clinical diagnostic laboratory services: cpt codes · 2020-02-28 · clinical diagnostic laboratory...

Clinical Diagnostic Laboratory Services: CPT Codes of 66 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 02/12/2020

Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.

CLINICAL DIAGNOSTIC LABORATORY SERVICES:

CPT CODES

Approval Date: February 12, 2020

This list of codes applies to the policy titled Clinical Diagnostic Laboratory Services.

APPLICABLE CODES

This list of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. The listing of a code does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws

that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or

guarantee claim payment. Other policies and guidelines may apply.

CPT Code

Medicare

Covered Preventive/Screening

Lab NCD/MPG (Payment Criteria Must Be Met)

Not Covered When

Submitted with

Screening Diagnosis

Comments

0001M-Infectious disease (Deleted 01/01/2019)

Refer to: Molecular

Pathology/Molecular Diagnostics/Genetic Testing

0002M-Molecular Pathology

Refer to: Molecular



Refer to: Molecular Pathology/Molecular Diagnostics/Genetic Testing


Refer to: Molecular





Refer to: Molecular


0009M-Molecular Pathology (Deleted 12/31/2019)

Refer to: Molecular





Refer to: Molecular




UnitedHealthcare® Medicare Advantage

Policy Appendix: Applicable Code List

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/c/clinical-diagnostic-laboratory-services.pdf



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG

(Payment Criteria Must Be Met)

Not Covered When

Submitted

with

Screening Diagnosis

Comments

0001U-Molecular Pathology

Refer to: Molecular





Refer to: Molecular







Refer to: Molecular Pathology/Molecular

Diagnostics/Genetic Testing










Refer to: Molecular










Refer to: Molecular



Refer to: Molecular




0020U-Drug metabolism, DNA (Deleted 10/01/2018)




CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


Refer to: Molecular





Refer to: Molecular



Refer to: Molecular





Refer to: Molecular



Refer to: Molecular


0028U-Drug metabolism, CYP2D6 (Deleted 10/01/2018)








Refer to: Molecular












Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular












Refer to: Molecular



Refer to: Molecular




0051U-Prescription drug monitoring, LC-MS/MS

X

0052U-Lipoprotein, W/5 Maj Classes

X



0054U-Prescription drug monitoring, 14+

X





0057U-Oncology (solid organ)

(Expired 06/30/2019) Refer to: Molecular




CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments






0060U-Twin zygosity, DNA X

0061U-Molecular Pathology X






0064U-Molecular Diagnostic X


0066U-Placental alpha-micro globulin-1

X


Refer to: Molecular




Refer to: Molecular













Refer to: Molecular
















CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

0080U-Oncology (lung) (Effective 01/01/2019)



0081U-Oncology (uveal melanoma) (Deleted 12/31/2019)


0082U-Drug test(s), 90+ drugs

or substances (Effective 01/01/2019)

X

0083U-Oncology, motility contrast tomography response) (Effective 01/01/2019)

X

0084U-Rbc Dna Gnotyp 10 Bld

Groups (Effective 07/01/2019)

Refer to: Molecular


0085U-Cdtb&Vinculin Igg Antb Ia (Effective 07/01/2019)



0086U-Nfct Ds Bact&Fng Org Id 6+ (Effective 07/01/2019)

Refer to: Molecular Diagnostic Infectious Disease Testing

0087U-Crd Hrt Trnspl Mrna 1283 Gen (Effective 07/01/2019)

Refer to: Molecular


0088U-Trnsplj Kdn Algrft Rej 1494 (Effective 07/01/2019)


0089U-Onc Mlnma Prame & Linc00518 (Effective

07/01/2019)



0090U-Onc Cutan Mlnma Mrna 23 Gene (Effective 07/01/2019)



0092U-Onc Lng 3 Prtn Bmrk

Plsm Alg (Effective 07/01/2019)


0093U-Rx Mntr 65 Com Drugs Urine (Effective 07/01/2019)

Refer to: Molecular


0094U-Genome Rapid Sequence Alys (Effective 07/01/2019)


0095U-Inflm Ee Elisa Alys Alg (Effective 07/01/2019)



0096U-Hpv Hi Risk Types Male Urine (Effective 07/01/2019)


0097U-Gi Pathogen 22 Targets (Effective 07/01/2019)


0098U-Respir Pathogen 14 Targets (Effective 07/01/2019)








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

0101U-Hered Colon Ca Do 15 Genes (Effective 07/01/2019)



0102U-Hered Brst Ca Rltd Do 17 Gen (Effective 07/01/2019


0103U-Hered Ova Ca Pnl 24

Genes (Effective 07/01/2019) Refer to: Molecular


0104U-Hered Pan Ca Pnl 32 Genes (Deleted 10/01/2019)

0105U-Neph Ckd Mult Eclia Tum Nec (Effective 10/01/2019)

