Medicare National & Local Coverage Determinations

Medicare has determined that some laboratory tests are not medically necessary and, therefore, not covered by the Medicare program. Screening tests, tests that are experimental, for research use only or are non-FDA approved are considered non-covered. In each of these cases, a signed Advanced Beneficiary Notice (ABN) must be obtained from the patient prior to the collection of the laboratory specimen (See ABN Section). Patients will be held responsible for payment of these services.

For a current list of non-covered tests, please visit CMS's Medicare Coverage Database at:

http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx

 To review the CMS published Guidelines for NATIONAL Laboratory Test Coverage Info please click here:

National Coverage Determination:

https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/Downloads/manual201601_ICD10.pdf

  To review the CMS published Guidelines for LOCAL Laboratory Test Coverage Info please click here:

 Local Coverage Determination

For information about Medicare Coverage Limitations on Screening PAP smears, please click here:

Screening PAP Smear NCD

 

Although all of the information is carefully researched and checked for accuracy and completeness, Clinical Pathology Laboratories Southeast, Inc. (CPLSE) accepts no responsibility with regard to errors, omissions, misuse, misinterpretations, or changes made after the revision date of the document.

CPT codes are provided for information only and are based on CPLSE's current understanding of Medicare rules and carrier instructions, and in accordance with the current issue of Physicians Current Procedural Terminology-CPT published by the American Medical Association (AMA).   Medicare coding may differ from coding used by other third party payers.  Questions regarding coding should be confirmed with the payer being billed.  CPLSE cannot accept responsibility for reimbursement that may or may not be received based on the procedure codes in this document.