites, Methamphetamine, Amphetamine) -9175 (Methamphetamines, THC) and Opiates) Phamatech QuickScreen At Home Drug Test Model: -9171 (Methamphetamines and Opiates) Phamatech, Inc 80305QW -9150 (Amphetamines, Cocaine Metabolites, Methamphetamines, Opiates, PCP and THC) Phamatech QuickScreen At Home 12 Drug Test Models 9308Z and 9308T(amphetamines, barbiturates, benzodiazepines, cocaine Phamatech, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, oxycodone, opiates, PCP, THC) Phamatech QuickScreen One Step (amphetamines, cocaine Phamatech, Inc 80305QW metabolites, methamphetamines, opiates, PCP) Phamatech QuickScreen One Srep Amphetamines Screening Test Phamatech, Inc 80305QW Phamatech QuickScreen One Srep Cocaine Screening Test Phamatech, Inc 80305QW Phamatech Quick Screen One Srep Methamphetamine Screening Phamatech, Inc 80305QW Test Phamatech Quick Screen One Srep Opiate Screening Test Phamatech, Inc 80305QW Phamatech Quick Screen One Srep PCP Screening Test Phamatech, Inc 80305QW Phamatech Quick Screen One Srep THC Screening Test Phamatech, Inc 80305QW Phamatech QuickScreen Pro Multi Drug Screening Test (Model 9177/ and 9178) Methamphetamine, THC, PCP, amphetamine, Phamatech, Inc 80305QW cocaine and opiates

DOH 681-018 May 2020 Page 30 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Phamatech QuickScreen Model 9177X (amphetamines, cocaine Phamatech, Inc 80305QW metabolites, opiates, PCP,THC) Phamatech Quickscreen Model 9178X (amphetamines, cocaine Phamatech, Inc 80305QW metabolites, opiates, methamphetamines, THC) PharmTox Rapid Exam Drug Screen Test Cup (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Amedica Biotech, Ind 80305QW methadone, MDMA, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) Physicians’ Test Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Alfa Scientific Designs, Inc 80305QW methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Polymed Therapeutic FaStep Marijuana Strip Polymed Therapeutics, Inc 80305QW Polymed Therapeutic FaStep Marijuana Panel Dip Polymed Therapeutics, Inc 80305QW Polymed Therapeutic FaStep Marijuana Quick Cup Polymed Therapeutics, Inc 80305QW Polymed Therapeutic FaStep Marijuana Turn-Key Split Cup Polymed Therapeutics, Inc 80305QW Polymed Therapeutic FaStep Methamphetamine Strip Polymed Therapeutics, Inc 80305QW Polymed Therapeutic FaStep Methamphetamine Panel Dip Polymed Therapeutics, Inc 80305QW Polymed Therapeutic FaStep Methamphetamine Quick Cup Polymed Therapeutics, Inc 80305QW Polymed Therapeutic FaStep Methamphetamine Turn-Key Split Polymed Therapeutics, Inc 80305QW Cup Polymed Therapeutics FaStep Panel Dip, Turn-Split Cup Polymed Therapeutics, Inc 80305QW (Amphetamines, Cocaine metabolites, Morphine, Phencyclidine) Polymed Therapeutics FaStep Strip (Amphetamine, Barbiturates, Buprenorphine, Cocaine metabolities, Methadone, Morphine, Polymed Therapeutics, Inc 80305QW Oxycodone, Phencyclidine) Polymed Therapeutics FaStep Barbiturates/Oxycodone Panel Dip Polymed Therapeutics, Inc 80305QW (Barbiturates, Oxycodone) Polymed Therapuetics FaStep Barbiturates/Oxycodone Quick Cup Polymed Therapeutics, Inc 80305QW and Turn Ket Split Cup (Barbiturates, Oxycodone) Polymed Therapeutics FaStep Buprenorphine/Methadone Panel Polymed Therapeutics, Inc 80305QW Dip and Quick Cup (Buprenorphine, Methadone) Polymed Therapeutics FaStep Buprenorphine/Methadone Turn-Key Polymed Therapeutics, Inc 80305QW Split Cup (Buprenorphine, Methadone) Polymed Therapeutics FaStep Marijuana Panel Dip 50 Polymed Therapeutics, Inc 80305QW Polymed Therapeutics FaStep Marijuana Quick Cup 50 Polymed Therapeutics, Inc 80305QW Polymed Therapeutics FaStep Marijuana Turn-Key Split Cup 50 Polymed Therapeutics, Inc 80305QW Polymed Therapeutics FaStep Methamphetamine Panel Dip 1000 Polymed Therapeutics, Inc 80305QW Polymed Therapeutics FaStep Methamphetamine Quick Cup 1000 Polymed Therapeutics, Inc 80305QW Polymed Therapeutics FaStep Methamphetamine Rapid Test Strip Polymed Therapeutics, Inc 80305QW Polymed Therapeutics FaStep Methamphtamine Turn-Key Split Polymed Therapeutics, Inc 80305QW Cup 1000 Polymed Therapeutcs FaStep Panel Dip, Quick Cup M300 (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Assure Tech (Hangzhou) Co., 80305QW Cannabinoids, Cocaine metabolites, PCP, Oxycodone, MDMA, Ltd. Methadone, Methamphetamines, Morphine) Polymed Therapeutcs FaStep Panel Dip, Quick Cup M2000 (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Assure Tech (Hangzhou) Co., 80305QW Cannabinoids, Cocaine metabolites, PCP, Oxycodone, MDMA, Ltd. Methadone, Methamphetamines, Morphine) Polymed Therapeutics FaStep Rapid Test Strip (Cannabinoids, Polymed Therapeutics, Inc 80305QW Methamphetamine)

DOH 681-018 May 2020 Page 31 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Polymed Therapeutics, Inc., FaStep Panel Dip M2000/Dip Assure Tech (Hangzhou) Co., M300/Cup M2000/Cup M300 (EDDP, Propoxyphene, Tricyclic Ltd antidepressants) Premier Biotech, Inc., MDETOX Multi-Drug Urine Test Cup and Dip Card (Amphetamines, Benzodiazepines, Cocaine Metabolites, THC, Methamphetamines, Morphine, Oxycodone, Barbiturates, Healgen Scientific 80305QW Buprenorphine, PCP, Methdone, EDDP, MDMA, Tricyclic antidepressants) Premier Biotech Inc. Premier Bio-Dip/Bio-Cup (Amphetamines, Barbiturates, Buprenorphine, Benzodiazepines, Cocaine metabolites, EDDP, MDMA, Methamphetamines, Morphine, Premier Biotech 80305QW Methdone, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants, THC) Premier BioTech Premier Bio-Cup & Bio-Dip (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, Advin Biotech, Inc. 80305QW THC, MDMA, methadone, EDDP, morphine, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) Premier BIOTECH Inc., Premier Bio-Panel Dip/Cup Tests (amphetamines, barbiturates, buprenorphine, benzodiazepines, THC, methadone, MDMA, methamphetamines, morphine, Premier Biotech Inc. 80305QW oxycodone, PCP, propoxyphene, tricyclic antidepressants, cocaine metabolites, EDDP) Premier Biotech, Inc., Premier Biotech Multi-Panel Drug Screen Dip Card/Cup with OPI 2000 Tests (Barbiturates, Benzodiazepines, Buprenorphine, Cocaine metabolites, MDMA, Methadone, Chemtron Biotech, Inc. 80305QW Methamphetamines, Opiates, Oxycodone, PCP, Propoxyphene, THC, Tricyclic antidepressants, Amphetamines) Premier BioTech inc., Premier UTox Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, Advin Biotech, Inc. 80305QW THC, MDMA, methadone, EDDP, morphine, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) Premier Integrity Solutions P/Tox Drug Screen Cup (OTC) amphetamines, barbiturates, benzodiazepines, cocaine Biosite Inc / Alere 80305QW metabolites, THC, MDMA, methadone, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants Princeton Biomeditech -Accusign Stik THC -Accusign THC -Accustik THC Princeton Biomeditech -Accustrip THC 80305QW -Lifesign Home Drug Test Marijuana -Status DS THC -Status Stik THC PTox Drug Screen Cup-Cassette Dip Card Format (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, Branan Medical Corp 80305QW methadone, methamphetamines, MDMA, morphine, Oxycodone, PCP, propoxyphene, THC, tricyclic antidepressants Quest Products DrugHAWK Home Drug Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, Amedica Biotech 80305QW THC, MDMA, methadone, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants)

DOH 681-018 May 2020 Page 32 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Quest Products DrugHAWK Home Drug Test Cup (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, methadone, Tianjin New Bay Bioresearch 80305QW methamphetamines, morphine, oxycodone, THC, tricyclic Co., Ltd. antidepressants) Quest Products, Inc. DrugHAWK MDMA and OPI Drug Test cup Tianjin New Bay Bioresearch 80305QW (urine) {Cup format} (MDMA, opiates) Co., Ltd. Quest Diagnostics Express Results Integrated Multi-Drug Screen Cup (amphetamines, cocaine metabolites, THC, MDMA, Innovacon, Ind 80305QW methamphetamines, opiates, PCP) Quidel Corporation, Triage Rapid OXY, BUP, MDMA Panel American Bio Medica 80305QW (Buprenorphine, MDMA, Oxycodone) Corporation American Bio Medica Quidel Corporation, Triage Rapid PCP Single Test (PCP) 80305QW Corporation QuikTest USA Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Alfa Scientific Designs 80305QW methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) Rapid Self Test, Inc. RST Drug of Abuse Multi-test Panel/Cup/Panel M/Cup M (amphetamines, barbiturates, benzodiazepines, Rapid Self Test 80305QW buprenorphine, THC, cocaine metabolites, methadone, methamphetamines, MDMA, morphine, oxycodone, PCP) Rapid Self Test, Inc. RST Drug of Abuse Multi-test Cup/Cup Rapid Self Test 80305QW M/Panel/Panel M (EDDP, tricyclic antidepressants, propoxyphene) Rapid Self Test Inc. RST Home Drug Test Kit Cup/Panel (THC) Wondfo Biotech Co., Ltd. 80305QW Rapid Self Test Inc., RST Home Multi-Drug Test Kit Cup (Urine) (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Guangzhou Wondfo Biotech THC, Cocaine metabolites, EDDP, Methadone, 80305QW Co., Ltd. Methamphetamines, MDMA, Morphine, Opiates, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) RediScreen Multi-Drug, Multi-Line Screen Test Device (amphetamines, THC, cocaine metabolites, methamphetamines, Acon Laboratories, Inc. 80305QW opiates, PCP) Redwood Toxicology Laboratory Reditest 6 Cassette Substance Abuse Screening Device: Cocaine metabolites, THC, Innovacon, Inc. 80305QW Methamphetamines, Opiates, PCP, Amphetamines Redwood Toxicology Laboratory Reditest Freedom Cup (amphetamines, barbiturates, benzodiazepines, cocaine Biosite, Inc. 80305QW metabolites, THC, MDMA, methadone, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) Redwood Toxicology Laboratory Reditest Home Drug Test (amphetamines, barbiturates, benzodiazepines, cocaine Biosite, Inc. 80305QW metabolites, THC, MDMA, methadone, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) Revolution Diagnostics, AccuSeal Pro Instant Test Cup Tianjin New Bay Bioresearch 80305QW (MDMA)(Opiates) Revolution Dx AccuSeal Pro Instant Test Cup Test (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, THC, Tianjin New Bay Bioresearch 80305QW methadone, methamphetamines, morphine, oxycodone, PCP, tricyclic antidepressants) Revolution Dx AccuSeal Pro Instant Test Cup Test Buprenorphine Tianjin New Bay Bioresearch 80305QW

DOH 681-018 May 2020 Page 33 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Rhema Scientific, Inc. Rhema Scientific Multi-Panel DrugScreen Cup Tests/Cup with OPI2000 Tests/Dip Card Tests/Dip Card with OPI2000 Tests (barbiturates, benzodiazepines, buprenorphine, Chemtron Biotech, Inc. 80305QW cocaine metabolites, MDMA, methamphetamines, methadone, oxycodone, PCP, propoxyphene, THC, tricyclic antidepressants, morphine) Rite Aid Corporation, Rite Aid Drug Test Kit (Amphetamines, Barbiturates, Benzodiazepines, THC, Cocaine metabolites, Methadone, Methamphetamines, Opiates, PCP, Propoxyphene, Healstone Biotech Inc 80305QW Tricyclic antidepressants, Buprenorphine, EDDP, MDMA, Morphine, Oxycodone) Safecare Biotech (Hangzhou) Co., Ltd. SAFECARE Multi-Drug Urine Test Dip Card/Test Cup (THC, amphetamines, cocaine Safecare Biotech 80305QW metabolites, benzodiazepines, methamphetamines, opiates, (Hangzhou)Co.,LTD. barbituates, methodone) Safecare Biotech (Hangzhou) Co., Ltd. SAFECARE Multi-Drug Safecare Biotech (Hangzhou) Urine Test Cup/Dip Card (MDMA, oxycodone, buprenorphine, PCP, 80305QW Co., Ltd. tricyclic antidepressants, propoxyphene) Safecare Biotech (Hangzhou) Co., Ltd. SAFECARE THC Urine Safecare Biotech (Hangzhou) 80305QW Strip Test (THC) Co., Ltd. Safecare Urine Test Cassette, Cup, Dip Card (Amphetamine, Safecare Biotech 80305QW Cocaine metabolites, Marijuana) (Hangzhou)Co.,LTD. SafeCup II Multi-Drug Urine Test Cup (EDDP, Tricyclic antidepressants, amphetamines, cocaine metabolites, THC, Healgen Scientific 80305QW methamphetamines, morphine, oxycodone, buprenorphine, MDMA, PCP, methodone, benzodiazepines, barbituates) Screen Tox Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, THC, cocaine metabolites, Alfa Scientific Designs, Inc 80305QW methadone, MDMA, methamphetamines, morphine, PCP, tricyclic antidepressants) SCI International New Choice At Home Drug Test (marijuana) strip Ind Diagnostic Inc 80305QW format SCI Medical Group, U-Check Opioid Home Drug Test Strip Healgen Scientific Limited 80305QW (Morphine) SDBiotek ForSure Buprenorphine Drug Cup Test (opiates) Tianjin New Bay Bioresearch 80305QW SHANGHAI VENTURE BIO-TECH CO., LTD., BIO-VENTURE Rapid Multi-Drup Test Easy/Split Key Cup for OTC Use SHANGHAI VENTURE BIO- 80305QW (amphetamines, Cocaine metabolites, methamphetamines, TECH CO., LTD. morphine, benzodiazepines, THC) SHANGHAI VENTURE BIO-TECH CO., LTD., BIO-VENTURE Rapid Test Cassette for OTC Use (amphetamines, Cocaine Shanghai Venture Bio-Tech 80305QW metabolites, methamphetamines, morphine, benzodiazepines, CO., Ltd. THC) Shenzhen Bioeasy Biotechnology Co., Ltd, BIOEASY Marijuana Shenzhen Bioeasy 80305QW Test Strip/Dip Card Biotechnology Co.,Ltd. Shenzhen Bioeasy Biotechnology Co., Ltd, BIOEASY Multi-Drug Test Cup (amphetamines, cocaine metabolites, Shenzhen Bioeasy methamphetamines, morphine, benzodiazepines, oxycodone, 80305QW Biotechnology Co., Ltd. barbiturates, buprenorphine, MDMA, PCP, methadone, tricyclic antidepressants, propoxyphene, THC) Speedy Solutions LLC, Speedy Tests Buprenorphine Panel Dip Assure Tech (Hangzhou) Co., 80305QW Tests Ltd