X

0106U-Gstr emptg 7 timed brth spec (Effective 10/01/2019)

X

0107U-C diff tox ag detcj ia stool (Effective 10/01/2019)

X

0108U-Gi barrett esoph 9 prtn bmrk (Effective 10/01/2019)

X

0109U-Id aspergillus dna 4 species (Effective 10/01/2019)

X

0110U-Rx mntr 1+oral onc rx&sbsts (Effective 10/01/2019)

X

0111U-Onc colon ca kras&nras alys (Effective 10/01/2019)


0112U-Iadi 16s&18s rrna genes (Effective 10/01/2019)

X

0113U-Onc prst8 pca3&tmprss2-erg (Effective 10/01/2019)

X

0114U-Gi barretts esoph vim&ccna1 (Effective 10/01/2019)

X

0115U-Respir iadna 18 viral&2 bact (Effective 10/01/2019)


0116U-Rx mntr nzm ia 35+oral flu (Effective 10/01/2019)

X

0117U-Pain mgmt 11 endogenous anal (Effective 10/01/2019)

X

0118U-Trnsplj don-drv cll-fr dna

(Effective 10/01/2019)

X

0119U-Crd ceramides liq chrom

plsm (Effective 10/01/2019)

X

0120U-Onc b cll lymphm mrna

58 gen (Effective 10/01/2019)

X

0121U-Sc dis vcam-1 whole blood (Effective 10/01/2019)

X

0122U-Sc dis p-selectin whl

blood (Effective 10/01/2019)

X

0123U-Mchnl fragility rbc prflg (Effective 10/01/2019)

X

0124U-Ftl cgen abnor 3 analytes


X

0125U-Ftl cgen abnor prnt comp 5 (Effective 10/01/2019)

X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

0126U-Ftl cgen abnor prnt comp 5 y (Effective 10/01/2019)

X

0127U-Ob pe 3 analytes (Effective 10/01/2019)

X

0128U-Ob pe 3 analytes y chrmsm (Effective 10/01/2019)

X

0129U-Hered brst ca rltd do panel (Effective 10/01/2019)


0130U-Hered colon ca do mrna pnl (Effective 10/01/2019)



0131U-Hered brst ca rltd do pnl

13 (Effective 10/01/2019)

Refer to: Molecular


0132U-Hered ova ca rltd do pnl 17 (Effective 10/01/2019)


0133U-Hered prst8 ca rltd do 11 (Effective 10/01/2019)


0134U-Hered pan ca mrna pnl 18 gen (Effective 10/01/2019)


0135U-Hered gyn ca mrna pnl

12 gen (Effective 10/01/2019) Refer to: Molecular


0136U-Atm mrna seq alys


Refer to: Molecular


0137U-Palb2 mrna seq alys (Effective 10/01/2019)


0138U-Brca1 brca2 mrna seq alys (Effective 10/01/2019)



0139U-Neuro Austm Meas 6 C Metablt (Effective 01/01/2020)

X

0140U-Nfct Ds Fungi Dna 15

Trgt (Effective 01/01/2020)

X

0141U-Nfct Ds Bact&Fng Gram Pos (Effective 01/01/2020)

X

0142U-Nfct Ds Bact&Fng Gram

Neg (Effective 01/01/2020)

X

0143U-Drug Assay 120+ Rx/Metablt (Effective 01/01/2020)

X

0144U-Drug Assay 160+

Rx/Metablt (Effective 01/01/2020)

X


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

0147U-Drug Assay 85+ Rx/Metablt (Effective

01/01/2020)

X


X

0149U-Drug Assay 60+

Rx/Metablt (Effective 01/01/2020)

X


X

0151U-Nfct Bct/Vir Resp Nfctj 33


X

0152U-Nfct Bct Fng Prst Dna >1000 (Effective 01/01/2020)

X

0153U-Onc Breast Mrna 101 Genes (Effective 01/01/2020)


0154U-Fgfr3 Gene Analysis (Effective 01/01/2020)



0155U-Pik3ca Gene Analysis (Effective 01/01/2020)


0156U-Copy Number Sequence

Alys (Effective 01/01/2020) Refer to: Molecular


0157U-Apc Mrna Seq Alys (Effective 01/01/2020)


0158U-Mlh1 Mrna Seq Alys

(Effective 01/01/2020) Refer to: Molecular Pathology/Molecular Diagnostics/Genetic Testing

0159U-Mlh1 Mrna Seq Alys

(Effective 01/01/2020) Refer to: Molecular Pathology/Molecular


0160U-Msh6 Mrna Seq Alys


0161U-Pms2 Mrna Seq Alys


0162U-Hered Colon Ca Trgt Mrna Pnl (Effective 01/01/2020)


