Medicare Coverage Policies

Currently Approved Medicare Part A
Medicare Coverage Policies or 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.

National Government Services Local Coverage Determinations (LCDs)

Current lab policies include:

  • Acid Phosphatase
  • B-type Natriuretic Peptide (BNP)
  • Human Papillomavirus (HPV) Testing
  • Lipid Profile/Cholesterol Testing
  • Qualitative Drug Screen
  • RAST Type Tests
  • Vitamin D Assay Testing

To review Local Coverage Determinations:

  1. Follow the link at the top of this list
  2. In right column, click bullet for Local Coverage Documents
  3. Under *Select Geographic Area/Region: choose New York – Upstate from the drop down menu
  4. Under *Select One or Both: type in the test name
  5. Enter

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

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

Screening for the Human Immunodeficiency Virus (HIV) Infection (210.7)

Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer (210.2)

To review National Coverage Determinations:

  1. Follow the link at the top of this list
  2. In right column, click bullet for National Coverage Documents
  3. Under *Select One or Both: type in the test name
  4. Enter