DOH 681-018 May 2020 Page 34 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Speedy Solutions LLC, Speedy Test Multi-Drug Panel Dip Tests (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Assure Tech (Hangzhou) Co., 80305QW Cocaine metabolites, MDMA, Methadone, Methamphetamines, Ltd Morphine, Oxycodone, PCP) Speedy Solutions LLC, Speedy Tests Opiates Panel Dip Tests Assure Tech (Hangzhou) Co., 80305QW (Morphine) Ltd Speedy Solutions LLC, Speedy Tests Methamphetamine Panel Dip Assure Tech (Hangzhou) Co., 80305QW Test (Methamphetamines) Ltd Statics Stik (THC, OP, COC, Ecstasy, Met) Princeton Biomeditech Corp 80305QW Syntron Bioresearch Quickscreen Buprenorphine Drug Cup Tianjin New Bay Bioresearch 80305QW (opiates) Syntron Bioresearch Inc. Quikscreen Multi MDMA Drug Cup Test Tianjin New Bay Bioresearch 80305QW (MDMA, Opiates) Syntron Bioresearch Quikscreen Multiple Drug Cup Test (Professional version) (amphetamines, THC, Cocaine metabolites, Tianjin New Bay Bioresearch 80305QW methamphetamines, PCP, Tricyclic antidepressants, oxycodone, morphine, methadone, benzodiazepines, barbiturates) Tanner Scientific Inc., BluRapids Multi-Drug Urine Test Panel and Test Cup (amphetamines, THC, Cocaine metabolites, Guangzhou Wondfo Biotech methamphetamines, PCP, Tricyclic antidepressants, opiates, 80305QW Co., LTD. MDMA, morphine, methadone, benzodiazepines, buprenorphine, barbiturates) Tanner Scientific Multi-Panel Drug Test Cup (Amphetamines, Barbituates, Benozodiapines, Buprenorphone, Cannabinoids, Cocaine Metabolites, EDDP, Methadone, Methamphetamines, Co-Innovation Biotech Co., Ltd 80305QW MDMA, Morphone, Oxycodone, PCP, Propoxyphene, Tricyclic anitdepressants) Tanner Scientific Inc., Platinum Line Multi-Panel Drug Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, methadone, MDMA, methamphetamines, UCP Biosciense, Inc 80305QW morphine, opiates, oxycodone, PCP, propoxyphene, THC, tricyclic antidepressants) TeenSavers Diag Teen Savers Home Drug Test (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, methadone, Amedica Biotech, Inc 80305QW MDMA, methamphetamines, opiates, oxycodone, PCP, THC, tricyclic antidepressants) Total Diagnostic Solutions Drug of Abuse Cassette/Cup (morphine, Alfa Scientific Designs, Inc 80305QW oxycodone) Total Diagnostic Solutions Multi-Drug of Abuse Urine Test (amphetamines, barbiturates, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, methadone, MDMA, methamphetamines, morphine, PCP, THC, tricyclic antidepressants) Tianjin New Bay Bioresearch Toxi-Cup MDMA and OPI (Opiates) Urine Drug Test 80305QW Co., Ltd. Toxi-Cup Urine Drug Test Cup (Amphetamines, Buprenophine, Methamphetamines, Oxycodone, PCP, THC, Benzodiazepines, Tianjin New Bay Bioresearch 80305QW Cocaine metabolites, Barbiturates, Morphine, Methadone, Tricyclic Co., Ltd. antidepressants) Transmetron Invitro Pro Drug Test Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, methampetamine, methadone, MDMA Transmetron 80305QW morphine,opiates, oxycodone, PCP, propoxyphene,tricyclic antidepressants)

DOH 681-018 May 2020 Page 35 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Transmetron, Inc. Invitro Pro Drug Test Cards (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, methampetamine, methadone, MDMA UCP Biosciences 80305QW morphine,opiates, oxycodone, PCP, propoxyphene,tricyclic antidepressants) Twin Spirit Inc DrugSmart Cup (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, methadone, MDMA, Amedica Biotech Inc 80305QW methamphetamines, oxycodone, opiates, PCP, THC, tricyclic antidepressants) UCP Biosciences, Inc., u-Card and u-Cup Drug Test Screen (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine Metabolities, MDMA, Opiates, Methamphetamines, UCP Biosciences, Inc 80305QW Morphine, PCP, THC, Methadone, Tricyclic Antidepressants, Oxycodone, Propoxyphene, EDDP ) UCP Biosciences, UCP Compact Drug Test Cards and Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, methadone, MDMA. methamphetamines, UCP Biosciences 80305QW morphine, oxycodone, opiates, PCP, propoxyphene, THC, tricyclic antidepressants) UCP Biosciences, UCP Multi-Drug Test Key Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, UCP Biosciences, Inc 80305QW methadone, MDMA. methamphetamines, oxycodone, opiates, PCP, propoxyphene, THC, tricyclic antidepressants) UCP Biosciences, UCP Drug Test Mini Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, UCP Biosciences, Inc 80305QW methadone, MDMA. methamphetamines, oxycodone, opiates, PCP, propoxyphene, THC, tricyclic antidepressants) UCP Biosciences, Inc., U-Card Drug Test Cards and Test Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, methadone, MDMA. methamphetamines, UCP Biosciences, Inc 80305QW morphine, oxycodone, opiates, PCP, propoxyphene, THC, tricyclic antidepressants UCP Biosciences U-Checker Drug screening Test Cups (amphetamines, barbiturates, benzodiazepines, cocaine UCP Biosciences, Inc 80305QW metabolites, methadone, MDMA. methamphetamines, morphine, oxycodone, opiates, PCP, THC, tricyclic antidepressants) UCP Biosciences UPC Compact Drug Test Cups/Cards UCP Biosciences, Inc 80305QW (buprenorphine, propoxyphene) UCP Biosciences UCP Drug screening Test Cups (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, methadone, UCP Biosciences, Inc 80305QW MDMA. methamphetamines, morphine, oxycodone, opiates, PCP, THC, tricyclic antidepressants) UCP Compact Drug Test Card/Cup Urine (EDDP) UCP Biosciences, Inc 80305QW UCP Drug Screening Test Cards/Cups (amphetamines, barbiturates, benzodiazepines, cocaine metabolites, methadone, UCP Biosciences, Inc 80305QW MDMA. methamphetamines, morphine, oxycodone, opiates, PCP, THC, tricyclic antidepressants) UCP Home Drug Screening Test Cards/Cups (buprenorphine, UCP Biosciences, Inc 80305QW propoxyphene) UCP Multiple Drug Screen Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, methadone, UCP Biosciences, Inc 80305QW MDMA. methamphetamines, morphine, oxycodone, opiates, propoxyphene, PCP, THC, tricyclic antidepressants)

DOH 681-018 May 2020 Page 36 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Ultimate Analysis Cup UA Cups (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, methadone, UCP Biosciences, Inc 80305QW MDMA. methamphetamines, morphine, oxycodone, opiates, PCP, propoxyphene, THC, tricyclic antidepressants) Ultimate Analysis Cup UA Cups Test Cards (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, UCP Biosciences, Inc 80305QW methadone, MDMA. methamphetamines, morphine, oxycodone, opiates, PCP, propoxyphene, THC, tricyclic antidepressants) US Diagnostics ProScreen Drugs of Abuse Cup (OTC) (amphetamines, barbiturates, benzodiazepines, THC, cocaine Biosite Inc / Alere 80305QW metabolites, methadone, MDMA, methamphetamines, opiates, oxycodone, PCP, tricyclic antidepressants) US Diagnostics UScreen Drugs of Abuse Card/Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, Guangzhou Wondfo Biotech 80305QW THC, cocaine metabolites, MDMA, methamphetamines, morphine, opiates, oxycodone, PCP, tricyclic antidepressants) US Diagnostics UScreen Drugs of Abuse Dip Card/Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolites, THC, methadone, methamphetamines, Guangzhou Wondfo Biotech 80305QW MDMA, morphine, opiates, oxycodone, PCP, tricylic antidepressants) US Diagnostics UScreenDrugs of Abuse Dip Card/Cup (cocaine metabolites, methadone, MDMA, methamphetamines, morphine, Guangzhou Wondfo Biotech 80305QW opiates, PCP, tricyclic antidepressants) US Laboratory Solutions, Inc. US Lab Drug Test Dip Card/Cup (amphetamines, barbiturates, buprenorphine, benzodiazepines, US Laboratory Solutions Inc. 80305QW cocaine metabolites, EDDP, MDMA, morphine, methadone, oxycodone, PCP, propoxyphene, tricyclic antidepressants, THC) uVera Diagnostics ,Inc. CR3 Keyless Split Sample Cup (Amphetamines, Barbituates, Cocaine Metabolites, Benzodiazepines, THC, Methamphetamines, MDMA, Morphine, Guangzhou Wondfo Biotech 80305QW PCP, Oxycodone, Burenorphine, Methadone, Tricyclic Anitdepressants) uVera Diagnostics, Inc. CR2 Multi-Drug Urine Test Cup (opiates, Guangzhou Wondfo Biotech 80305QW buprenorphine) uVera Diagnostics, Inc. CR3 Multi-Drug Urine Test Cup (opiates, Guangzhou Wondfo Biotech 80305QW buprenorphine) uVera Diagnostics, Inc. SMARTOX U2 Multi-Drug Urine Test Cup Guangzhou Wondfo Biotech 80305QW (opiates, buprenorphine) uVera Diagnostics, Inc. SMARTOX U3 Multi-Drug Urine Test Cup Guangzhou Wondfo Biotech 80305QW (opiates, buprenorphine) Virginia Kendall Corporations, Budpak and UCHECK MOP One Healgen Scientific 80305QW Step Morphine Test Strip (Morphine) Virginia Kendall Corporations, Budpak and UCHECK Morphine Test Healgen Scientific 80305QW Strip (Morphine) Walmart Stores, Confirm Biosciences Equate Multi Drug of Abuse Urine Test Cup (amphetamines, benzodiazepines, cocaine metabolites, THC, methamphetamines, morphine, oxycodone, Healgen Scientific Limited 80305QW barbiturates, buprenorphine, MDMA, PCP, methadone, EDDP, tricyclic antidepressants) Wal-mart Stores, Inc, ReliOn Home Drug Urine Cup Test (amphetamines, barbiturates, benzodiazepines, cocaine Alfa Scientific Designs, Inc 80305QW metabolites, MDMA methadone, methamphetamines, morphine, oxycodone PCP, THC, tricyclic antidepressants)

DOH 681-018 May 2020 Page 37 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) WayPoint Biomedical Health Essist Multi-Drug Test Cup (amphetamines, TCH, cocaine metabolites, Innovacon, Inc. 80305QW methamphetamine/amphetamine, opiates, PCP, MDMA) WHPM, Inc. DrugCheck NxScan OnSite Drug Test/Cup (THC) / ( benzodiazepines, morphine) / ( oxycodone, PCP, methadone) / (buprenorphine, barbiturates, morphine) / (EDDP, MDMA, tricyclic WHPM, Inc./Hemosure 80305QW antidepressants) / (methamphetamines, amphetamines, cocaine metabolites) WHPM Inc, First Sign Drug of Abuse Cup Test(amphetamines, cannabinoids, cocaine metabolites, methadone, W.H.P.M., Inc 80305QW methamphetamines, opiates, oxycodone, PCP, benzodiazepines, buprenorphine, butalbital, morphine) WHPM Inc, First Sign Drug of Abuse Dip Card Test Test(amphetamines, cannabinoids, cocaine metabolites, W.H.P.M., Inc 80305QW methadone, methamphetamines, opiates, oxycodone, PCP, benzodiazepines, morphine) WHPM Inc., First Sign Multi-Drug Dip Card/Cup Test W.H.P.M., Inc. 80305QW (amphetamines, methamphetamines, cocaine metabolites) Wolfe Drug Testing RealityCheck Integrated Specimen Cup (amphetamines, cocaine metabolites, methamphetamines, MDMA, Innovacon, Inc. 80305QW opiates, PCP, THC) Wondfo Amphetamine Urine Test (Cup & DipCard (AMP 500) Guangzhou Wondfo Biotech 80305QW Wondfo Amphetamine, Secobarbital, Oxazepam Urine Test (Cup & Guangzhou Wondfo Biotech 80305QW Dip Card) Wondfo Buprenorphine Urine Test Cup/Dip Card Guangzhou Wondfo Biotech 80305QW Wondfo THC Urine Test (Cup & Dip Card) Guangzhou Wondfo Biotech 80305QW Wondfo Cocaine Urine Test (Cup & Dip Card) (COC 150) Guangzhou Wondfo Biotech 80305QW Wondfo MDMA Urine Test (Cup & Dip Card) Guangzhou Wondfo Biotech 80305QW Wondfo Methadone Urine Test (Cup & Dip Card) Guangzhou Wondfo Biotech 80305QW Wondfo Methamphetamines Urine(Cup & Dip Card) (MET 500) Guangzhou Wondfo Biotech 80305QW Wondfo Morphine Urine Test (Cup & Dip Card) Guangzhou Wondfo Biotech 80305QW Wondo Nortriptyline Urine Test (Cup & Dip Card) Guangzhou Wondfo Biotech 80305QW Wondfo Oxycodone Urine Test (Cup & Dip Card) Guangzhou Wondfo Biotech 80305QW Wondfo PCP Urine Test (Cup & Dip Card) Guangzhou Wondfo Biotech 80305QW Wondfo Propoxyphene (Cup & Dip Card) Guangzhou Wondfo Biotech 80305QW Wondfo Multi-Drug Urine Test (Cup/Dipcard) (cocaine metabolites, methadone, MDMA. methamphetamines, morphine, PCP, tricyclic Guangzhou Wondfo Biotech 80305QW antidepressants) Wondfo Multi-Drug Urine Test (Cup/Dipcard) (amphetamines, Guangzhou Wondfo Biotech 80305QW barbiturates, benzodiazepines, oxycodone, THC, ) Wondfo Multi-Drug Urine Test (Cup/Dipcard) (Buprenorphine) Guangzhou Wondfo Biotech 80305QW Wondfo Multi-Drug Urine Test (Cup/Dipcard) (amphetamine, , benzodiazepines, barbiturates, buprenorphine cocaine metabolites, Guangzhou Wondfo Biotech 80305QW MDMA methadone, methamphetamines, morphine, PCP THC, tricyclic antidepressants) Wondfo Biotech Co., Ltd., Wondofo Propoxyphene Urine Test Cup Guangzhou Wondfo Biotech 80305QW and DipCard Wondfo USA Co., Ltd, Prime Screen Multi-Drug Test Panel (amphetamine, barbiturates, benzodiazepines, buprenorphine, Guangzhou Wondfo Biotech cannabinoids, cocaine metabolites, methadone, 80305QW Co., Ltd methamphetamines, MDMA, morphine, tricyclic antidepressants, oxycodone, PCP)