80047-Multi-Test Laboratory Panels

X

80048- Multi-Test Laboratory Panels

X

80050-Multi-Test Laboratory Panels-General health panel

Never Covered


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X

80061-Multi-Test Laboratory Panels-Lipid panel

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.23 Lipids

Testing


X

80074-Multi-Test Laboratory

Panels

See CMS: Clinical Diagnostic

Laboratory Services, Medicare

National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.33 Hepatitis Panel/Acute Hepatitis Panel


X

80081-Multi-Test Laboratory Panels-Obstetric Panel

NCD 210.7 Screening for HIV Infection

80150-Therapeutic Drug Levels X






80162-Therapeutic Drug Levels


Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.24 Digoxin Therapeutic Drug Assay






















CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments












80305-Drug Screens Refer to: Qualitative Drug

Testing for Indications Other Than Mental Health

80306-Drug Screens Refer to: Qualitative Drug Testing for Indications Other

Than Mental Health

80307-Drug Screens Refer to: Qualitative Drug Testing for Indications Other Than Mental Health

80320-Drug Screens Invalid





























CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments
































80400-Stimulation and Suppression Test Panels

X

80402-Stimulation and

Suppression Test Panels

X


X



X


X



X


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X


X


X


X


X


X



X



X


X



X


X



X


X


X


X

81000-Urine Tests X

81001-Urine Tests X

81002-Urine Tests X

81003-Urine Tests X

81005-Urine Tests X

81007-Urine Tests X

81015-Urine Tests X

81020-Urine Tests X

81025-Urine Tests X

81050-Urine Tests X

81099-Urine Tests X

81105-Molecular Pathology Refer to: Molecular Pathology/Molecular




81107-Molecular Pathology Refer to: Molecular Pathology/Molecular Diagnostics/Genetic Testing





CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments




81112-Molecular Pathology Refer to: Molecular






















81174-Molecular Pathology






CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular


81181– Molecular Pathology










Refer to: Molecular



Refer to: Molecular










Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular









81211-Molecular Pathology (Deleted 01/01/2019)



Refer to: Molecular



(Deleted 01/01/2019) Refer to: Molecular


81214-Molecular Pathology (Deleted 01/01/2019)








Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular











81230-Cytochrome

Refer to: Molecular


81231-Cytochrome

Refer to: Molecular










Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular









81247-G6PD


81248-G6PD

Refer to: Molecular


81249-G6PD

Refer to: Molecular










Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments




81258-HBA1/HBA2


81259-HBA1/HBA2

Refer to: Molecular





Refer to: Molecular












Refer to: Molecular



Refer to: Molecular










Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular


81284-FXN (frataxin)



Refer to: Molecular












Refer to: Molecular



Refer to: Molecular










Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular












Refer to: Molecular



Refer to: Molecular










Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular












Refer to: Molecular



Refer to: Molecular









81334-Runt related transcription

factor 1

Refer to: Molecular


81335-TPMT

Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular












Refer to: Molecular



Refer to: Molecular


81363-Hemoglobin, subunit beta


81364-Hemoglobin, subunit beta






Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular












Refer to: Molecular



Refer to: Molecular










Refer to: Molecular



Refer to: Molecular








CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







Refer to: Molecular





Refer to: Molecular












Refer to: Molecular



Refer to: Molecular










Refer to: Molecular



Refer to: Molecular






81493-Coronary artery disease, mRNA

X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

81500-Multianalyte Assays with Algorithmic Analyses (MAAA)





81504-Multianalyte Assays with

Algorithmic Analyses (MAAA) Refer to: Molecular





Algorithmic Analyses (MAAA)

X


X


X


X


X


X


Algorithmic Analyses (MAAA) Refer to: Molecular



Algorithmic Analyses (MAAA)

Refer to: Molecular









81528-Oncology (colorectal) screening

NCD 210.3 Colorectal Cancer Screening Tests

81535-Oncology (gynecologic)



81536-Oncology (gynecologic)


81538-Oncology (lung)



81539-Oncology (high-grade prostated cancer)


81540-Oncology (tumor of unknown origin)




CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

81541-Oncology (prostate), mRNA



81545-Oncology (thyroid)


81551-Oncology (prostate)

Refer to: Molecular





Algorithmic Analyses (MAAA) (Effective 01/01/2019)

Refer to: Molecular Diagnostic

Infectious Disease Testing

81599-Unlisted multianalyte assay with algorithmic analysis



82009-Chemistry X

82010-Chemistry X

82013-Chemistry X

82016-Chemistry X

82017-Chemistry X

82024-Chemistry X

82030-Chemistry X

82040-Chemistry X

82042-Chemistry X

82043-Chemistry X

82044-Chemistry X

82045-Chemistry X

82075-Chemistry X

82085-Chemistry X

82088-Chemistry X

82103-Chemistry X

82104-Chemistry X

82105-Chemistry: Alcohol-Alpha-fetoprotein (AFP)

