Collaborative Laboratory Services, St. Francis Hospital & Medical Center Hartford, CT

The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the Medicare program throughout the United States.

In order to ensure that services paid for by the Medicare program are indeed medically necessary, CMS has identified laboratory tests that require medical necessity documentation.

These National Coverage Determination (NCD's) and Local Coverage Determination (LCDs) policies and applicable ICD-9 codes can be found at the websites listed below.

 

  • National Coverage Determinations  as of July 2013 click here

  • CT: Local Coverage Determinations as of July 2013 click here

 

 

Policy Name

National

Local

Frequency

DX
 

AFP (Alpha-fetoprotein)

 
 

BNP (B-type Natriuretic Peptide Testing)

 

 
 

CA 15-3/CA 27.29-CA 19-9-CA125

 

 
 

CBC(Blood Counts) NON-COVERED CODES LISTED ONLY

 

 
 

CEA (Carcinoembryonic Antigen)

 
 

Collagen Crosslinks, any Method

 

 
 

Circulating Tumor Cell Assay

   Not Covered
 

Combined Ovarian Cancer Biomarker Tests

 

 Not Covered
 

Digoxin Therapeutic Drug Assay

 

 
 

Drug Screen (Qualitative)

 

 
 

Fecal Occult Blood Test

 

  
 

Galectin-3

   Not Covered
 

GGT (Gamma Glutamyl Transferase)

 

 
 

GLUCOSE (Blood Glucose Testing)

 
 

Glyco Hemoglobin-aka Hemoglobin A1C (Glycated Hemoglobin/Glycated Protein)

 
 

HCG (Human Chorionic Gonadotropin) Quantitative

 

 
 

Hepatitis Panel/Acute Hepatitis Panel
 

HIV (Human Immunodeficiency Virus (HIV) Testing-Diagnosis)

 

 
 

Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)

  

 
 

Iron Studies( Serum Ferritin, Iron, IBC, Transferrin)

  

 
 

Lipid Profile/Cholesterol Testing
 

PSA (Prostate Specific Antigen)
 

PT (Prothrombin Time)
 

PTT (Partial Thromboplastin Time)

  
 

RAST (Allergy Testing) (30 Allergen Per Year Max)

  
 

Thyroid Testing

  
 

Urine Culture

    
 

Vitamin D Assay Testing

    

Medicare  Disclaimer
The Centers for Medicare and Medicaid Services use transmittals to communicate new and revised policies.  To access the CMS online manual system visit http://www.cms.gov/regulations-and guidance/guidance/transmittals/index.html