DOH 681-018 May 2020 Page 38 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Wondfo USA Co., Ltd. Q-Cup Multi-Drug Urine Test Cup (amphetamine, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, EDDP, methadone, Wondfo Biotech Co., Ltd. 80305QW methamphetamines, MDMA, morphine, opiates, oxycodone, PCP, propoxyphene, tricyclic antidepressants) Wondfo USA Co., Ltd, T-Cup Compact Multi-Drug Urine Test Cup/T-Cup Multi-Drug Urine Test Cup (amphetamine, barbiturates, Guangzhou Wondfo Biotech benzodiazepines, buprenorphine, cannabinoids, cocaine 80305QW Co., Ltd metabolites, methadone, methamphetamines, MDMA, morphine, opiates, tricyclic antidepressants, PCP) Wondfo USA Co., Ltd. T-Cup Flat Multi-Drug Urine Test Cup (Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cannabinoids, Cocaine metabolites, EDDP, Methadone, Wondfo USA Co, Ltd. 80305QW Methamphetamines, MDMA, Morphine, Opiates, Oxycodone, PCP, Propoxyphene, Tricyclic antidepressants) Wondfo USA Co., Ltd One Step Saliva Alcohol Test Strip Ethanol TECO Diagnostics 80305QW (alcohol) Wondfo USA Co., Ltd CLIA Screen Multi-Drug Urine Test Cup Guangzhou Wondfo Biotech 80305QW (methadone, tricyclic antidepressants) Co., Ltd Wondfo USA Co., Ltd CLIA Screen Multi-Drug Urine Test Cup (amphetamines, barbiturates, benzodiazepines, buprenorphine , Guangzhou Wondfo Biotech 80305QW cocaine metabolites, methamphetamines, MDMA, morphine, Co., Ltd oxycodone, PCP, cannabinoids) Wondfo USA Co., Ltd CLIA Screen Multi-Drug Urine Test Cup Guangzhou Wondfo Biotech 80305QW (methadone, tricyclic antidepressants) Co., Ltd Wondfo USA Co., Ltd CLIA Screen Multi-Drug Urine Test Panel (amphetamines, barbiturates, benzodiazepines, cannabinoids, Guangzhou Wondfo Biotech 80305QW cocaine metabolites, methamphetamines, MDMA, morphine, Co., Ltd oxycodone, PCP, buprenorphine) Wondfo USA, Preview Multi-Drug Uring Test Cup/Panel (amphetamines, barbiturates, benzodiazepines, buprenorphine, Guangzhou Wondfo Biotech cannabinoids, cocaine metabolites, methadone, MDMA, 80305QW Co., Ltd methamphetamines, opiates, morphine, PCP, tricyclic antidepressants) Worldwide Medical Corporation First Check Home Drug Test Worldwide Medical Corporation 80305QW (amphetamines) Worldwide Medical Corporation, First Check Home Drug Test Panel Worldwide Medical Corporation 80305QW 3 (THC-COC-Met) Worldwide Medical Corporation, First Check Home Drug Test Worldwide Medical Corporation 80305QW (THC-COC) Worldwide Medical Corporation, First Check Home Drug Test Worldwide Medical Corporation 80305QW (THC) Worldwide Medical Corporation, First Check Home Drug Test Panel Worldwide Medical Corporation 80305QW 4 (THC-COC-OPI-MET) Worldwide Medical First Check Multi Drug Cup 7 OTC (Amphetamines, THC, Cocaine Metabolites, Worldwide Medical Corporation 80305QW Methamphetamines, MDMA, Opiates, PCP Wunder Test Home Drug Screen (Marijuana) Hien Nguyen 80305QW Xiamen USEFUL Imp and Exp CO., LTD, Diagnostic Test One Step Rapid Test Cup/Dipcard (amphetamines, barbiturates, benzodiazepines, buprenorphine, THC, cocaine metabolites, Healgen Scientific 80305QW proxyphene, methadone, methamphetamines, MDMA, morphine, oxycodone, PCP, tricyclic antidepressants) Electrolyte Panel

DOH 681-018 May 2020 Page 39 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Abaxis Piccolo Blood Chemistry Analyzer WB (Electrolyte Reagent Abaxis, Inc 80051QW Disc) Abaxis Piccolo xpress Chemistry Analyzer WB (Electrolyte Reagent Abaxis, Inc 80051QW Disc) Erythrocyte Sedimentation Rate (ESR) (nonautomated) Various 85651 Esterone-3-Glucuronide Unipath Limited Clearplan Easy Fertility Monitor Unipath, Inc. 82679QW Ethanol Acon Lab Mission Saliva Alcohol Test Strip Acon Laboratories, Inc 82055QW Alere Toxicology iScreen Saliva Alcohol Test Strip Acon Laboratories, Inc 82055QW Alfa Scientific Designs Oral-View Saliva Alcohol Test Strip Acon Laboratories, Inc 82055QW American Screening Reveal Saliva Alcohol Test Acon Laboratories, Inc 82055QW Chematics Inc. Alco-Screen Saliva Alcohol Chematics, Inc. 82055QW Chematics Inc. Alco-Screen 02 Saliva Alcohol Chematics, Inc 82055QW CLIAwaived Rapid Saliva Alcohol Test Acon Laboratories, Inc 82055QW Express Diagnostics International, Incorporated Saliva Alcohol Test Teco Diagnostics 82055QW Germaine Laboratories Aim Strip Alcohol Saliva Acon Laboratories, Inc 82055QW Jant Pharmacal Corp Accustrip Saliva Alcohol Test Strip Acon Laboratories, Inc 82055QW Premier Biotech Inc., Saliva Alcohol Test Teco Diagnostics 82055QW OraSure Technologies Q.E.D. A-150 Saliva Alcohol Test OraSure Technologies 82055QW OraSure Technologies Q.E.D. A-350 Saliva Alcohol Test OraSure Technologies 82055QW STC Q.E.D. A-150 Saliva Alcohol Test OraSure Technologies 82055QW STC Q.E.D. A-350 Saliva Alcohol Test OraSure Technologies 82055QW Teco Diagnostics Saliva Alcohol Test Teco Diagnostics 82055QW Fern Test (Saliva for Ovulation) – See Ovulation Follicle Stimulating Hormone (FSH) Acon Laboratories FSH Menopause Predictor Test Acon Laboratories, Inc. 83001QW Acon Laboratories FSH One Step Menopause Test Strip/Device Acon Laboratories, Inc. 83001QW Applied Biotech Menopause Predictor Test (FSH) Applied Biotech, Inc. 83001QW Applied Biotech Instacheck FSH Test (Professional) Applied Biotech, Inc. 83001QW Applied Biotech RU25 Plus FSH Menopause Test Applied Biotech, Inc. 83001QW Biotechnostix Rapid Response FSH One Step Menopause Test Acon Laboratories, Inc. 83001QW Device BTNS Rapid Response FSH Menopausal Test Ind Diagnostics, Inc. 83001QW Genosis Fertell Female Fertility Test (FSH) Genosis, Inc. 83001QW Genua Menopause Monitor Test), Qualitative Genua 1944, Inc. 83001QW IND Diagnostic, Inc. One Step FSH Menopausal Test (midstream) IND Diagnostic, Inc. 83001QW IND Diagnostic, Inc. One Step Strip Style FSH Menopausal Test IND Diagnostic, Inc. 83001QW (professional use) IND Diagnostic, Inc. One Step FSH Menopausal Test IND Diagnostic, Inc. 83001QW (Strip/Cassette) IND Diagnostic, Inc. One Step Cassette Style FSH Menopausal IND Diagnostic, Inc. 83001QW Test (professional use) Pan Probe Biotech Early Detect Menopause Test FSH Early Detect, Inc. 83001QW Phamatech Moments Menopause Check (FSH) Phamatech 83001QW QuantRx Biomedical QuantRx Female Fertility Test Quantrx Biomedical Corp 83001QW RAC Medical Clarity FSH One Step Menopause Test Device Acon Laboratories, Inc. 83001QW (professional use) Synova Healthcare Menocheck Menopause Indicator Applied Biotech, Inc. 83001QW Test/Menocheckpro (professional use)

DOH 681-018 May 2020 Page 40 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Universal Meditech Inc., DiagnosUS FSH Menopausal Urine Test – Universal Meditech Inc. 83001QW Strip/Cassette Fructosamine LNX Fructosamine Test System LXN Corporation 82985QW LXN Duet Glucose Monitoring System (for fructosamine and LXN Corporation 82985QW glucose [see below] LXN IN CHARGE Diabetes Control System (glucose monitoring LXN Corporation 82985QW device [see below] & fructosamine) Gamma Glutamyl Transferase (GGT) Abaxis Piccolo Blood Chemistry Analyzer WB (Chem 6, Chem 13 Abaxis, Inc. 82977QW Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Abaxis, Inc. 82977QW Reagent Disc) Abaxis Piccolo xpress Chemistry Analyzer WB (Chem 6, Chem 13, Abaxis, Inc. 82977QW Liver) Glucose Blood glucose by glucose monitoring devices cleared by the FDA Various 82962 specifically for home use Abaxis Piccolo Blood Chem Analyzer WB(Chem 6, Chem 13, CMP, Abaxis, Inc. 82947QW BMP, Metlyte 8, Renal) Abaxis Piccolo Point Of Care Chemistry Analyzer (Lipid Panel Abaxis, Inc. 82947QW Reagent Disc) Glucose Abaxis Piccolo xpress Chem Analyzer WB (Chem 6, Chem 13, Abaxis, Inc. 82947QW CMP, BMP, Lipid Panel Plus, Metlyte 8, Renal) Abbott i-STAT G Cartridge (WB) i-STAT Corporation 82947QW Abbott i-STAT 4+ Cartridge (WB) i-STAT Corporation 82947QW Abbott i-STAT 6+ Cartridge (WB) i-STAT Corporation 82947QW Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 82947QW Accuchek Instant Plus dual Testing System Roche Diagnostics 82962 Alere Cholestech LDX (glucose)(WB) Alere, Inc 82947QW Alere San Diego, Inc., Cholestech LDX {WB} Abbott 82947QW Arkray SPOTCHEM EZ Chemistry Analyzer (WB) Arkray, Inc. 82947QW BioLand Technology Ltd., Bioland Blood Glucose Monitoring Bioland Technology Ltd. 82947QW System Biomedix Inc Q Steps Biometer G/C Dual Monitoring System Biomedix, Inc. 82962 Bruno MD6 Multi-Functional Monitoring System TaiDoc Technology Corporation 82947QW Cholestech LDX (Software version 1.40 or above) Cholestech 82947QW -Post glucose dose 82950QW -GTT 3 spec 82951QW -GTT ea additional sample >3 samples 82952QWea Cygnus Inc. GlucoWatch Automatic Glucose Biographer Cygnus, Inc Pending Diagnostic Test Group, Clarity Blood Glucose Monitoring System Taidoc Technology Corporation 82947QW EKF Diagnostics, Inc. EKF Diagnostics STAT-Site WB Dual Analyte TaiDoc Technology Corporation 82947QW Measurement System Germaine Laboratories Inc. AimStrip Tandem Lipid Profile and OSANG Healthcare Co., Ltd. 82947QW Glucose Measuring System HemoCue B-Glucose Photometer 82947QW -Post glucose dose 82950QW -GTT 3 spec HemoCue 82951QW -GTT ea additional sample >3 samples 82952QWea HemoCue Glucose 201 Micro cuvettes and Glucose 201 82947QW Analyzer/201DM

DOH 681-018 May 2020 Page 41 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) -Post glucose dose HemoCue 82950QW -GTT 3 spec 82951QW -GTT ea additional sample >3 samples 82952QWea Jant Pharmacal Lipid Plus Lipid Profile and Glucose Measuring Infopia Co, Ltd 82465QW System KETO-CHECK, INC. Keto-Mojo ß-Ketone & Blood Glucose TaiDoc Technology Corporation Pending Monitoring System/Professional KPI Healthcare Co., Ltd. CURO L5 Lipid Profile and Glucose OSANG Healthcare Co., Ltd. Pending Measuring System/Test Strips LXN Duet Glucose Monitoring System (for fructosamine [see LXN Corporation 82962 above] and glucose) LXN IN CHARGE Diabetes Control System (glucose monitoring LXN Corporation 82962 device & fructosamine [see above]) Nova Biomedical StatStrip Glucose Hospital Meter System Nova Biomedical Corporation Pending Nova Biomedical StatStrip Glucose Hospital Meter System Nova Biomedical Corporation Pending (prescription use only) Polymer Technology Systems Cardiochek PA Analyzer PTS Polymer Technology Systems, 82962 (prescription use) Inc. Polymer Technology Systems Cardiochek Plus, Cardiochek Home Use and Cardiochek PA Analyzer test strips Polymer Technology Systems, Inc., CardioChek Home Test System Polymer Technology Systems, 82947QW (CardioChek eGLU test strips, CaridoChek Home Chol+HDL+Glu Inc. Test strips)

-PTS Panels Glucose and eGLU test strips

-Post glucose dose 82950QW

-GTT 3 spec 82951QW 82952QW -GTT ea additional sample >3 samples ea StatStrip Xpress Blood Glucose Montoring System Nova Biomedial Corporation Pending SD Biosensor USA, Inc., SD LipidoCare (BT) Home System (SD SD BIOSENSOR Pending LipidoCare Home Blood Glucose Test Strip) SD Biosensor USA, Inc., SD LipidoCare (BT) Professional System SD BIOSENSOR Pending (SD LipidoCare Professional Blood Glucose Test Strip) Wako APOLOWAKO Analyzer (WB) 82947QW Wako Chemicals USA -Post glucose dose 82950QW