See CMS: Clinical Diagnostic Laboratory Services, Medicare

National Coverage

Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.25 Alpha-fetoprotein

82106-Chemistry x

82107-Chemistry x

82108-Chemistry x

82120-Chemistry x

82127-Chemistry x

82128-Chemistry x

82131-Chemistry x



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

82135-Chemistry x

82136-Chemistry x

82139-Chemistry x

82140-Chemistry x

82143-Chemistry x

82150-Chemistry x

82154-Chemistry x

82157-Chemistry x

82160-Chemistry x

82163-Chemistry x

82164-Chemistry x

82172-Chemistry: Apolipoprotein

Refer to: Biomarkers in Cardiovascular Risk Assessment

82175-Chemistry X

82180-Chemistry X

82190-Chemistry X

82232-Chemistry X

82239-Chemistry X

82240-Chemistry X

82147-Chemistry X

82148-Chemistry X

82252-Chemistry X

82161-Chemistry X

82270-Chemistry: Occult Blood


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.34 Fecal Occult Blood Test NCD 210.3 Colorectal Cancer

Screening Tests

82271-Chemistry: Occult Blood X

82272-Chemistry: Occult Blood

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage

Determinations (NCD) Coding

Policy Manual and Change Report; NCD 190.34 Fecal Occult Blood Test

82274-Chemistry: Occult Blood X

82286-Chemistry X

82300-Chemistry X

82306-Chemistry X

82308-Chemistry X

82310-Chemistry X

82330-Chemistry X

82331-Chemistry X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

82340-Chemistry X

82355-Chemistry X

82360-Chemistry X

82365-Chemistry X

82370-Chemistry X

82373-Chemistry X

82374-Chemistry X

82375-Chemistry X

82376-Chemistry X

82378-Carcinoembryonic antigen

(CEA)


Laboratory Services, Medicare National Coverage

Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.26 Carcinoembryonic Antigen

82379-Chemistry X

82380-Chemistry X

82382-Chemistry X

82383-Chemistry X

82384-Chemistry X

82387-Chemistry X

82390-Chemistry X

82397-Chemistry X

82415-Chemistry X

82435-Chemistry X

82436-Chemistry X

82438-Chloride; other source NCD 190.5 Sweat Test

82441-Chemistry: Chlorinated Hydrocarbons

X

82465-Chemistry: Cholesterol, Total

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.23 Lipids Testing

82480-Chemistry X

82482-Chemistry X

82485-Chemistry X

82495-Chromium

NCD 300.1 Obsolete or Unreliable Diagnostic Tests

82507-Citrate X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

82523-Chemistry: Collagen Crosslinks, Any Method


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.19 Collagen Crosslinks, Any Method

82525-Chemistry X

82528-Chemistry X

82530-Chemistry X

82533-Chemistry X

82540-Chemistry X

82542-Chemistry X

82550-Chemistry X

82552-Chemistry X

82553-Chemistry X

82554-Chemistry X

82565-Chemistry X

82570-Chemistry X

82575-Chemistry X

82585-Chemistry X

82595-Chemistry X

82600-Chemistry X

82607-Chemistry X

82608-Chemistry X

82610-Chemistry: Cryoglobulin-Dibucaine


82615-Chemistry X

82626-Chemistry X

82627-Chemistry X

82633-Chemistry X

82634-Chemistry X

82638-Chemistry X

82642-Chemistry X

82652-Chemistry X

82656-Chemistry X

82657-Chemistry X

82658-Chemistry X

82664-Chemistry X

82668-Chemistry X

82670-Chemistry X

82671-Chemistry X

82672-Chemistry X

82677-Chemistry X

82679-Chemistry X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

82693-Chemistry X

82696-Chemistry X

82705-Chemistry X

82710-Chemistry X

82715-Chemistry X

82725-Chemistry X

82726-Chemistry X

82728-Chemistry: Ferritin


Laboratory Services, Medicare National Coverage Determinations (NCD) Coding

Policy Manual and Change Report; NCD 190.18 Serum Iron Studies

82731-Chemistry X

82735-Chemistry X

82746-Chemistry X

82747-Chemistry X

82757-Chemistry X

82759-Chemistry X

82760-Chemistry X

82775-Chemistry X

82776-Chemistry X

82777-Chemistry X

82784-Chemistry X

82785-Chemistry X

82787-Chemistry X

82800-Chemistry X

82803-Chemistry X

82805-Chemistry X

82810-Chemistry X

82820-Chemistry X

82930-Chemistry X

82938-Chemistry X

82941-Chemistry X

82943-Chemistry X

82945-Chemistry X

82946-Chemistry X

82947-Chemistry: Glucose Testing


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.20 Blood Glucose Testing



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments




82950-Chemistry: Glucose

Testing X


X

82952-Chemistry X

82955-Chemistry X

82960-Chemistry X




82963-Chemistry X

82965-Chemistry X

82977-Chemistry: Glutamyltransferase, gamma (GGT)


