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






AFP (Alpha-fetoprotein)



BNP (B-type Natriuretic Peptide Testing)




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








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




  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 guidance/guidance/transmittals/index.html