-GTT 3 spec 82951QA

82952QW -GTT ea addition sample >3 samples ea Vidan Diagnostics, LLC. Lucidplus Ref. No. 300300 Blood Glucose TaiDoc Technology Corporation Pending Plus β-Ketone Monitoring System (Glucose monitoring devices) Glycosylated HGB Alere Technologies AS, Alere Afinion AS100 Analyzer Axis-Shield Pos As 83036QW Alere Technologies AS, Afinion 2 Analyzer Alere Technologies AS 83036QW Alere Technologies AS, AS100 Analyzer Alere Technologies AS 83036QW Axis-Shield Afinion AS100 Analyzer (HbA1C) Axis-Shield Pos As 83036QW Bayer A1C Now Self check Bayer Healthcare, LLC 83037QW Bayer A1C Now+ (professional use) Bayer Healthcare, LLC 83036QW Bio-Rad Micromat II Hemoglobin A1C Prescription Home Use Bio-Rad 83037QW BIO-RAD in2it(II) System Analyzer Prescription Home Use Bio-Rad Laboratories, Inc 83037QW Bristol-Myers Squibb, Co. Choice DM Bristol-Myers Squibb, Co 83036QW Polymer Technology Systems, Chek Diagnostics A1C Now SelfCheck 83036QW Inc

DOH 681-018 May 2020 Page 42 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Polymer Technology Systems, Chek Diagnostics A1C Now+ Professional Use 83036QW Inc Cholestech GDX A1C Test (Prescription Home Use) (hemoglobin Cholestech Corporation 83037QW A1C)[7-1-02] MEC Dynamics Avie A1c Test System MEC Dynamics Corp 83036QW Metrika DRx HbA1C for glycosylated hemoglobin Metrika, Inc. 83036QW Metrika InView Multi-Test A1C Monitor Metrika, Inc. 83036QW Metrika A1c Now (Glycosylated hemoglobin, total) Metrika, Inc. 83036QW Polymer Technology Systems, Inc., CVS Health At Home A1C Test PTS Diagnostics 83036QW Kit, At-Home A1C System and Test Kit Provalis Diagnostics Glycosal HbA1c Provalis Diagnostics Ltd. 83037QW Provalis Diagnostics G5 Glycosal I HbA1c Provalis Diagnostics Ltd. 83036QW Provalis Diagnostics G5 Glycosal II HbA1c Provalis Diagnostics Ltd. 83036QW Provalis Diagnostics In2it In-Office Analyzer (II) A1C prescription Provalis Diagnostics Ltd 83037QW home use test system Polymer Technology Systems, 83036QW PTS Diagnostics A1CNow + Professional Use Inc PTS Diagnostics A1Cnow Self Check D/B/A PTS Diagnostics 83037QW Siemens DCA 2000 Analyzer Siemens Healthcare Diagnostics 83036QW Siemens DCA 2000+ Analyzer Siemens Healthcare Diagnostics 83036QW Siemens Medical Solutions Siemens Medical Diagnostics DCA Vantage Analyzer 83036QW Diagnostics Wako APOLOWAKO Analyzer (WB) Wako Chemicals USA Inc 83036QW HDL Cholesterol Abaxis Piccolo xpress Chemistry Analyzer {capillary-finger stick} Abaxis, Inc. 83718QW (HDL cholesterol) Abaxis Piccolo xpress Chemistry Analyzer WB (Lipid Panel/Lipid Abaxis, Inc 83718QW Panel Plus) Abaxis Piccolo Point of Care Chemistry Analyzer WB (Lipid Abaxis, Inc 83718QW Panel/Lipid Panel Plus) Accutech CholesTrak HDL Cholesterol Home Test AccuTech, LLC 83718QW ACON Laboratories Inc., Mission Cholesterol Pro Monitoring ACON Laboratories, Inc. 83718QW System Alere Cholestech LDX (HDL)(WB) Alere, Inc 83718QW Alere San Diego, Inc., Cholestech LDX {WB} Abbott 83718QW Arkray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 83718QW Cholestech LDX (Must have software version 1.40 or above) Cholestech 83718QW Infopia USA LipidPro Infopia Co Ltd 83718QW Infopia USA LipidPro Professional Lipid Profile and Glucose Infopia Co Ltd 82465QW Measuring System Jant Pharmacal LipidPlus Lipid Profile and Glucose Measuring Infopia Co, Ltd 83718QW System KPI Healthcare Co., Ltd. CURO L5 Lipid Profile and Glucose OSANG Healthcare Co., Ltd. 83718QW Measuring System/Test Strips Polymer Technology Systems BioScanner, BioScanner Plus, Polymer Technology Systems, 83718QW Bioscanner 2000 for HDL Cholesterol Inc. Polymer Technology Systems Cardiochek Plus, Cardiochek Home Use and Cardiochek PA Analyzer test strips Polymer Technology Systems, 83718QW -PTS Panels Lipid Panel test strips Inc. -CardioChek Home Lipid Panel test strips Polymer Technology Systems, Inc., CardioChek PA Home Test Polymer Technology Systems, System (CardioChek Home Lipid Panel test strips, CaridoChek 83718QW Inc. Home Chol+HDL+Glu test strips)

DOH 681-018 May 2020 Page 43 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Mission Cholesterol Monitoring System and Mission Cholesterol Pro Acon Laboratories, Inc. 83718QW Monitoring System SD Biosensor USA, Inc., SD LipidoCare Home System (SD SD BIOSENSOR Pending LipidoCare Home Lipid Panel Test Strip) SD Biosensor USA, Inc., SD LipidoCare (BT) Professional System (SD Lipidocare Professional System (SD LipidoCare (BT) SD BIOSENSOR Pending Professional Lipid Panel Test Strip) Helicobacter Pylori Abbott FlexPack HP Test for whole blood Abbott Laboratories 86318QW Abbott Signify H. pylori (whole blood) Abbott Laboratories 86318QW Abbott Signify H. pylori Cassette (whole blood) Abbott Laboratories 86318QW Abbott TestPack Plus H. pylori (for whole blood) Abbott Laboratories 86318QW Acon Helicobacter pylori Rapid Test Device (WB) Acon Laboratories 86318QW Alere Clearview H.pylori Whole Blood Only Alere San Deigo, Inc 86318QW Alere Signify H.pylori Whole Blood Only Alere San Deigo, Inc 86318QW Alfa Sci. Designs Instant View H. pylori (WB) Alfa Scientific Designs, Inc. 86318QW Applied Biotech SureStep H. pylori WB test (WB) Applied Biotech 86318QW ARJ Pylo-Plus Urease Test (gastric biopsy tissue) ARJ Medical, Inc 87077QW Ballard Medical Products (Delta West) CLOtest for H. pylori in Ballard Medical Products 87077QW gastric biopsy tissue Beckman Coulter Primary Care Diagnostics Flexsure H. pylori Beckman Coulter, Inc. 86318QW (whole blood) Becton Dickinson LINK 2 H. pylori Rapid Test (for whole blood) Becton Dickinson 86318QW Same as Boehringer Mannheim AccuStat H. pylori OneStep BTNX Inc Rapid Response H. pylori Rapid Test Device (WB) BTNX Inc. / Innovacon 86318QW Cardinal Hlth SP Brand Rapid Test H. pylori (WB) Applied Biotech, Inc. 86318QW ChemTrak AccuMeter H. pylori test for WB ChemTrak 86318QW CLIAwaived H. pylori Whole Blood Rapid Test Alfa Scientific Designs, Inc. 86318QW Clarity H. pylori Rapid Test Device (WB) Innovacon 86318QW De Healthcare Prod Truview H. pylori Test (WB) Applied Biotech, Inc. 86318QW Diagnostic Test Group Clarity H. pylori Rapid Test Device (WB) Princeton Biomeditech Corp 86318QW EarlyDetect H. pylori Whole Blood Rapid Test Alfa Scientific Designs Inc 86318QW Fisher Healthcare Sure-Vue H. pylori Test (WB) Innovacon 86318QW Germaine Laboratories AimStep H. pylori (WB) Acon Laboratories, Inc. 86318QW Germaine Laboratories AimStep H. pylori (WB) Princeton Biomeditech Corp. 86318QW GI Supply Div. Chek-Med Systems HP One (H. pylori in gastric GI Supply Div. Chek-Med 87077QW biopsy tissue) Systems GI Supply HP-FAST for H. pylori in gastric biopsy Mycoscience Labs, Inc. 87077QW Henry Schein OneStep+ H. pylori (whole blood) Applied Biotech, Inc. 86318QW Immunostics Detector H. pylori (WB) Princeton Biomeditech Corp 83618QW Instant Tech. iScreen H. pylori Rapid Test Device Acon Laboratories, Inc 86318QW Inverness BTNX Inc Rapid Response H. pylori (wb) Acon Laboratories, Inc 86318QW Inverness Medical Clearview H. pylori Test (WB) Innovacon, Inc. 86318QW Inverness Medical SIGNIFY H. pylori whole blood Innovacon, Inc. 86318QW JANT Accutest Rapid Urease test (H.pylori detection) ARJ Medical, Inc. Pending Jant Parmacal Accutest H. pylori rapid Test Device (WB) Innovacon 86318QW Jant Parmacal H. pylori WB Test Applied Biotech, Inc. 86318QW LifeSign H. pylori WB (for whole blood) Princeton BioMeditech Corp 86318QW LifeSign Status H. pylori (for WB) Princeton BioMeditech 86318QW McKesson H. pylori Test (WB) (Cassette) Alere 86318QW McKesson Medi-Lab Performance H. pylori (WB) Innovacon 86318WQ Med Inst.CorpPronto Dry H. pylori (gastric biopsy) Medical Instruments Corp 87077QW Medline H. pylori Test Cassette (whole blood) Alere 87077QW

DOH 681-018 May 2020 Page 44 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Merid. Biosci. ImmunoCard STAT! H.pylori (WB) Meridian Bioscience 86318QW Merid. Biosci. ImmunoCard STAT! HpSA (stool) Meridian Bioscience 87899QW Polymedco, Inc. Poly stat H. pylori (WB) Applied Biotech, Inc. 86318QW PreMaxim RadiScreen H. pylori (WB) Acon Laboratories, Inc 86318QW Princeton BioMeditech BioSign H.pylori WB Princeton BioMeditech Corp 86318QW Princeton BioMeditech BioSign H.pylori WB (OSOM H. pylori) Princeton BioMeditech Corp 86318QW {serum, plasma, whole blood} Pro-Advantage by NDC H. pylori Device WB Innovacon, Inc 86318QW PSS Consult H. pylori Cassette WB finger stick only Alere 86318QA Quidel QuickVue H.pylori (WB) Quidel 86318QA Quidel QuickVue H. pylori gII Test (WB) Quidel 86318QW Quidel QuickVue One-Step H. pylori test for (WB) Quidel 86318QW Quidel QuickVue One-Step H. pylori II test (WB) Quidel 86318QW Remel RIM A.R.C. H. pylori Test (WB) Remel 86318QW Roche Diagnostics AccuStat H. pylori OneStep (WB) Roche Diagnostics 86318QW Select Medical Products Brand Rapid Test H. pylori Innovacon 86318QW Serim Pyloritek Test Kit for Helicobacter pylori in gastric biopsy Serim 87077QW tissue Serim Pyloritek VP Test Kit (H.pylori) (WB) Serim Research Corporation 87077QW SmithKline FlexSure HP test for IgG antibodies to H. pylori in whole SmithKline Diagnostics, Inc. 86318QW blood Stanbio RELY H.pylori Rapid Test (WB finger stick only) Alere 86318QW Trinity Uni-Gold H. pylori (whole blood) Trinity BioTech, PLC 86318QW Wampole Laboratories Clearview H. pylori II (WB) Applied Biotech, Inc. 86318QW Hematocrit Abbott i-STAT 3+ Cartridge (WB) i-STAT Corporation 85014QW Abbott i-STAT 4+ Cartridge (WB) i-STAT Corporation 85014QW Abbott i-STAT 6+ Cartridge (WB) i-STAT Corporation 85014QW Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 85014QW Microhematocrit (spun) Various 85013 Micro Diag. Spuncrit DRC-40 Infrared Analyzer Micro Diagnostics Spuncrit 85014QW UltraCrit Separation Technology, Inc 85014QW Wampole STAT-CRIT Wampole 85014QW Hemoglobin Abbott i-STAT 3+ Cartridge (WB) i-STAT Corporation 85017QW Abbott i-STAT 4+ Cartridge (WB) i-STAT Corporation 85017QW Abbott i-STAT 6+ Cartridge (WB) i-STAT Corporation 85017QW Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 85017QW Aim Strip Hb Hemoglobin (Hb) Testing System Acon Laboratories, Inc. 85018QW Alere HemoPoint HX System Stanbio Laboratory 85018QW Alere HemoPoint H2 Hemoglobin Measurement Sys Stanbio Laboratory 85071QW Avie Total HbTest System (professional use) Mee Dynamics Corp 85018QW Biosafe Laboratory’s Anemiapro Self Screener Biosafe Laboratory 85018QW Biotest Hemoglobin Measuring System Biotest 85018QW Clarity HbCheck Hemoglobin Testing System Acon Laboratories, Inc. 85018QW CLIAwaived Inc. Hemoglobin (Hb) Testing System CLIAwaived Inc. 85018QW Copper-sulfate (non-automated) Various 83026 Diaspect Hemoglobin Measuring System Diaspect Medical GMBH 85018QW EKF Diagnostic Hemo_Contol Measurement and Hemo_Control EKF Diagnostic GMBH Pending Microcuvettes EKF-diagnostic GmbH, DiaSpect Tm system EKF-diagnostic GmbH 85018QW Hemocue Donor Hemoglobin Checker System Hemocue 85018QW