Determinations (NCD) Coding

Policy Manual and Change Report; NCD 190.32 Gamma Glutamyl Transferase

82978-Chemistry X

82979-Chemistry X

82985-Chemistry: Glycated protein

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding

Policy Manual and Change Report; NCD 190.21 Glycated Hemoglobin/Glycated Protein

83001-Chemistry X

83002-Chemistry X

83003-Chemistry X

83006-Chemistry X

83009-Chemistry X

83010-Chemistry X

83012-Chemistry X

83013-Chemistry X

83014-Chemistry X

83015-Chemistry X

83018-Chemistry X

83020-Chemistry X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

83021-Chemistry X

83026-Chemistry X

83030-Chemistry X

83033-Chemistry X

83036-Chemistry: Hemoglobin;

glycosylated (A1C)


Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.21 Glycated Hemoglobin/Glycated Protein

83037-Chemistry X

83045-Chemistry X

83050-Chemistry X

83051-Chemistry X

83060-Chemistry X

83065-Chemistry X

83068-Chemistry X

83069-Chemistry X

83070-Chemistry X

83080-Chemistry X

83088-Chemistry X

83090 Chemistry: Homocysteine


83150-Chemistry X

83491-Chemistry X

83497-Chemistry X

83498-Chemistry X

83500-Chemistry X

83505-Chemistry X

83516-Chemistry X

83518-Chemistry X

83519-Chemistry X

83520-Chemistry X

83525-Chemistry X

83527-Chemistry X

83528-Chemistry X

83540-Chemistry: Iron

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change

Report; NCD 190.18 Serum Iron Studies



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

83550-Chemistry: Iron Binding Capacity


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.18 Serum Iron Studies

83570-Chemistry X

83582-Chemistry X

83586-Chemistry X

83593-Chemistry X

83605-Chemistry X

83615-Chemistry X

83625-Chemistry X

83630-Chemistry X

83631-Chemistry X

83632-Chemistry X

83633-Chemistry X

83655-Chemistry X

83661-Chemistry X

83662-Chemistry X

83663-Chemistry X

83664-Chemistry X

83670-Chemistry X

83690-Chemistry X

83695-Lipoprotein (a)


83698-Lipoprotein-associated phospholipase A2 (Lp-PLA2)


83700-Lipoprotein, blood; electrophoretic separation and quantitation


Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.23 Lipids Testing Or refer to: Biomarkers in Cardiovascular Risk Assessment

83701- Lipoprotein blood; high resolution fractionation and quantitation of lipoproteins

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.23 Lipids Testing

Or refer to: Biomarkers in Cardiovascular Risk Assessment



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

83704-Lipoprotein, blood; quantitation of lipoprotein

particle number


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.23 Lipids Testing Or refer to: Biomarkers in Cardiovascular Risk Assessment

83718-Lipoprotein, direct measurement; high density cholesterol


Policy Manual and Change Report; NCD 190.23 Lipids

Testing

83719-Lipoprotein, direct measurement; VLDL cholesterol


83721-Lipoprotein, direct

measurement; LDL cholesterol


Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.23 Lipids Testing Or refer to: Biomarkers in

Cardiovascular Risk Assessment

83722-Chemistry X

83727-Chemistry X

83735-Chemistry X

83775-Chemistry X

83785-Chemistry X

83789-Chemistry X

83825-Chemistry X

83835-Chemistry X

83857-Chemistry X

83861-Chemistry X

83864-Chemistry X

83872-Chemistry X

83873-Chemistry X

83874-Chemistry X

83876-Chemistry X

83880-Chemistry X

83883-Chemistry X

83885-Chemistry X

83915-Chemistry X

83916-Chemistry X

83918-Chemistry X

83919-Chemistry X

83921-Chemistry X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

83930-Chemistry X

83935-Chemistry X

83937-Chemistry X

83945-Chemistry X

83950-Chemistry X

83951-Chemistry X

83970-Chemistry X

83986-Chemistry X

83987-Chemistry X

83992-Assay for Phencyclidine

Invalid

04/01/2018

83993-Chemistry X

84030-Chemistry X

84035-Chemistry X

84060-Chemistry X

84066-Chemistry X

84075-Chemistry X

84078-Chemistry X

84080-Chemistry X

84081-Chemistry X

84085-Chemistry X

84087-Chemistry X

84100-Chemistry X

84105-Chemistry X

84106-Chemistry X

84110-Chemistry X

84112-Chemistry X

84119-Chemistry X

84120-Chemistry X

84126-Chemistry X

84132-Chemistry X

84133-Chemistry X

84134-Chemistry X

84135-Chemistry X

84138-Chemistry X

84140-Chemistry X

84143-Chemistry X

84144-Chemistry X

84145-Chemistry X

84146-Chemistry X

84150-Chemistry X

84152-Chemistry X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

84153-Chemistry: Prostate Specific Antigen


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.31 Prostate Specific Antigen

