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Medical Necessity Checker (NY)

Medical Necessity Checker (MA)

Medicare Medical Review Policies

Code Listings for ICD-10CM

Medicare

Reasons for Denial for All Lab NCDs

Non-covered ICD-10-CM Codes for All Lab NCDs

Coding Guidelines for All Lab NCDs

 

190.12 - Urine Culture, Bacterial

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

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

190.15 Blood Counts

190.16 - Partial Thromboplastin Time (PTT)

190.17 - Prothrombin Time (PT)

190.18 - Serum Iron Studies

190.19 - Collagen Crosslinks, Any Method

190.20 - Blood Glucose Testing

190.21 - Glycated Hemoglobin/Glycated Protein

190.22 - Thyroid Testing

190.23 - Lipids Testing

190.24 - Digoxin Therapeutic Drug Assay

190.25 - Alpha-fetoprotein

190.26 - Carcinoembryonic Antigen

190.27 - Human Chorionic Gonadotropin

190.28 - Tumor Antigen by Immunoassay CA 125

190.29 - Tumor Antigen by Immunoassay CA 15-3/CA 27.29

190.30 - Tumor Antigen by Immunoassay CA 19-9

190.31 - Prostate Specific Antigen

190.32 - Gamma Glutamyl Transferase

190.33 - Hepatitis Panel/Acute Hepatitis Panel

190.34 - Fecal Occult Blood Test

B-type Natriuretic Peptide (BNP) Testing 

Heavy Metal Testing 

Molecular Pathology Procedures 

Multimarker Serum Tests Related to Ovarian Cancer Testing 

Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) 

RAST Type Tests 

Respiratory Pathogen Panel Testing 

Thyroid Nodule Molecular Testing 

Urine Drug Testing 

Vitamin D Assay Testing 

 

 

Aetna®

Celiac Disease Laboratory Testing

Diagnosis of Vaginitis

Fibrotest (Hepatic Fibrosis)

Genetic Testing

Homocysteine Testing

Polymerase Chain Reaction Testing

Tumor Markers

Vitamin D testing

View the complete list of Aetna Clinical Policy Bulletins here

Cigna®

VITAMIN D TESTING EFFECTIVE 03/15/2024

NUCLEIC ACID PATHOGEN TESTING EFFECTIVE 05/15/2024

EmblemHealth®

View the complete list of EmblemHealth reimbursement policies here

View EmblemHealth Preventive Care/Screening policy for commercial members here

HealthFirst®

General Principles Laboratory Test Coverage

Allergen Testing

Cardiovascular Disease Risk Assessment

Diabetes Mellitus Testing

Diagnostic Testing of Common Sexually Transmitted Infections

Folate Testing

Hepatitis Testing

Pediatric Preventive Screening

Prenatal Screening (Nongenetic)

Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Thyroid Disease Testing

Urine Culture Testing for Bacteria

Vitamin B12 and Methylmalonic Acid Testing

Vitamin D Testing

View the complete list of HealthFirst policies here

UnitedHealthcare®

HEPATITIS SCREENING EFFECTIVE 10/01/2020
HEPATITIS SCREENING APPLICABLE ICD 10 DIAGNOSIS CODES LIST

United Healthcare® Community Plan

CLINICAL DIAGNOSTIC LABS POLICY

• Acute Hepatitis Panel Approved ICD-10 Codes
• Alpha Fetoprotein (AFP) Approved ICD-10 Codes
• CA-125 Approved ICD-10 Codes
• CA 15-3/CA27.29 Approved ICD-10 Codes
• CA 19-9 Approved ICD-10 Codes
• Carcinoembryonic Antigen (CEA) Approved ICD-10 Codes
• Digoxin Approved ICD-10 Codes
• Gamma Glutamyl Transferase (GGT) Approved ICD-10 Codes
• Hemoglobin A1C Approved ICD-10 Codes
• Human Chorionic Gonadotropin (hCG) Approved ICD-10 Codes
• Iron Serum Approved ICD-10 Codes
• Lipid Panel Approved ICD-10 Codes
• PSA Approved ICD-10 Codes
• Prothrombin Time (PT) Approved ICD-10 Codes
• Partial Thromboplastin Time (PTT) Approved ICD-10 Codes
• Thyroid Approved ICD-10 Codes
• Urine Culture Approved ICD-10 Codes

 

 

RADIOALLERGOSORBENT (RAST) 

ICD-10 Diagnosis Code Listing

VITAMIN D TESTING POLICY

ICD-10 Vitamin D Testing List

HEPATITIS SCREENING POLICY EFFECTIVE 10/01/2020

HEPATITIS SCREENING APPLICABLE ICD 10 CODE LIST EFFECTIVE 10/01/2020

VIRAL HEPATITIS SEROLOGY TESTING POLICY

Viral Hepatitis Serology Testing ICD-10 List

Viral Hepatitis Serology Testing CPT Codes List