DOH 681-018 May 2020 Page 45 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Hemocue Hemoglobin System HemoCue 85018QW Hemocue Hemoglobin 201+/Hemocue Hemoglobin Microcuvette Hemocue 85018QW System HemoCue Hb 201 DM Analyzing System Hemocue 85018QW HemoCue Hb 301 System Hemocue 85018QW HemoCue Hb 801 System HemoCue AB 85018QW GDS Diagnostics HemoSite Meter for Hgb GDS Diagnostics 85018QW GDS Technology STAT-Site M Hgb Test System (hemoglobin) GDS Technology 85018QW ITC HGB PRO Prof. Hemoglobin Testing System ITC 85018QW McKesson Medical-Surgical Inc., McKesson Consult Hemoglobin EKF Diagnostics Inc. 85018QW Testing System Mission Plus Hemoglobin (Hb) Testing System Acon Laboratories, Inc. 85018QW Stanbio Hemoglobin Analyzer Stanbio 85018QW Stanbio HemoPoint H2 Hemoglobin Measurement System Stanbio 85018QW Stanbio HemoPoint H2 DM Hemoglobin Measurement System (with Stanbio 85018QW data management) Hepatitis C Virus Antibody OraQuick HCV Rapid Antibody Test and Oraquick HCV Visual Orasure Technologies 86803QW Reference Panel HIV Alere Determine HIV-1/2 Ag/Ab Combo Fingerstick Whole Blood) Orgenics, LTD. 87806QW bioLytical INSTI HIV-1 Antibody Test (finger stick WB) bioLytical Laboratories, Inc 86701QW bioLytical Laboratories, INST1 HIV-1/HIV-2 Antibody Test bioLytical Laboratories, Inc. 86703QW (Fingerstick whole blood) bioLytical Laboratories, INST1 HIV-1/HIV-2 Antibody Test bioLytical Laboratories, Inc. 86703QW (venipuncture whole blood and plasma) Chembio Diagnostic Systems, Inc, DPP HIV ½ Assay (Oral Fluid, Chembio Diagnostic Systems, 86703QW Fingerstick WB, Venipuncture WB) Inc Chembio Diagnostic Systems, Chembio HIV ½ STAT-PAK Assay (finger stick & venipuncture WB) 86703QW Inc Chembio Diagnostic Systems, Chembio DPP HIV ½ Assay (oral fluid) G0433QW Inc Chembio Diagnostic Systems, Clearview COMPLETE HIV 1 / 2 (finger stick & venipuncture WB 86703QW Inc Orgenics, Alere Determine HIV-1/2 Ag/Ab Combo (Fingerstick Orgenics, Ltd. 87806QW Whole Blood) Oraquick Advance Rapid HIV-1/2 Antibody Test (oral fluid, finger OraSure Technologies, Inc 86703QW stick & venipuncture WB) OraQuick In-Home HIV Test (oral fluid) Orasure Technologies, Inc 86703QW Oraquick Rapid HIV-1 Antibody Test (HIV-1 antibodies) (finger stick OraSure Technologies, Inc 86701QW & venipuncture WB) Trinity Biotech Uni-Gold Recombigen HIV Test (finger stick and Trinity Biotech Manufacturing 86701QW venipuncture whole blood) Limited Influenza Abbott, DIGIVAL (BinaxNOW Influenza A & B Card 2) {Direct Nasal Abbott Diagnostics 87804QW and NP Swabs} Scarborough, Inc. Abbott, ID NOW Instrument {Nasal and Nasopharyngeal Swabs} Abbott Diagnostics 87804QW (Influenza A/B) Scarborough, Inc. Alere BinaxNOW Influenza A & B Card (nasopharyngeal, nasal Alere Scarborough, Inc 87804QA wash/aspirate) Alere BinaxNOW Influenza A & B Card 2 with reader (Direct Nasal Alere Scarborough, Inc Pending and NP Swabs)

DOH 681-018 May 2020 Page 46 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Alere, ID NOW Instrument {Nasal and Nasopharyngeal swabs} Alere Scarborough, Inc. 87804QW (Influenza A/B) Alere Influenza A & B Test (Nasal Swab only) Alere Scarborough, Inc 87502QW Alere I Influenza A & B Test (Direct Nasal Swab only) Alere Scarborough, Inc 87502QW Alere i System (Alere i Influenza A & B 2) Alere Scarborough, Inc 87804QA Alere Scarborough Inc. Medline Influenza A & B Test Alere Scarborough, Inc 87804QA BD Veritor Plus Analyzer (nasal, nasopharyngeal swabs) (Influenza BD 87804QW A/B) BD Veritor System, Rapid Flu A+B (nasal, nasopharyngeal) (also Becton Dickinson and Co 87804QW version with reader) Binax NOW Flu A Test (Influenza A) Binax, Inc. 87804QW Binax NOW Flu B Test (Influenza B) Binax, Inc. 87804QW Binax NOW Influenza A&B Test (NP/nasal wash, nasal swabs) Binax, Inc. 87804QW BioSign Flu A+B test (nasal, nasopharyngeal) Princeton Biomeditech Corp. 87804QW BTNX Rapid Response Influenza A Test Cassette Sa Scientific Inc 87804QW BTNX Rapid Response Influenza B Test Cassette Sa Scientific Inc 87804QW Cepheid Gene Xpert Xpress System (Xpert Flu Xpress) Cepheid 87804QW Cepheid GeneXpert Xpress System (Xpert Xpress Flu Assay) Cepheid 87804QW {GeneXpert Xpress IV hub configuration} Cepheid Xpert Flu+RSV Xpress, Xpert Nasopharyngeal Sample Cepheid 87807QW Collection Kit, GeneXpert Xpress System (GX-I) Clearview Exact II Influenza A & B (Nasal swabs only) Inverness Medical 87804QW Cobas Infulenza A/B Nucleic Acid Test for Use on the cobas Liat IQUUM, INC 87804QW System EarlyDetect Pro Influenza A Test SA Scientific Inc 87804QW EarlyDetect Pro Influenza B Test SA Scientific Inc 87804QW Henry Schein OneStep+Influenza A&B Test Binax Inc 87804QW Princeton BioMeditech LifeSign LLC, Status Flu A+B 87804QW Corporation McKesson Consult Diagnostic Influenza A&B (Nasal and Princton BioMeditech Corp 87804QW Nasopharyngeal Swabs) McKesson Consult Influenza A & B (Nasal and Nasopharyngeal) Princton BioMeditech Corp 87804QW Alere Scarborough, Inc D/B/A Medline Industries, Inc. Meidline Influenza A &B Test 87804QW Binax, Inc. Meridian Bioscience Inc., ImmunoCard STAT! Flu A&B (Nasal and Princeton BioMeditech Corp 87804QW Nasopharyngeal Swabs) Mesa Biotech Accula (Influenza A/B) Mesa Biotech Inc. 87804QW PBM Princeton Biomedical Corp. ImmunoCard STAT! Flu A&B Princeton BioMeditech Corp 87804QW (Nasal and Nasopharyngeal Swabs) Polymedco Inc., Ploy stat Flu A&B (Nasal and Nasopharyngeal Princeton BioMeditech 87804QW swabs) Corporation Quidel QuickVue Influenza Test [Influenza A/B] Quidel Corporation 87804QW Quidel QuickVue Influenza A+B Test Quidel Corporation 87804QW Roche Molecular, cobas Liat System (cobas Liat Influenza A/B Iquum, Inc Pending Assay) SA Scientific SAS Influenza A SA Scientific, Inc. 87804QW SA Scientific SAS Influenza B SA Scientific, Inc. 87804QW Sekisui Acucy System (Acucy A&B Test) {Nasal and Sekisui Diagnostics, LLC 87804QW Nasopharyngeal swab) Sekisui Diagnostics LLC, OSOM Ultra Flu A Influence A/B 87804QW Sekisui Diagnostics, LLC, OSOM Ultra Plus Flu A&B Test {Nasal Sekisui Diagnostics, LLC 87804QW and Nasopharyngeal Swabs} Seiksui Inc., Silaris Dock (Influenza A/B) Mesa Biotech, Inc. 87804QW

DOH 681-018 May 2020 Page 47 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Sofia Analyzer & Influenza A+B FIA (nasal) Quidel Corp. 87804QW Sofia 2 for use with Sofia Influenza A+B FIA Quidel Corp. 87804QW ZymeTX Zstatflu Test (Influenza A/B) ZymeTX, Inc. 87449QW Ketones (Blood) Abbott Freestyle precision pro glucose and beta-ketone monitoring Abbott Diabetes Care 82010QW system Abbott Laboratories, Medisense Precision Xtra Advanced Diabetes Abbott Laboratories 82010QW Management System (ketone) Abbott Precision Xceed Pro Blood Glucose and B-Ketone Abbott Diabetes Care Ind 82010QW Monitoring System (ketone) AmVenturex, Inc., KetoCoach Blood Ketone Monitoring System Apex Bio Technology Corp. 82010QW Apex Biotechnology Corp., KET-1 Blood Ketone Monitoring System Apex Biotechnology Corp. 82010QW Bruno MD6 Multi-Functional Monitoring System TaiDoc Technology Corporation 82010QW EKF Diagnostics, Inc. EKF Diagnostics STAT-Site WB Dual Analyte TaiDoc Technology Corporation 82010QW Measurement System ForaCare Inc., TD-4041 Smart Dongle Blood Glucose plus β-ketone TaiDoc Technology Corporation 82010QW Monitoring System i-Sens, Inc., KetoSens Blood β-Ketone Monitoring System (Ketone, i-Sens, Inc. 82010QW blood) KETO-CHECK, INC. Keto-Mojo ß-Ketone & Blood Glucose TaiDoc Technology Corporation 82010QW Monitoring System/Professional Nova Max Mini Glucose and B-Ketone Monitoring Nova Biomedical 82010QW Nova Max Plus Glucose and B-Ketone Monitoring Nova Biomedical 82010QW Polymer Technology Systems BioScanner/BioScaner PTS for Blood Polymer Technology Systems, 82010QW Ketones Inc. Vidan Diagnostics, LLC. Lucidplus Ref. No. 300300 Blood Glucose TaiDoc Technology Corporation 82010QW Plus β-Ketone Monitoring System (ketone, blood) Lactic Acid KDK Corp Lactate Pro System OTC (Lactic Acid) KDK Corporation 83605QW LDL Cholesterol Polymer Technology Systems Cardiochek/Cardiochek PA Analyzer Polymer Technology System 83721QW Lead ESA Biosciences LeadCare II Blood Lead Testing System (whole ESA Biosciences, Inc. 83655QW blood) Lipid Profile (Cholesterol, HDL Cholesterol and Triglycerides) Abaxis Piccolo Point of Care Chemistry Analyzer (Lipid Panel Piccolo 80061QW Reagent Disc)(WB) Alere San Diego, Inc., Cholestech LDX {WB} Abbott 80061QW Arkray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 80061QW ACON Laboratories Inc., Mission Cholesterol Pro Monitoring ACON Laboratories, Inc. 80061QW System (cholesterol, HDL cholesterol, triglycerides) ACON Laboratories Inc., Mission Lipid Panel Monitoring System {ACON Laboratories Inc., Mission Lipid Panel Test Cartridges} ACON Laboratories, Inc. 80061QW (Cholesterol, Triglyceride, HDL Cholesterol) Cholestech LDX (Software version 1.40 or above) Cholestech 80061QW Infopia USA LipidPro Lipid Profile Test Strips Infopia Co Ltd 80061QW Infopia USA LipidPro Professional Lipid Profile and Glucose Infopia Co Ltd 82465QW Measuring System Jant Pharmacal LipidPlus Lipid Profile and Glucose Measuring Infopia Co, Ltd 80061QW System

DOH 681-018 May 2020 Page 48 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Jant Pharmacal Lipid Plus Lipid Profile and Glucose Measuring Infopia Co, Ltd 80061QW System(LipidPro Lipid Profile test strips) Jant Pharmacal Corp,LipidPlus Professional Lipid Profile and Infopia Co, Ltd 80061QW Glucose Measuring System Jant Pharmacal Corp,LipidPlus Professional Lipid Profile and Infopia Co, Ltd 80061QW Glucose Measuring System(LipidPlus Lipid Profile test strips) Jant Pharmacal LipidPlus lipid profile and glucose measuring Infopia Co., Ltd 80061QW system Jant Pharmacal LipidPlus lipid profile and glucose measuring Infopia Co., Ltd 80061QW system(LipidPro Lipid Profile test strips) KPI Healthcare Co., Ltd. CURO L5 Lipid Profile and Glucose OSANG Healthcare Co., Ltd. 80061QW Measuring System/Test Strips Polymer Technology System, Inc., CardioChek Plus Test System Polymer Technology Systems, 80061QW (PTS Panels Lipid Panel test strips) Inc Polymer Technology Systems Bioscanner Plus (PTS Panels Lipid Polymer Technology Systems, 80061QW Panel Test Strips) Inc Polymer Technology Systems Cardiocheck and Cardiochek PA Polymer Technology Systems, 80061QW Analyzers (PTS Panels Lipid Panel Test Strips) Inc Polymer Technology Systems, Inc., CardioChek Home Test System Polymer Technology Systems, 80061QW (CardioChek Home Lipid Panel test strips) Inc Mission Cholesterol Monitoring System and Mission Cholesterol Pro Acon Laboratories, Inc. 80061QW Monitoring System (Cholesterol, HDL cholesterol, Triglyceride) SD Biosensor USA, Inc., SD LipidoCare Home System (SD SD BIOSENSOR Pending LipidoCare (BT) Home Lipid Panel Test Strip) SD Biosensor USA, Inc., SD LipidoCare (BT) Professional System SD BIOSENSOR Pending (SD LipidoCare Professional Lipid Panel Test Strip) Lithium Akers Laboratory Inc InstaRead Lithium System (finger stick or Akers Laboratories, Inc. 80178QW venipuncture whole blood) ReliaLAB, Inc. InstaRead Lithium System (finger stick or Akers Laboratories, Inc. 80178QW venipuncture whole blood) Luteinizing Hormone (LH) (see ovulation tests) BTNX Inc Rapid Response LH Ovulation Test Ind Diagnostic Inc Pending Chembio Diagnostic Systems, Chembio Sure Check Ovulation Predictor 83002QW Inc Invernexx Medical Early Ovulation Predictor Stix Selfcare, Inc. 83002QW Saless Enterprises New Choice Ovulation Predictor (Cassette, Ind Diagnostic Inc 83002QW Midstream) Unipath Limited Clearplan Easy Fertility Monitor Unipath, Ltd 83002QW Lyme Disease Quidel Sofia 2 {Fingerstick whole blood} Lyme disease antibodies Quidel Corporation 86618QW (Borrelia burgdorferi Abs) Wampole PreVue B. burgdorferi Antibody for Lyme Disease Wampole 86618QW Antibodies Matrix Metalloproteinases-9 (MMP-9) Quidel Corporation, InflammaDry Quidel Corporation 83516QW Rapid Pathogen Screening, Inc. InflammaDry Rapid Pathogen Screening, Inc. 83516QW Microalbumin Micral Chemstrip Roche/Boehringer Mannheim 82044QW Beckman Coulter ICON Microalb Beckman Coulter 82044QW Diag. Chemicals ImmunoDip Urinary Albumin Test Diagnostic Chemicals 82044QW