84154-Chemistry X

84155-Chemistry X

84156-Chemistry X

84157-Chemistry X

84160-Chemistry X

84163-Chemistry X

84165-Chemistry X

84166-Chemistry X

84181-Chemistry X

84182-Chemistry X

84202-Chemistry X

84203-Chemistry X

84206-Chemistry X

84207-Chemistry X

84210-Chemistry X

84220-Chemistry X

84228-Chemistry X

84233-Chemistry X

84234-Chemistry X

84235-Chemistry X

84238-Chemistry X

84244-Chemistry X

84252-Chemistry X

84255-Chemistry X

84260-Chemistry X

84270-Chemistry X

84275-Chemistry X

84285-Chemistry X

84295-Chemistry X

84300-Chemistry X

84302-Chemistry X

84305-Chemistry X

84307-Chemistry X

84311-Chemistry X

84315-Chemistry X

84375-Chemistry X

84376-Chemistry X

84377-Chemistry X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

84378-Chemistry X

84379-Chemistry X

84392-Chemistry X

84402-Chemistry X

84403-Chemistry X

84410-Chemistry X

84425-Chemistry X

84430-Chemistry X

84431-Chemistry X

84432-Chemistry X

84436-Chemistry: Thyroid Tests


Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.22 Thyroid Testing

84437-Chemistry: Thyroid Tests X



Policy Manual and Change Report; NCD 190.22 Thyroid Testing

84442-Chemistry: Thyroid Tests X



Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.22 Thyroid Testing

84445-Chemistry X

84446-Chemistry X

84449-Chemistry X

84450-Chemistry X

84460-Chemistry X

84466-Chemistry: Transferrin


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.18 Serum Iron Studies

84478-Chemistry: Triglycerides


Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.23 Lipids Testing



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

84479-Chemistry: Thyroid Hormone


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.22 Thyroid Testing

84480-Chemistry X

84481-Chemistry X

84482-Chemistry X

84484-Chemistry X

84485-Chemistry X

84488-Chemistry X

84490-Chemistry X

84510-Chemistry X

84512-Chemistry X

84520-Chemistry X

84525-Chemistry X

84540-Chemistry X

84545-Chemistry X

84550-Chemistry X

84560-Chemistry X

84577-Chemistry X

84578-Chemistry X

84580-Chemistry X

84583-Chemistry X

84585-Chemistry X

84586-Chemistry X

84588-Chemistry X

84590-Chemistry X

84591-Chemistry-NOS Vitamin Never Covered

84597-Chemistry X

84600-Chemistry X

84620-Chemistry X

84630-Chemistry X

84681-C-peptide X

84702-Gonadotropin, chorionic; quantitative

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.27 Human

Chorionic Gonadotropin

84703-Gonadotropin X

84704-Gonadotropin X

84830-Ovulation tests X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

84999- Unlisted chemistry procedure


Diagnostics/Genetic Testing NCD 190.7 Human Tumor Stem Cell Drug Sensitivity Assays

85002-Hematology; Bleeding Time Test

X

85004-Blood Counts


Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.15 Blood

Counts

85007-Blood Counts

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.15 Blood

Counts

85008-Blood Counts


Report; NCD 190.15 Blood Counts

85009-Hematology; Blood Counts

X

85013-Blood Counts

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.15 Blood Counts

85014-Blood Counts


Report; NCD 190.15 Blood Counts

85018- Blood Counts


Policy Manual and Change Report; NCD 190.15 Blood Counts



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

85025-Blood Counts


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.15 Blood Counts

85027-Hematology; Blood

Counts

X

85032-Blood Counts




X


X


X


X

85048-Blood Counts



85049-Blood Counts


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.15 Blood Counts

85055-Hematology;

Coagulopathy Testing

X

85060-Hematology; Coagulopathy Testing

X

85097-Hematology;


X


X


X


X


X


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X


X


X


X


X


X

85260-Hematology;


X

85270-Hematology;


X


X

85290-Hematology;


X


X

85292-Hematology;


X


X


X


X


X


X


X


X


X


X

85337-Hematology;


X

85345-Hematology;


X


X

85348-Hematology;


X


X

85362-Hematology;


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X


X


X


X


X


X

85390-Hematology;


X

85396-Hematology;


X


X

85400-Hematology;


X


X

85415-Hematology;


X


X


X


X


X


X


X


X


X


X

85530-Hematology;


X

85536-Hematology;


X


X

85547-Coagulopathy Testing

Mechanical Fragility

Investigational

Deny


X

85555-Hematology;


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X


X


X

85610-Coagulopathy Testing

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.17

Prothrombin Time (PT)


X


X


X


X


X


X


X

85670-Hematology;


X


X


X

85730-Partial Thromboplastin Time (PTT)Thromboplastin time, partial

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.16 Partial Thromboplastin Time (PTT)

85732-Partial Thromboplastin Time (PTT)

