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Medicare Coverage Policies

Currently Approved Medicare Part A
Medicare Coverage Policies
for Specific Clinical Laboratory Tests

DISCLAIMER

The policies listed below have been approved and published by either our local Medical Review Board for Local Medicare Coverage policies or by CMS as National Coverage policies regarding laboratory reimbursement. We are sharing these policies with you for your information. As an ordering provider you are required to provide the most appropriate code/text diagnosis for lab tests ordered, however you are not limited to these codes.

Local Coverage Policies are located at Empire's website. National Coverage Polices are located at CMS's website. You will need to use your browser back button to return to this page.

Empire Medicare Services
Local Coverage Determinations (LCDs)

CMS Medicare Coverage Database
Lab National Coverage Determinations (NCDs)

(You can click in the header for LCD Name to toggle between a sort by LCD number and an alphabetical sort by test name.)

Acid Phosphatase

B-type Natriuretic Peptide (BNP)

Erythrocyte Sedimentation Rate (ESR)

High-Sensitivity C-Reactive Protein (hsCRP)

Homocysteine Level, Serum

Parathormone (PTH)

Serum Magnesium
Troponin Testing

Alpha-fetoprotein
Blood Counts
Blood Glucose Testing
CEA (Carcinoembryonic Antigen)
Collagen Crosslinks, Any Method
Digoxin Therapeutic Drug Assay
Fecal Occult Blood
GGT (Gamma Glutamyl Transferase)
Glycated Hemoglobin and Glycated Protein
HCG (Human Chorionic Gonadotropin)
Hepatitis Panel/Acute Hepatitis Panel
HIV Testing (Diagnosis)
HIV Testing (Prognosis includes monitoring)
Lipid Profile and Cholesterol Testing
Partial Thromboplastin Time
Prostate Specific Antigen (PSA)
Prothrombin Time
Serium Iron Studies
Thyroid Testing including TSH
Tumor Antigen by Immunoassay CA 15-3/CA27-29
Tumor Antigen by Immunoassay CA 19-9
Tumor Antigen by Immunoassay CA 125
Urine Culture

NOTE:  The following Local Coverage Determinations (LCDs) were retired effective 5/31/07.   Amylase; Chloride (Serum Levels); Helicobacter Pylori Tests; Ionized Calcium; Pap Smear of the Cervical or Vaginal Mucosa and Screening Pelvic Examinations; Phosphorus Levels (Serum); Potassium (Serum) Levels: Reticulocyte Counts; Urinalysis.