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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 National Government Services' website. National Coverage Polices are located at CMS's website. You will need to exit the pop-up window to return to this page.

National Government Services
Local Coverage Determinations (LCDs)

Current lab policies include:

- Acid Phosphatase

- B-type Natriuretic Peptide (BNP)

- Beta2-Microglobulin

- Erythrocyte Sedimentation Rate (ESR)

- Flow Cytometry

- Hepatic Function Panel

- High-Sensitivity C-Reactive Protein (hsCRP)

- Homocysteine Level, Serum

- Human Papillomavirus (HPV) Testing

- Immunohistochemistry

- Ionized Calcium

- Irradiated Blood Products

- Lipid Profile/Cholesterol Testing

- Parathormone (Parathyroid Hormone, PTH, Immunoreactive PTH)

- Prostate Specific Antigen

- Qualitative Drug Screen

- RAST Type Tests

- Serum Magnesium Testing

- Syphilis Tests

- Viral Hepatitis Serology Tests

 

To review them:

1) Follow the link above

2) Click on "Accept"' after reading the attestation

3) Click on "Local Coverage Determinations" under Quick Links

4) Under Select a Specialty, select "Pathology/Laboratory" & under Status select "Active"

5) Click "Search"

 

CMS Medicare Coverage Database
Nat'l Coverage Determinations (NCDs)

- 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
- Serum 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

To review them:

1) Follow the link above

 

 

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