X

85810-Blood Viscosity X



86000-Immunology X

86001-Immunology X

86003-Immunology X

86005-Immunology X

86008-Immunology X

86021-Immunology X

86022-Immunology X

86023-Immunology X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

86038-Immunology X

86039-Immunology X

86060-Immunology X

86063-Immunology X

86077-Blood Bank Services X



86140-C-Reactive Protein

(hsCRP)

Refer to: Biomarkers in

Cardiovascular Risk Assessment

86141-C-Reactive Protein (hsCRP)


86146-Immunology X

86147-Immunology X

86148-Immunology X






86155-Immunology X

86156-Immunology X

86157-Immunology X

86160-Immunology X

86161-Immunology X

86162-Immunology X

86171-Immunology X

86200-Immunology X

86215-Immunology X

86225-Immunology X

86226-Immunology X

86235-Immunology X

86255-Immunology X

86256-Immunology X

86277-Immunology X

86280-Immunology X



86300-Diagnostic Immunology Testing


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.29 Tumor Antigen by Immunoassay CA 15-3/CA 27.29



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments



National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.30 Tumor Antigen by Immunoassay CA 19-9



Report; NCD 190.28 Tumor Antigen by Immunoassay CA

125

86305-Immunology X

86308-Immunology X

86309-Immunology X

86310-Immunology X




86317-Immunology X

86318-Immunology X

86320-Immunology X

86325-Immunology X

86327-Immunology X

86329-Immunology X

86331-Immunology X

86332-Immunology X

86334-Immunology X

86335-Immunology X

86336-Immunology X

86337-Immunology X

86340-Immunology X

86341-Immunology X

86343-Immunology X

86344-Immunology X

86352-Assay Cellular Function

NCD 190.8 Lymphocyte Mitogen Response Assays

86353-Assay Cellular Function

NCD 190.8 Lymphocyte Mitogen

Response Assays

86355-Immunology X

86356-Immunology X

86357-Immunology X

86359-Immunology X

86360-Immunology X

86361-Immunology X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

86367-Immunology X

86376-Immunology X

86382-Immunology X

86384-Immunology X


Refer to: Molecular


86403-Immunology X

86406-Immunology X

86430-Immunology X

86431-Immunology X

86480-Immunology X

86481-Immunology X

86485-Immunology X

86486-Immunology X

86490-Immunology X

86510-Immunology X

86580-Immunology X

86590-Immunology X

86592-Syphilis Testing NCD 210.10 Screening for STIs

86593-Syphilis Testing NCD 210.10 Screening for STIs

86602-Infectious Testing X













86631-Antibody; Chlamydia NCD 210.10 Screening for STIs

86632-Antibody; Chlamydia NCD 210.10 Screening for STIs











CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments
















86689-Testing for Antibodies to Infectious Agents


Policy Manual and Change Report; NCD 190.14 HIV Testing, Diagnostic






86701-Testing for HIV Antibodies


Report; NCD 190.14 HIV Testing, Diagnostic



Policy Manual and Change Report; NCD 190.14 HIV Testing, Diagnostic



National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.14 HIV Testing, Diagnostic

86704-Hepatitis B

NCD 210.6 Screening for

Hepatitis B Virus Infection



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

86705-Hepatitis B

NCD 210.6 Screening for Hepatitis B Virus Infection

86706-Hepatitis B

NCD 210.6 Screening for Hepatitis B Virus Infection





























86780-Antibody; Treponema pallidum

NCD 210.10 Screening for STIs













CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

86805-Histocompatibility Testing

NCD 190.1 Histocompatibility Testing












NCD 190.1 Histocompatibility

Testing



Testing





Testing



86828-Histocompatibility Testing X








86849- Unlisted immunology procedure

Refer to: Molecular Pathology/Molecular Diagnostics/Genetic Testing NCD 190.7 Human Tumor Stem Cell Drug Sensitivity Assays

NCD 300.1 Obsolete or Unreliable Diagnostic Tests

86850-Transfusion Services X















CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


86910-Transfusion Services Never Covered

86911-Transfusion Services Never Covered
























87003-Identification of

Microorganisms

X

87015-Identification of Microorganisms

X


Microorganisms

X


X


X


X


X


X


X


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X


X

87086-Culture, bacterial; quantitative, colony count, urine


Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.12 Urine Culture, Bacterial

87088-Culture, bacterial; with

isolation and presumptive

identification of each isolates, urine


Laboratory Services, Medicare

National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.12 Urine Culture, Bacterial