DOH 681-018 May 2020 Page 49 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Diagnostic Chemicals Urinary Albumin Screen Urine Dipstick Diagnostic Chemicals Limited 82044QW (microalbumin) (USA) Genzyme Diagnostics OSOM ImmunoDip Urinary Albumin Test Genzyme Diagnostics 82044QW HemoCue Albumin 201 System (Albumin, Urinary) Hemocue AB 82043QW Siemens Clinitek 50 Chemistry Analyzer (see also under Urinalysis) Bayer 82044QW Siemens Clinitek Status Urine Chemistry Analyzer Bayer HealthCare, LLC 82044QW Siemens Diag. MICROALBUSTIX Reagent Strips Bayer 82044QW Mononucleosis Acceava Mono Cassette (WB) Biosite Inc 86308QW Acceava Mono II (whole blood) Biosite Inc 86308QW Acon Mono Rapid Test Strip/Device (whole blood) Acon Laboratories, Inc. 86308QW AimStep Mono (whole Blood) Princeton Biomedical Corp 86308QW Applied Biotech One Step+ Mono Test Applied Biotech, Inc 86308QW Applied Biotech SureStep Mono Test (whole blood) Applied Biotech, Inc 86308QW Applied Biotech Truview Mono Test Applied Biotech, Inc 86308QW Beckman Coulter Icon Mono Test (whole blood) Beckman Coulter, Inc 86308QW BioStar Acceava Mono Test (whole blood) BioStar, Inc. 86308QW BioStar Acceava Mono II (whole blood) Acon Laboratories, Inc. 86308QW Cardinal SP Brand Rapid Test Mono Applied Biotech, Inc. 86308QW Clarity MONO Mononucleosis Rapid Test (WB) Princeton Biomeditech Corp 86308QW Clearview Mono-Plus II Applied Biotech, Inc. 86308QW Clearview Mono Whole Blood Inverness Medical 86308QW Consult Diagnostics Mononucleosis Cassette (WB) Princeton BioMeditech Corp 86308QW DE Healthcare Products Truview Mono Test Applied Biotech, Inc. 86308QW Genzyme Contrast Mono (whole blood) Genzyme Diagnostics 86308QW Genzyme OSOM Mono Test Genzyme Diagnostics 86308QW Genzyme Rapid Mono (whole blood) Genzyme Diagnostics 86308QW Genzyme Sure-Vue Signature MONO Test (WB) Wyntek Diagnostics, Inc. 86308QW Henry Schein One Step+ Mono Test (whole blood) Applied Biotech, Inc. 86308QW Henry Schein One Step + Ultra MonoTest Kit {Whole Blood} Sekisui Diagnostics, LLC 86308QW Immuno Detector BioSign Mono WB Princeton Biomeditech Corp 86308QW Immuno Detector Mono WB Princeton Biomeditech Corp 86308QW Instant Technologies iScreen Mononucleosis Rapid Test Strip and Acon Laboratories, Inc 86308QW Device Jant Accutest Infectious Mononucleosis (WB) Jant Pharmacal Corporation 86308QW Jant Accutest Value+ Mono Rapid Test (WB) Innovacon, Ind 86308QW Jant Pharmacal Corp, Accutest Rapid Mono Test (WB) Princeton Biomeditech Corp 86308QW LifeSign Status Mono Test (WB) LifeSign 86308QW LifeSign UniStep Mono Test (whole blood) LifeSign 86308QW Mckesson Consult Mononucleosis Test Cassette (WB) Princeton Biomeditech Corp 86308QW McKesson Medi-Lab Performance Infection Mononucleosis Test Applied Biotech, Inc. 86308QW Medi-Lab Performance Mononucleosis Test (WB) McKesson Medical/Surgical 86308QW Medline Mono Test Cassette (WB) Princeton BioMeditech Corp 86308QW Meridian ImmunCard STAT Mono (WB) Applied Biotech, Inc. 86308QW OneStep Pro+ Mono (WB) Princeton BioMeditech 86308QW PerMaxim RediScreen Mononucleosis (WB) Acon Laboratories, Inc. 86308QW Polymedco, Inc. Poly stat Mono for Infectious Mononucleosis [whole Applied Biotech, Inc. 86308QW blood] Polymedco Polystat Mono(WB) Princeton BioMeditech Corp 86308QW Poly Stat Mono Test (WB) Innovacon 86308QW Princeton BioMeditech BioSign Mono WB Princeton BioMeditech 86308QW ProAdvantage by NDC Inf. Mono Test Device WB Biosite, Inc 86308QW

DOH 681-018 May 2020 Page 50 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Quidel CARDS O.S. Mono (for whole blood) Quidel 86308QW Quidel QuickVue+ Infectious Mononucleosis (WB) Quidel 86308QW RAC Medical Clarity MONO Rapid Test (WB) Acon Laboratories, Inc. 86308QW Rapid Response Mono Rapid Test Device (WB) Acon Laboratories, Inc. 86308QW Remel RIM A.R.C. Mono Test Applied Biotech, Inc. 86308QW Sekisui Diagnostics, LLC. OSOM Mono Test {Whole blood} Sekisui Diagnostics, LLC 86308QW Seradyn Color Q Mono Seradyn 86308QW Signify Mono Cassette (WB) Innovacon 86308QW Signify Mono Test Applied Biotech, Inc. 86308QW Signify Mono Whole Blood Inverness Medical 86308QW Stanbio Rely Mono Rapid Test (WB) Innovacon, Inc 86308QW Wampole Mono-Plus WB Wampole 86308QW Wyntek Diagnostics OSOM Mono test (WB) Wyntek Diagnostics 86308QW Wyntek Diagnostics Signify Mono Test (WB) Wyntek Diagnostics 86308QW Nicotine (or its metabolites) CLIAwaived Instant Nicotine Detection Test Mossman Associates, Inc 80305QW DynaGen NicCheck 1 Test Strips DynaGen, Inc 80305QW Mossman Associates NicCheck I Test Strips Mossman Associates Inc 80305QW Occult Blood 82270 Immunoassa y tests:82274 Fecal Occult Blood Various QW G0328QW (screening series 1-3) 82274QW / Fecal Occult Blood Immunochemical Tests Various G0328QW 82274QW / Fecal Occult Blood Immunological Test (IFOBT) Various G0328QW Aerscher Hemaprompt/FG (gastric occult blood) Aerscher Diagnostics 82271QW Alfa Scientific Designs Instant-View Fecal Occult Blood Self-Test Alfa Scientific Desgins, Inc Pending (Cassette) Alfa Scientific Designs Fecal Occult Blood Self-Test Alfa Scientific Designs, Inc Pending Alfa Scientific Designs, Inc. Instant-view-plus Immunochemical 82274QW/ Alfa Scientific Designs, Inc. Fecal Occult Blood Test G0328QW Orient Gene and Healgen AllSource IFOB One Step Rapid Test Pending Scientific Limited Beckman Coulter Primary Care Diagnostics Gastroccult/Hemoccult Beckman Coulter, Inc. 82271QW Sensa Elite (gastric occult blood) 82274QW/ BTNX Inc. Rapid Response Fecal Occult Blood (FOB) Self Test Alfa Scientific Designs, Inc G0328QW Cen-Med Enterprises, Elite Plus Silver Immunochemical Rapid 82274QW/ Teco Diagnostics Fecal Occult Blood Test G0328QW 82274QW / Compliance Gold Fecal Occult Blood Test - ER Immunostics, INC. G0328QW Eiken Chemical Co., LTD OC-Light S FIT (1) Eiken Chemial Co. LTD Pending Enterix Inc. InSure One – One Day Fecal Immunochemical Test InSure One Pending Fisher Healthcare Sure Vue Signature Immunochemical Fecal WHPM Inc/Hemosure Pending Occult Blood Test (iFOBT)

DOH 681-018 May 2020 Page 51 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Germaine Laboratories AimStep Immunological Fecal Occult Blood 82274QW / New Bay Bioresearch Co Old Test (iFOBT) G0328QW 82274QW / Hema Screen Specific iFOBT Immunostics, INC. G0328QW Henry Schein One Step + IFOBT Immunostics, Inc. Pending Polymedco Cancer Diagnostic Henry Schein One Step Pro+FIT(1) Pending Products, LLC 82274QW / Immunostics, Inc hema screen ER Immunostics, Inc G0328QW Jant Pharmacal Corporation Accutest ValuPak Immunochimcal Zhejiang Orient Gen Biotech Co. Pending Fecal Occult Blood Test Ltd. 82274QW / Know Fecal Occult Blood (FOB) Self Test Alfa Scientific Designs, Inc G0328QW 82274QW / McKesson Consult Immunochemical Fecal Occult Blood Test Immunostics, Inc. G0328QW Zhejiang Orient Gene Biotech 82274QW / Medical Disposables Co., MD IFOB One Step Rapid Test Co., Ltd. G0328QW Princeton BioMeditech 82274QW Medline iFOB TEST Corporation G0328QW 82274QW / Rapid Response Fecal Occult Blood (FOB) Self Test Alfa Scientific Designs, Inc G0328QW 82274QW/ Rapid ResponseI FIT-Fecal Immunochemical Test Orient Gene Biotech G0328QW Princeton Biomeditech 82274QW/ Sekisui Daignostics, LLC OSOM iFOB Test Corporation G0328QW Siemens Hematest Reagent Tablets Siemens Healthcare Diagnostics Pending SmithKline Gastroccult SmithKline 82271QW Zhejiang Orient Gene Biotech Tanner Scientific iFOB One Step Rapid Test Pending Co., Lts Wondfo Biotech Co., Ltd. Preview iFOB Immunochemical Fecal 82274QW/ Wondfo Biotech Co., Ltd. Occult Blood Test (FIT) G0328QW Osmolarity TearLab Corp TearLab Osmolarity System (tears) TearLab Corporation 83861QW Osteoporosis Ostex International Osteomark NTX Point-of-care prescription Ostex International, Inc. 82523QW home use (collagen type I crosslink, N-Telopeptides (NTX) Ovulation Tests Visual color comparison tests for human LH Various 84830 BTNX Inc Rapid Response LH Ovulation Test Ind Diagnostic Inc Pending Luna Fertility Indicator (saliva) Luna Pending MFB Fertility, Inc. Proov Test MFB Fertility, Inc. Pending O2 Unlimited Donna Ovulation Tester (saliva) O2 Unlimited 87210QW Stesans Maybe?Mom Mini Ovulation Microscope (saliva) Maybe? M.O.M., Inc. 87210QW TCI Ovulation Tester (saliva) TCI New York 87210QW PH All qualitative color comparison pH testing body fluids (other than Various 83986QW blood) Common Sense Ltd Fem-V Test Kit (vag pH) Common Sense, Ltd 83986QW Common Sense Ltd VA-SENSE Kit (vag pH) Common Sense, Ltd 83986QW Common Sense Ltd Norma-Sense Vag Discharge pH Common Sense, Ltd 83986QW Common Sense Ltd VI-SENSE Acidity (vag pH) Common Sense, Ltd 83986QW

DOH 681-018 May 2020 Page 52 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Common Sense Ltd VS-SENSE Test (vag pH) Common Sense, Ltd 83986QW Dale Med Prod. RightLevel pH (gastric pH) EZ-NG LLC 83986QW Dale Med Prod. RightSpot pH (gastric pH) EZ-NG LLC 83986QW Duramed Pharmaceuticals AmniScreen Home Detection Liner Kit Common Sense, Ltd 83986QW Femtek Phem-Alert (vaginal pH) Femtek, LLC 83986QW Lil’ Drug Store Products Vagi-Screen Vaginal Health Test (vaginal Lil’ Drug Store Products Inc 83986QW pH) 82120QW Litmus Concepts FemExam Test Card (vaginal pH and amines) Litmus Concepts, Inc. amines 82120QW Quidel QuickVue Advance pH and Amines Test Quidel Corporation amines RightBio Metrics, RightSpot Infant pH Indicator Right Bio Metrics 83986QW RightBio Metrics, RightSpot Small Bore pH Indicator (Gastric pH) RightBio Metrics 83986QW Phosphorus Abaxis Piccolo Blood Chem Analyzer WB (Renal Panel) Abaxis, Inc 84132QW Piccolo xpress Chem Analyzer WB (Renal Panel) Abaxis, Inc 84132QW Platelet Aggregation Accumetrics Verify Now Aspirin Assay Accumetrics, Inc 85576QW Potassium Abaxis Piccolo Blood Chem Analyzer WB (CMP, BMP, Electrolyte, Abaxis, Inc 84132QW Metlyte 8, Renal) Abaxis Piccolo xpress Chem Analyzer WB(CMP, BMP, Electrolyte, Abaxis, Inc 84132QW Metlyte 8, Renal) Abbott i-STAT 3+ Cartridge (WB) i-STAT Corporation 84132QW Abbott i-STAT 4+ Cartridge (WB) i-STAT Corporation 84132QW Abbott i-STAT 6+ Cartridge (WB) i-STAT Corporation 84132QW Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 84132QW Pregnancy Test (URINE) Visual Color Comparison tests Various 81025 Siemens Clinitek 50 Chemistry Analyzer (see also under Urinalysis) Siemens 84703QW Siemens Clinitek Status Urine Chemistry Analyzer Siemens 84703QW Protime (Prothrombin Time) Alere INRatio2 PT/INR (professional/home use) Alere, Inc 85610QW AvoSure PT System (prescription home use) Avocet Medical, Inc. 85610QW AvoSure PRO (Professional Use) Avocet Medical, Inc. 85610QW CoaguSense Prothrombin Time (PT/INR) Coagusense, Ind 85610QW CoaguSense Self-Test Protime/INR (Prescription Home Use) Coagusense, Inc. 85610QW Hemosense INRATIO System Hemosense, Inc. 85610QW International Technidyne Protime Microcoagulation System International Technidyne Corp 85610QW International Technidyne Protime Microcoagulation System International Technidyne Corp 85610QW ProTime 3 Cuvette Lifescan Harmony INR Monitoring System (Prescription Home Use Lifescan 85610QW and Professional Use) (reports INR only) Lifescan Rubicom Prothrombin Time Monitoring System Lifescan, Inc. 85610QW Roche Diagnostics CoaguChek-PST for prothrombin time Roche Diagnostics 85610QW Roche Diagnostics CoaguChek and CoaguChek S System, PT-S Roche Diagnostics 85610QW Test Strips (prothrombin time) Roche Diagnostics CoaguChek XS (prothrombin time) Roche Diagnostics 85610QW Roche Diagnostics CoaguChek XS Plus (prothrombin time) Roche Diagnostics 85610QW Roche Diagnostics CoaguChek Vantus System (prothrombin) Roche Diagnostics 85610QW Protein, Total

