Assisting your patients who have Medicare coverage can be a challenging task. There are a number of ever-changing specifications and requirements necessary to ensure proper submission and expedition of your Medicare patients laboratory work. In order to assist you and your patients, please refer to the Medicare tools provided below.

Medicare Diagnosis Guide (ICD-10 codes effective for dates of service 10/1/15 and beyond)

NOTE: The information in the policies listed below is meant only as a guide. These policies will be updated as changes are made by CMS and/or Noridian Administrative Services. The most recent changes are displayed in red font on each policy.

Alpha-fetoprotein

B-type Natriuretic Peptide (BNP)

Bladder/Urothelial Tumor Markers

Blood Counts (CBC)

CA 125

CA 15-3 (CA 27.29)

CA 19-9

Carcinoembryonic Antigen (CEA)

Collagen Cross Links

Controlled Substance Monitoring and Drugs of Abuse Testing

Culture, Urine, Bacterial

Digoxin Therapeutic Drug Assay

Flow Cytometry

Gamma Glutamyl Transferase 

Glucose Testing (Blood)

Glycated Hemoglobin/Protein

Hepatitis C Virus Screening (Adults)

Hepatitis Panel

HIV Infection Screening

HIV Testing (Diagnosis)

HIV Testing (Prognosis including monitoring)

Human Chorionic Gonadotropin Quantitative

Iron Studies

Lipids Testing (Lipid Panel)

MolDX: Biomarkers in Cardiovascular Risk Assessment 

MolDX: BRCA1 and BRCA2 Genetic Testing

MolDX: CYP2C19, CYP2D6 Genetic Testing

MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease

MolDX: Genetic Testing for Hypercoagulability/Thrombophilia(Factor V Leiden, Factor II Prothrombin and MTHFR)

MolDX: Genetic Testing for Lynch Syndrome 

MolDX: HLA-B*5701 Genetic Testing

Non-Covered ICD-10 Codes

Occult Blood; Fecal (Screening)

Occult Blood; Fecal (Diagnostic)

Pap Smears/Liquid-Based (Diagnostic)

Pap Smears/Liquid-Based (Screening)

Partial Thromboplastin Time (PTT)

Prostate Cancer Screening Tests (PSA)

Prostate Specific Antigen, Total (PSA)

Prothrombin Time (PT)

Serum Magnesium 

Special Histochemical Stains and Immunohistochemical Stains

Thyroid Testing (Including TSH)

Vitamin D Assay Testing

 

Medicare Tools

Advance Beneficiary Notice of Non-Coverage (ABN)

Estimated Patient Pricing List

ICD-10 Medical Coding - Provider Resources

Medicare Preventative Services Guide

Quick Reference Guide of Limited Coverage Tests (ICD-10)

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