X


X


X


X


Microorganisms

X


X


Microorganisms

X


X


X


X


X


X


Microorganisms

X


X


X


X


X


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X


X


X


X


X


X


Microorganisms

X


Microorganisms

X


X


Microorganisms

X


X


Microorganisms

X


X


X


X


X


X


X


X


X


X


Microorganisms

X


Microorganisms

X


X


Microorganisms

X


X


Microorganisms

X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X

87270-Infectious agent antigen detection by immunofluorescent technique


87271-Fluorescence Microscopy by Organism

X


X


X


X


X


X

87278-Microbiology X











87320-Infectious agent antigen detection by enzyme immunoassay technique












87340-Infectious agent antigen

detection by immunoassay technique

NCD 210.6 Screening for

Hepatitis B Virus (HBV) Infection

87341-Infectious agent antigen detection by immunoassay technique

NCD 210.6 Screening for Hepatitis B Virus (HBV) Infection





CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments




X



X


X

87420-Infectious agent antigen detection by immunoassay

technique

X


technique

X


X


X


X


technique

X



X

87471-Infectious agent detection by nucleic acid


87472-Infectious agent detection

by nucleic acid






by nucleic acid




X


by nucleic acid

















CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments





Refer to: Molecular Diagnostic Infectious Disease Testing NCD 210.10 Screening for STIs

87492-Detection Infectious

Agent



87493-Detection Infectious Agent


87495-Detection Infectious

Agent




by nucleic acid (DNA or RNA)



87497-Infectious agent detection by nucleic acid (DNA or RNA)























by nucleic acid






by nucleic acid




by nucleic acid

















CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments











87534-Detection Infectious Agent by Probe Techniques


Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.14 HIV Testing, Diagnostic

Or refer to: Molecular Diagnostic Infectious Disease Testing



Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.14 HIV Testing, Diagnostic Or refer to: Molecular Diagnostic Infectious Disease Testing

87536-Detection Infectious Agent, HIV-1

See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.13 HIV Testing, Monitoring




Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.14 HIV Testing, Diagnostic



See CMS: Clinical Diagnostic Laboratory Services, Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.14 HIV

Testing, Diagnostic Or refer to: Molecular Diagnostic Infectious Disease Testing



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

87539-Detection Infectious Agent, HIV-2


National Coverage Determinations (NCD) Coding Policy Manual and Change Report; NCD 190.13 HIV Testing, Monitoring Or refer to: Molecular Diagnostic Infectious Disease Testing
































87582- Infectious agent detection



Refer to: Molecular Diagnostic Infectious Disease Testing and NCD 210.10 Screening for STIs


















CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments














by nucleic acid




by nucleic acid






by nucleic acid






by nucleic acid











87802-Infectious agent detection X










detection by immunoassay

X

87880-Detection Infectious Agent by Immunoassay

X


X

87900-Drug Sensitivity Genotype/Phenotype

X

87901-Infectious agent genotype analysis






CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments





87905-Infectious agent enzymatic activity

X







87999-Unlisted microbiology

procedure



88000-Autopsy Services Never Covered
















88104-Cytopathology X




88120-Cytopathology


88121-Cytopathology

Refer to: Molecular



88130-Chromatin identification X

88140-Chromatin identification X

88141-Cytopathology

Special Considerations

88142-Cytopathology

Special

Considerations

88143-Cytopathology




CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments

88147-Cytopathology


88148-Cytopathology


88150-Cytopathology


88152-Cytopathology


88153-Cytopathology


88155-Cytopathology





88164-Cytopathology


88165-Cytopathology

Special

Considerations

88166-Cytopathology


88167-Cytopathology

Special

Considerations



88174-Cytopathology

Special

Considerations

88175-Cytopathology



88182-Flow cytometry X






88199-Unlisted cytopathology procedure


88230-Tissue culture NCD 190.3 Cytogenetic Studies





88240-Cryopreservation NCD 190.3 Cytogenetic Studies

88241-Cryopreservation NCD 190.3 Cytogenetic Studies

88245-Chromosome analysis NCD 190.3 Cytogenetic Studies





CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments







88271-Molecular cytogenetics NCD 190.3 Cytogenetic Studies









88291-Cytogenetics & molecular cytogenetics

NCD 190.3 Cytogenetic Studies

88299-Unlisted cytogenetic

study

NCD 190.3 Cytogenetic Studies

88300-Surgical Pathology No Restrictions






88311-Surgical Pathology X





















CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments











88364-In situ hybridization X



88366-In situ hybridization X




















88720-Other Pathology

Procedures

X


Procedures

X

88740-Other Pathology Procedures

X


Procedures

X


X


X


X



CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments


X


X


X


X


X


X


Procedures

X

89230-Sweat collection by

iontophoresis

NCD 190.5 Sweat Test


Refer to: Molecular Pathology/Molecular Diagnostics/Genetic Testing NCD 190.7 Human Tumor Stem

Cell Drug Sensitivity Assays

89250-Reproductive Medicine X





























CPT Code

Medicare Covered

Preventive/

Screening

Lab NCD/MPG


Not Covered When

Submitted

with

Screening Diagnosis

Comments











Refer to: Molecular


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clinical diagnostic laboratory services: cpt codes · 2020-02-28 · clinical diagnostic laboratory...

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