DOH 681-018 May 2020 Page 53 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Abaxis Piccolo Blood Chem Analyzer WB (Chem 13, CMP) Abaxis, Inc 84155QW Abaxis Piccolo xpress Chemistry Analyzer WB (Liver Panel Plus) Abaxis, Inc 84155QW Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Abaxis, Inc. 84155QW Reagent Disc)(WB) Abaxis Piccolo xpress Chem Analyzer WB (Chem 13, CMP) Abaxis, Inc 84155QW Arkray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 84155QW Renal Function Panel Abaxis Piccolo Blood Chem Analyzer WB (Renal Function Panel) Abaxis, Inc 80069QW Abaxis Piccolo express Chem Analyzer WB (Renal Function Panel) Abaxis, Inc 80069QW RSV (Respiratory Syncytial Virus) Abbott Diagnostics Scarborough Inc., BinaxNOW RSV Card {For Abbott Diagnostics 87807QW NP Swabs and NP Wash specimens} Scarborough, Inc. Alere BixaxNOW RSV Card Alere Scarborough, Inc 87807QW Alere i System Alere Scarborough, Inc 87807QW Alere, ID NOW Instrument {Nasopharyngeal swabs} Alere Scarborough, Inc. 87807QW Cepheid Gene Xpert Xpress System (Xpert Flu/RSV Xpress) Cepheid 87807QW Cepheid GeneXpert Xpress System (Xpert Xpress Flu/RSV Assay) Cepheid 87807QW {GeneXpert Xpress IV hub configuration} Cepheid Xpert Flu+RSV Xpress, Xpert Nasopharyngeal Sample Cepheid 87807QW Collection Kit, GeneXpert Xpress System (GX-I) Cobas RSV Nucleic Acid Test for Use on the cobas Liat System IQUUM, INC 87807QW BD Veritor Plus Analyzer (Nasopharyngeal swabs) BD Diagnostic Systems 87807QW BD Veritor System for Rapid Detection of RSV Becton Dickinson & Co 87807QW Binax NOW RSV Test (RSV antigen, qual) Binax, Inc. 87807QW Fisher Scientific Sure-Vue RSV Test SA Scientific, Inc. 87807QW Integrated Biotechnology Quick Lab RSV Test (direct antigen, Integrated Biotechnology, Corp 87807QW qualitative) Meridian Biosci. Immunocard Stat! RSV Plus Meridian Bioscience, Inc. 87807QW Mesa Biotech Accula (Accula RSV Test) Mesa Biotech, Inc. 87807QW Quidel Quick Vue RSV Test Quidel Corp 87807QW Quidel Sofia 2 (Sofia RSV FIA) Quidel Corporation 87807QW Rapid Response RSV Test Sa Scientific Inc 87807QW Remel Xpect RSV SA Scientific, Inc. 87807QW SA Scientific SAS RSV Alert SA Scientific, Inc. 87807QW SA Scientific SAS RSV Test SA Scientific, Inc. 87807QW Sofia RSV Quidel Corporation 87807QW Sofia 2 for use with the Sofia RSV FIA Quidel Corporation Pending Wampole Laboratories Clearview Integrated Biotechnology Corp 87807QW Semen Bonraybio LensHooke X1 Semen Quality Analyzer Bonraybio Co., Ltd. Pending Embryotech Laboratories FertiMARQ Home Diagnostic Screening Embryotech Laboratories, Inc. 89300QW Test for Male Infertility Fertell Male Fertility Test Genosis, LTD 89321QW Fertility Solutions Semen Analysis Qualitative Fertility Solutions 89300QW MotilityCount SwimCount Sperm Quality Test MotilityCount ApS 89300QW SpermCheck Fertility Princeton Biomeditech Corp Pending SpermCheck Vasectomy Princeton Biomeditech Corp 83900QW Trak Male Fertility Testing System Sandstone Diagnostics, Inc Pending Medical Electronic Systems, YO Home Sperm Test Pending LTD Sodium

DOH 681-018 May 2020 Page 54 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Abaxis Piccolo Blood Chem Analyzer WB (CMP, BMP, Electrolyte, Abaxis, Inc 84295QW Metlyte 8, Renal) Abaxis Piccolo xpress Chem Analyzer WB(CMP, BMP, Electrolyte, Abaxis, Inc 84295QW Metlyte 8, Renal) Abbott i-STAT 3+ Cartridge (WB) i-STAT Corporation 84295QW Abbott i-STAT 4+ Cartridge (WB) i-STAT Corporation 84295QW Abbott i-STAT 6+ Cartridge (WB) i-STAT Corporation 84295QW Abbott i-STAT CHEM8+ Cartridge (WB) i-STAT Corporation 84295QW Strep Antigen Test Abbott Signify Strep A Dipstick Innovacon 87880QW Abbott Signify Strep A Test Wyntek 87880QW Acceava Strep A Twist Rapid Test Innovacon 87880QW Acceava Strep A Test Innovacon 87880QW Accustrip Strep A Princeton Biomeditech Corp 87880QW Acon Strep A Rapid Strip Test Acon 87880QW Acon Strep A Twist Rapid Test Acon 87880QW Alere, Strep A, Alere I Instrument Alere Scarborough, Inc 87880QW Alere i Instrument (Alere i Strep A 2) Alere Scarborough, Inc 87880QW Alere Scarborough, ID NOW Instrument (Strep A) Alere Scarborough, Inc. 87880QW Applied Biotech SureStep Strep A (II) Applied Biotech, Inc 87880QW Applied Biotech SureStep Strep A Exact Applied Biotech, Inc 87880QW BD Diagnostic Systems – Point BD Diagnostic Systems, BD Veritor System 87880QW of Care BD Veritor System for Rapid Detection of Group A Strep Becton Dickinson & Co. 87880QW Beckman Coulter ICON DS Strep A Test Princeton BioMeditech 87880QW Beckman Coulter ICON FX Strep A Test (formerly SmithKline) Binax 87880QW Beckman Coulter Primary Care Diagnostics ICON DS Strep A Test Acon Laboratories 87880QW Beckman Coulter Primary Care Diagnostics ICON SC Strep A Test Acon Laboratories 87880QW Beckman Coulter Primary Care Diagnostics ICON FX Strep A Beckman Coulter, Inc. 87880QW Immunochemical Strep A Antigen Test Becton Dickinson Chek Group A Strep Test Innovacon, Ind 87880QW Becton Dickinson LINK 2 Strep A Rapid Test Becton Dickinson 87880QW Binax Clearview Advanced Strep A Binax, Inc 87880QW Binax NOW Strep A Test Binax, Inc 87880QW BioStar Acceava Strep A Test BioStar 87880QW Biotechnostix Rapid Response Strep A Rapid Test Devise/Strip Acon Laboratories 87880QW BTNX Rapid Response Strep A Rapid Test Strips Sa Scientific, Inc 87880QW Cardinal Health SP Brand Rapid Test Strep A Dipstick / Rapid Test Applied Biotech, Inc. 87880QW Strep A Cassette Cardinal Health Strep A Cassette and Dipstick-Rapid Test Alere Sd 87880QW Cepheid Gene Xpert Xpress System (Xpert Xpert Strep A) Cepheid 87880QW (Streptococcus, group A) Cepheid Gene Xpert Xpress System (Xpert Xpress Strep A) Cepheid 87880QW {GeneXpert Xpress IV hub configuration} Clarity Strep A Rapid Test Wondfo Biotech Co., Ltd 87880QW Clearview Strep A Exact Dipstick Applied Biotech, Inc. 87880QW CLIA Waived Inc Rapid STREP A Test Sa Scientific Inc 87880QW Consult Diagnostics STREP A Rapid Dipstick Innovacon, Inc 87880QW CTMI Strep A Rapid Test Strip Innovacon, Ind 87880QW DE Healthcare Products, TruView Strep A Test / Strep A Cassette DE Healthcare Products 87880QW Guangzhou Wondfo Biotech Dealmed Medical Supplies LLC, Strep A Rapid Test Kit 87880QW Co., Ltd.

DOH 681-018 May 2020 Page 55 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) PBM Princeton BioMeditech Dealmed Medical Supplies LLC, Strep A Rapid Test Kit 87880QW Corporation Diagnostic Test Group Clarity Strep A Rapid Test Strips Princeton BioMeditech Corp 87880QW Easy Healthcare Corporation, Areta Strep A Swab Test Wondfo Biotech Co., Ltd. 87880QW Fisher HealthCare Sure-Vue Strep A (direct from throat) Applied Biotech, Inc. 87880QW Genzyme Contrast Strep A Genzyme Diagnostics 87880QW Genzyme OSOM Ultra Strep A Test (25 test kit) Genzyme Diagnostics 87880QW Germaine Laboratories StrepAim Rapid Dipstick Test (Strep Group Acon Laboratories, Inc. 87880QW A) Germaine Laboratories Strep AIM Tower Acon Laboratories, Inc. 87880QW Henry Schein Inc, OneStep+ Strep A Test / OneStep+ Strep A Henry Schein, Inc 87880QW Dipstick Test / OneStep+ Strep A Cassette Test / OneStep Pro+ ICON DS Strep A Test ACON Laboratories, Inc. 87880QW IMCO Strep A Rapid Test Wondfo Biotech Co., Ltd. 87880QW IMI Signify Strep A Dipstick Innovacon Inc 87880QW Immunostics Detector Strep A Direct ACON Laboratories, Inc. 87880QW Immunostics Immuno/StrepA Detector ACON Laboratories, Inc. 87880QW Instant Tech iStrep One Step Strep A Test ACON Laboratories, Inc. 87880QW Inverness Med BioStar Acceava Strep A Test ACON Laboratories, Inc. 87880QW Inverness Med BioStar Acceava Strep A Twist Innovacon, Inc 87880QW Inverness Medical Clearview Strep A Exact II Dipstick Innovacon, Inc. 87880QW Inverness Medical Signify Strep A Cassette Innovacon, Inc 87880QW Jant Pharmacal AccuStrip Strep A (II) Jant Pharmacal 87880QW Jant Pharmacal AccuStrip Strep A Value+ Test Strip Innovacon 87880QW Jant Pharmacal Accutest Integrated Strep A Rapid Test Device Jant Pharmacal 87880QW Jant Pharmacal Clinipak Strep A Rapid Test Strip Jant Pharmacal 87880QW Guangzhou Wondfo Biotech Jant Pharmacal Corporation, accustrip VALUPAK Strep A Test Strip 87880QW Co., Ltd. Laboratory Supply Company (LSC) PEP Strep A Cassette / PEP Acon Laboratories Co 87880QW Strep A Dipstick Test LABSCO Advantage Strep A Princeton BioMediTech Corp 87880QW Roche Molecular, cobas Liat System IQuum, Inc. 87880QW LifeSign LLC Status Strep A Princeton BioMediTech Corp 87880QW Mainline Confirms Strep A Dots Test Mainline Technology, Inc 87880QW McKesson Consult Diagnostics Strep A Test Dipstick Alere 87880QW Princeton BioMeditech McKesson Consult Strep A Test Cassette 87880QW Corporation McKesson Medi-Lab Performance Strep A Test Dipstick/Cassette Applied Biotech, Inc. 87880QW McKesson Medi-Lab Strep A Test Dipstick Innovacon, Inc. 87880QW McKesson Medi-Lab Strep A Test – Twist Innovacon, Inc. 87880QW McKesson Strep A Test Dipstick/Cassette Applied Biotech, Inc. 87880QW Medline Strep A Test Strips {Throat Swabs} Alere, INC. 87880QW MediLab Performance Strep A Twist Rapid Test MediLab 87880QW Meridian Diag. ImmunoCard STAT Strep A Meridian Diagnostics 87880QW Moore Medical The Supply Experts Strep A Test – Cassette Innovacon, Inc 87880QW Moore Medical The Supply Experts Strep A Rapid Test – Dipstick Innovacon 87880QW Mooremedical Strep A Rapid Test – Dipstick Alere San Diego Inc 87880QW PEP Performance Enhanced Products Strep A Cassette Test / Acon Laboratories 87880QW Strep A Dipstick PerMaxin Rediscreen Strep A Rapid Test Acon Laboratories 87880QW PerMaxin Rediscreen Strep A Twist Cassette Innovacon 87880QW Polymedco, Inc. Poly Stat A (II) for Group A Strep [direct from throat Applied Biotech, Inc. 87880QW swab]

DOH 681-018 May 2020 Page 56 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Poly stat Strep A Flip Test Princeton BioMediTech Corp 87880QW Poly stat Strep A Strip Test Princeton Biomeditech Corp 87880QW Polymedco Poly Stat Strep A Dipstick Innovacon 87880QW Polymedco Poly Stat Strep A Liquid Test Polymedco 87880QW Princeton BioMediTech BioStrep A Test Princeton BioMediTech Corp 87880QW Princeton Biomeditech Status First Strep A Princeton BioMediTech Corp 87880QW ProAdvantage by NDC Strep A Test Innovacon 87880QW PSS Consult Diagnostics Strep A Dipstick Innovacon 87880QW PSS World Medical Select Diagnostics Strep A Dipstick Innovacon 87780QW PSS World Medical Select Diagnostics Strep A Twist Innovacon 87780QW Quidel QuickVue Dipstick Strep A Quidel 87880QW Quidel QuickVue In-Line Strep A Quidel 87880QW Quidel QuickVue In-Line One-Step Strep A Quidel 87880QW Quidel Sofia 2 (Sofia Strep A+ FIA) throat swab only Quidel 87880QW Quidel Sofia Strep A+ FIA (from throat swab only) Quidel Corp 87880QW RAC Medical Clarity Strep A Twist Rapid Strep Test Device/Strip Acon laboratories, Co 87880QW SMC Direct, LLC, RefuAH Strep A Rapid Wondfo Biotech Co., LTD. 87880QW Remel RIM A.R.C. Strep A Test (direct from throat swab) Applied Biotech, Inc. 87880QW SA Scientific SAS Strep A (direct from throat swab) SA Scientific, Inc. 87880QW Sacks Medical Refuah Strep A Rapid Test Acon Laboratories 87880QW StatusFirst Strep A Princeton BioMeditech Corp 87880QW Select Medical Products Brand Rapid Test Strep A Dipstick Innovacon, Inc 87880QW Sekisui Diag OSOM Strep A Test (direct throat swab) Sekisui Diagnostics 87880QW Sekisui Diag OSOM Ultra Strep A Test Sekisui Diagnostics 87880QW Select Medical Products Brand Rapid Test Strep A Twist Innovacon, Inc 87880QW Signify Strep A Dipstick Applied Biotech, Inc. 87880QW SmithKline ICON Fx Strep A Test (from throat swab only) Binax 87880QW Stanbio Laboratory E-Z Well Strep A Rapid Device Test Acon Laboratories Co 87880QW Stanbio Qustick Strep A Acon Laboratories Co 87880QW StrepAim Princeton Biomeditech Corp 87880QW Guangzhou Wondfo Biotech Wondfo One Step Strep A Swab Test 87880QW Co., LTD. Wondfo Biotech Co., Ltd, Preview Strep A Test Kit Wondfo Biotech Co., Ltd. 87880QW Wondfo Biotech Co., Ltd, WondView Strep A Test Kit Wondfo Biotech Co., Ltd. 87880QW Wyntek Diagnostics OSOM Strep A Test Wyntek Diagnostics, Co 87880QW Wyntek Diagnostics OSOM Ultra Strep A Test Wyntek Diagnostics, Co 87880QW Syphilis Diagnostics Direct LLC Syphilis Health Check (Fingerstick WB Diagnostics Direct LLC 86780QW Only) Trichomonas Genzyme Osom Trichomonas Rapid Test Genzyme Corp 87808QW Sekisui Diag OSOM Trichomonas Rapid Test Genzyme Corp 87808QW Triglycerides Abaxis Piccolo xpress Chemistry Analyzer {capillary-finger stick} Abaxis, Inc. 84478QW (Triglyceride) Abaxis Piccolo express Chemistry Analyzer WB (Lipid Panel/Lipid Abaxis, Inc 84478QW Panel Plus) Abaxis Piccolo POC/xpress Chemistry Analyzer WB (Lipid Abaxis, Inc 84478QW Panel/Lipid Panel Plus) ACON Laboratories Inc., Mission Cholesterol Pro Monitoring ACON Laboratories, Inc. 84478QW System (triglycerides) Alere Cholestech LDX (triglyceride)(WB) Alere, Inc 84478QW

DOH 681-018 May 2020 Page 57 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Alere San Diego, Inc., Cholestech LDX {WB} Abbott 84478QW Arkray SPOTCHEM EZ Chem Analyzer (WB) Polymedco, Inc 84478QW Cholestech LDX (Must have software version 1.40 or above) Cholestech 84478QW Germaine Laboratories Inc. AimStrip Tandem Lipid Profile and OSANG Healthcare Co., Ltd. 84478QW Glucose Measuring System Infopia USA LipidPro Infopia Co Ltd 84478QW Infopia USA LipidPro Professional Lipid Profile and Glucose Infopia Co Ltd 82465QW Measuring System Jant Pharmacal LipidPlus Lipid Profile and Glucose Measuring Infopia Co, Ltd 84478QW System KPI Healthcare Co., Ltd. CURO L5 Lipid Profile and Glucose OSANG Healthcare Co., Ltd. 84478QW Measuring System/Test Strips Polymer Technology Systems, Inc, BioScanner, Bioscanner Plus, Polymer Technology Systems, 84478QW Bioscanner 2000 Inc. Polymer Technology Systems Cardiochek Plus, Cardiochek Home Use and Cardiochek PA Analyzer test strips Polymer Technology Systems, 84478QW -PTS panels Lipid Panel test strips Inc. -CardioChek Home Lipid Panel test strips Mission Cholesterol Monitoring and Mission Cholesterol Pro ACON Laboratories, Inc. 84478QW Monitoring System SD Biosensor USA, Inc., SD LipidoCare Home System (SD SD BIOSENSOR Pending LipidoCare (BT) Home Lipid Panel Test Strip) SD Biosensor USA, Inc., SD LipidoCare (BT) Professional System SD BIOSENSOR Pending (SD LipidoCare Professional Lipid Panel Test Strip) Wako APOLOWAKO Analyzer Wako Chemicals USA 84478QW TSH Aventir Biotech LLC FORSURE TSH (WB) Screening Devices Canada Inc 84443QW BTNX Inc Rapid Response TSH (WB) Screening Devices Canada Inc 84443QW CLIA waived Inc Thyroid Test Rapid TSH Cassette (WB) Screening Devices Canada Inc 84443QW Screening Devicdes Canada, Germaine Laboratories, Inc AimStep Thyroid Screen (WB) 84443QW Inc Little Nell Labs ThyroChek TSH (WB) Little Nell Labs, Inc. 84443QW Jant Pharmacal Corp Accutest TSH (WB) Screening Devices Canada 84443QW Pharmaceutical Marketing Thyrotest TSH (WB) Screening Devices Canada 84443QW Qualigen Inc FastCheck TSH (WB) Screening Devices Canada 84443QW ThyroTest Whole Blood TSH Test (WB) ThyroTec, Inc. 84443QW Uric Acid Abaxis Piccolo Blood Chemistry Analyzer (Chem 13 Panel) (WB) Abaxis, Inc. 84550QW Abaxis Piccolo xpress Chemistry Analyzer (Chem 13 Panel) (WB) Abaxis, Inc. 84550QW ForaCare, Inc. FOR A MD6 Uric Acid Monitoring System Test Strips TaiDoc Technology Corporation 84550QW Nova Max Uric Acid Monitoring System (Fingerstick Whole Blood) Nova Biomedical Corp 84550QW Urinalysis Dipstick or tablet reagent urinalysis {nonautomated} (bilirubin--- ketone---protein---urobilinogen---blood--- leukocytes--pH--ascorbic Various 81002 acid--- glucose--- nitrite---sp gr) Acon Laboratories, Inc. Mission U120 Smart Urine Analyzer (Acon Laboratories, Inc. Mission Urinalysis Reagent Strips) (bilirubin--- Acon Laboratories, Inc 81003QW blood--- ascorbic acid--- glucose--- ketone--- leukocytes--- nitrite--- protein--- urobilinogen--- specific gravity--- pH) Acon Laboratories, Inc. Mission U120 Smart Urine Analyzer (Acon Laboratories, Inc. Mission Urinalysis Reagent Strips (Microalbumin, Acon Laboratories, Inc 81003QW Creatinine)) (creatinine--- protein)

DOH 681-018 May 2020 Page 58 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Acon Laboratories Insight U120 Urine Analyzer (bilirubin--- creatinine---ketone--- protein--- urobilinogen---blood--- leukocytes--- Acon Laboratories, Inc 81003QW pH---glucose--- nitrite--- sp gr) Acon Laboratories Mission UTI Urinary Tract Infection Test Strips Acon Laboratories, Inc Pending (leukocyte esterase, nitrite) Acon Mission U120 Urine Analyzer (bilirubin---creatinine---ketone--- protein---urobilinogen--- blood--- leukocytes---pH---glucose--- nitrite- Acon Laboratories, Inc 81003QW --sp gr) Acon Mission Foresight U120 Urine Analyzer Acon Laboratories, Inc 81003QW Biosys Laboratories Optima Urine Analyzer (bilirubin--- ketone--- protein--- urobilinogen--- blood--- leukocytes---pH--- glucose--- Biosys Laboratories 81003QW nitrite---sp gr) Biosys Laboratories Optima II Urine Analyzer (bilirubin---ketone--- protein--- urobilinogen--- blood---leukocytes--- pH--- glucose--- Biosys Laboratories 81003QW nitrite---sp gr) BTNX, Inc., Rapid Response U120S Urine Analyzer Test System (BTNX, Inc. Rapid Response Urinalysis Reagent Strips (protein--- ACON Laboratories, Inc. 81003QW creatinine) BTNX, Inc., Rapid Response U120S Urine Analyzer Test System (ascorbic acid--- bilirubin--- blood--- glucose--- ketone--- leukocyte--- ACON Laboratories, Inc. 81003QW protein--- pH--- specific gravity--- urobilinogen--- nitrite) BTNX Rapid Response U120 Urine Analyzer (bilirubin---keton--- protein---urobilinogen--- blood--- leukocyte---pH---glucose---nitrite-- Acon Laboratories 81003QW -sp gr) Chemstrip Mini UA (bilirubin---ketone---protein---urobilinogen--- Roche/Boehringer Mannheim 81003QW blood--- leukocyte---pH---glucose---nitrite---sp gr) Clarity Diagnostics LLC, Clarity U122 Urine Analyzer (bilirubin--- ketone---protein---urobilinogen---blood--- leukocytes---pH---glucose- ACON Laboratories, INC 81003QW --nitrite---sp gr) Clarity Diagnostics LLC, Clarity Urocheck U120C Urine Analyzer ACON Laboratories, INC 81003QW Test System Urinalysis Reagent Strips (creatinine---protein) Cole-Taylor Marketing Inc CTI-120 Urine Strip Analyzer (bilirubin--- ketone---protein---urobilinogen---blood--- leukocytes---pH--- Acon Laboratories Inc 81003QW glucose---nitrite---sp gr) Consult diagnostics Urine Analyzer (bilirubin--- ketone---protein--- Yd Diagnostics 81003QW urobilinogen---blood--- leukocyte---pH---glucose---nitrite---sp gr) Diagnostic Test Group Clarity Urocheck 120 Urine Analyzer (bilirubin---ketone--- protein---urobilinogen---blood--- leukocytes--- Acon Laboratories, Inc 81003QW pH---glucose--- nitrite---sp gr) Express Diagnostics International, Incorporated UTI Test Teco Diagnostics 81003QW Strips(leukocyte esterase, nitrite) Express Diagnostics International, Incorporated Urine Reagent Strips 10 for Urinalysis (bilirubin---ketone--- protein---urobilinogen-- Teco Diagnostics 81003QW -blood---leukocytes---pH---glucose--- nitrite---sp gr) Germaine Laboratories AimStrip Urine Analyzer (bilirubin---ketone-- - protein--- urobilinogen--- blood--- leukocytes--- pH---glucose--- Acon Laboratories, Inc 81003QW nitrite---sp gr) Germaine Laboratories, Inc. AimStrip Urine Analyzer 2 System (AimStrip Urine reagent Strips and Fisherbrand Urine Reagent AimStrip Urine Analyzer 2 81003QW Strips) (creatinine, urobilinogen, glucose, leukocytes, ascorbic acid, ketone, blood, specific gravity, nitrite, protein, bilirubin, pH) Healthy.io Ltd., DIP/U.S. Urine Analysis Test System (protein, Healthy.io Ltd. 81003QW nitrite, blood, glucose, pH, specific gravity)

DOH 681-018 May 2020 Page 59 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Henry Schein OneStepPlus Urine Analyzer (bilirubin--- ketone--- protein---urobilinogen---blood--- leukocytes--- pH---glucose--- nitrite- Macheerey-Nagel GmbH & Co 81003QW --sp gr---ascorbic acid) Henry Schein Urispec Plus Urine Analyzer (bilirubin---ketone--- protein---urobilinogen---blood--- leukocytes---pH---glucose---nitrite-- Macheerey-Nagel GmbH & Co 81003QW - sp gr) Hypoguard Diascreen 50 Urine Chemistry Analyzer (bilirubin--- ketone---protein---urobilinogen---blood--- leukocytes---pH--- Hypoguard 81003QW glucose---nitrite---sp gr) Immunostics Inc Detector Uristrip+ Analyzer (bilirubin---ketone--- protein---urobilinogen---blood---leukocytes--- pH---glucose--- nitrite- Acon Laboratories 81003QW -- sp gr) Inui, inui In-Home Urine Analysis Test System (leukocytes, glucose, Inui 81003QW ketone, nitrite, protein) Jant Pharmacal Accutest M2 Microalbumin Urine Reagent Strips Teco Diagnostics 81003QW (creatinine--- protein) Jant Pharmacal Corporation Accustrip URS Reader (bilirubin--- ketone---protein---urobilinogen---blood--- leukocytes---pH---glucose- Macherey-Nagel GmbH & Co 81003QW --nitrite---sp gr) McKesson 120 Urine Analyzer (bilirubin---ketone---protein--- urobilinogen---blood--- leukocytes---pH---ascorbic acid---glucose--- Acon Laboratories 81003QW nitrite ---sp gr) Mckesson Consult 120 Urine Analyzer (ascorbic acid, bilirubin, blood, glucose, ketone, leukocytes, Ph, protein, nitrite, specific Teco Diagnostics 81003QW gravity, urobilinogen) Mckesson Medical-Surgical Inc., Consult Diagnostic Microalbumin/Creatinine Urine Reagent Strips 2 Parameter Quidel Corporation 81003QW (creatinine—protein) Mediwatch urine watch Urine Analyzer (bilirubin--- ketone--- protein Acon Laboratories, Inc 81003QW ---urobilinogen---blood--- leukocytes---pH---glucose---nitrite---sp gr) Medline 120 Urine Analyzer (bilirubin---creatinine---ketone---protein- Acon Laboratories, Inc 81003QW --urobilinogen---blood---leukocytes---pH---glucose---nitrite---sp gr) Moore Medical Urine Analyzer U120 (ascorbic acid---bilirubin--- ketone---protein---urobilinogen---blood--- leukocytes---pH---glucose- Acon Laboratories, Ind 81003QW --nitrite---sp gr) NDC Inc., Pro Advantage Urine Analyzer Test System (creatinine--- ACON Laboratories 81003QW protein) NDC Inc Pro Advantage by NDC Urine Analyzer (bilirubin---ketone-- -protein---urobilinogen---blood--- leukocytes---pH---glucose---nitrite- Acon Laboratories, Inc 81003QW --sp gr) Physician Sales Service PSS Select Urine Analyzer (bilirubin--- Physician Sales and Services, ketone---protein---urobilinogen ---blood---leukocytes---pH---glucose- 81003QW Inc --nitrite---sp gr) RefuAH U120 Urine Analyzer (bilirubin---ketone---protein--- Acon Laboratories, Inc 81003QW urobilinogen---blood---leukocytes--- pH--- glucose ---nitrite---sp gr) Roche Diagnostics Urisys 1100 Urine Analyzer (bilirubin--- ketone--- protein---urobilinogen---blood--- leukocytes ---pH---glucose ---nitrite Roche Diagnostics Corp 81003QW ---sp gr) Roche Diagnostics Chemstrip 101 Urine Analyzer- (bilirubin--- ketone---protein---urobilinogen ---blood--- leukocytes---pH--- Roche/Boehringer Mannheim 81003QW glucose---nitrite---sp gr) Siemens Clinitek 50 Urine Chemistry Analyzer (bilirubin---ketone--- protein---urobilinogen---blood--- leukocytes---pH---HCG---glucose--- Siemens 81003QW nitrite ---sp gr---creatinine microalbumin)

DOH 681-018 May 2020 Page 60 of 61

Approved Test Name/Specific Test System Manufacturer CPT Code(s) Siemens Clinitek Status Urine Chemistry Analyzer (bilirubin--- ketone---protein---urobilinogen---blood--- leukocytes---pH---glucose- Siemens 81003QW --nitrite---sp gr---creatinine---microalbumin) Siemens Clinitek Status+ Analyzer (bilirubin---ketone---protein--- HCG---blood ---leukocytes---pH-glucose---nitrite---sp gr--- Siemens 81003QW creatinine---microalbumin) Siemens Clinitek Status Connect System (bilirubin---ketone--- protein---HCG---blood---leukocytes---pH---glucose---nitrite---sp gr--- Siemens 81003QW creatinine---microalbumin) Stanbio Uri-Trak 120 Urine Analyzer bilirubin--- ketone---protein--- Acon Laboratories, Inc 81003QW glucose---blood---leukocytes---pH---urobilinogen---nitrite---sp gr) ThermoBiostar PocketChem UA (bilirubin---ketone---protein--- Arkray 81003QW urobilinogen---blood---leukocytes---pH---glucose---nitrite---sp gr) Universal Meditech Inc., DiagnosUS Urinalysis Reagent Strips (leukocytes, nitrite, urobilinogen, protein, pH, blood, specific gravity, Universal Meditech Inc. 81003QW ketone, bilirubin, glucose) YD Diagnostics Corp., URiSCAN Optima Urine Chemistry Test System (leukocytes, nitrite, urobilinogen, protein, pH, blood, specific YD Diagnostics 81003QW gravity, ketone, bilirubin, glucose)

DOH 681-018 May 2020 Page 61 of 61