Healthcare Professionals

Medicare Coverage Policies

The policies listed here are the Medicare Local Coverage Determinations (LCDs) and the National Coverage Determinations (NCDs) and are intended to be a quick reference, not a substitute for the complete LCDs, NCDs or the ICD-10 manual.

The complete policies may be accessed through Centers for Medicare and Medicaid Services.

See Which Policy Should I Choose based on CPT code?

Please refer to the ICD-10 manual for a complete listing of ICD-10 codes. The ultimate responsibility for correct coding lies with the ordering physician. All ICD-10 codes must be medically appropriate for the patient's condition and consistent with the information found in the patient's medical record for the date of service.

Most Medicare Advantage Plans follow these coverage policies. Please consult the specific Medicare Advantage carrier for confirmation.

2023

Medical Policy	CPT
4KScore Test	81539
Acute Hep Panel/Hepatitis Panel	80074
Allergy testing	82785, 86001, 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076, 95079, 86003, 82785
Alpha-Fetoprotein	82105
Assays of Vitamins/Metabolic Function	82180, 82306, 82379, 82607, 82652, 82746, 83090, 83698, 84207, 84252, 84255, 84425, 84446, 84590, 85497, 85385, 86352, 84255, 84591, 84999
Biomarkers for Oncology	0002U, 0003U, 0005U, 0009U, 0013U, 0014U, 0016U, 0017U, 0022U, 0026U, 81120, 81121, 81170, 81175, 81176, 81206, 81207, 81208, 81210, 81218, 81219, 81235, 81245, 81246, 81261, 81262, 81263, 81270, 81272, 81273, 81275, 81276, 81287, 81292, 81293, 81294, 81301, 81310, 81311, 81313, 81314, 81315, 81316, 81321, 81322, 81323, 81327, 81334, 81340, 81342, 81350, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81435, 81436, 81437, 81438, 81445, 81450, 81479, 81503, 81520, 81525, 81538, 81540, 81545
Biomarkers Overview	0001U , 81201 , 81202 , 81203 , 81240 , 81241 , 81242 , 81250 , 81251 , 81252 , 81253 , 81254 , 81255 , 81256 , 81257 , 81258 , 81259 , 81265 , 81266 , 81267 , 81268 , 81269 , 81288 , 81290 , 81295 , 81296 , 81297 , 81298 , 81299 , 81300 , 81317 , 81318 , 81319 , 81324 , 81325 , 81326 , 81329 , 81332 , 81336 , 81337 , 81370 , 81371 , 81372 , 81373 , 81375 , 81376 , 81378 , 81379 , 81380 , 81382 , 81490 , 81595 ,
Blood Count	85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032
Blood Glucose Test	82947, 82948, 82962
BRCA1 & BRCA2 Genetic Testing	81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433
Carcinoembryonic Antigen	82378
Collagen Cross Links	82523
Colorectal Cancer Screening	81528, 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0327, G0328
Comprehensive Stool Guideline aka Gastrointestinal Pathogen Panel	87505, 87506, 87507, 0097U
Controlled Substance/Monitoring and Drug Abuse	80305, 80306, 80307, 80159, 80171, 80173, 80183, 80184, 83789, 83992, 84999, G0480, G0481, G0482, G0483, G0659
C-Reactive Protein High Sensitivity Testing (HSCRP)	86141
Cytogenetic Studies	88230, 88233, 88235, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291
Digoxin (Therapeutic Drug Assay)	80162
Fecal Occult Blood	82272
Flow Cytometry	88182, 88184, 88185, 88187, 88188, 88189
FLU/COVID Policy	87636
Gamma Glutamyl Transferase	82977
Glycated Hemoglobin/protein	82985, 83036
Histocompatibility Test	86812, 86813, 86816, 86817, 86821, 86825, 86826
Human Chorionic Gonadotrpin (Beta HCG)	84702
Human Immunodeficiency Virus HIV Testing (diagnosis)	86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538
Human Immunodeficiency Virus HIV Testing (monitoring )	87536, 87539
Lipids Testing	80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478
Lymphocyte Mitogen Response Assays	86352, 86353
Molecular Pathology and Genetic Testing
Partial Thromboplastin Time (PTT)	85730
Prothrombin-Time-(PT)	85610
Prostate Specific Antigen (PSA)	84153
Respiratory Pathogen Panel Testing	0240U, 0241U, 87428, 87631, 87636, 87637 & 0115U, 0202U, 0223U, 0225U, 87632, 87633
Serum Iron Study	82728, 83540, 83550, 84466
Sweat Test	82438, 89230
Thyroid Testing	84436, 84439, 84443, 84479
Tumor Antigen CA125	86304
Tumor Antigen CA 15-3, CA 27.29	86300
Tumor Antigen CA19-9	86301
Urine Culture, Bacterial	87086, 87088

2022

Medical Policy	CPT
4KScore Test	81539
Acute Hep Panel/Hepatitis Panel	80074
Allergy testing	82785, 86001, 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076, 95079, 86003, 82785
Alpha-Fetoprotein	82105
Assays of Vitamins/Metabolic Function	82180, 82306, 82379, 82607, 82652, 82746, 83090, 83698, 84207, 84252, 84255, 84425, 84446, 84590, 85497, 85385, 86352, 84255, 84591, 84999
Biomarkers for Oncology	0002U, 0003U, 0005U, 0009U, 0013U, 0014U, 0016U, 0017U, 0022U, 0026U, 81120, 81121, 81170, 81175, 81176, 81206, 81207, 81208, 81210, 81218, 81219, 81235, 81245, 81246, 81261, 81262, 81263, 81270, 81272, 81273, 81275, 81276, 81287, 81292, 81293, 81294, 81301, 81310, 81311, 81313, 81314, 81315, 81316, 81321, 81322, 81323, 81327, 81334, 81340, 81342, 81350, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81435, 81436, 81437, 81438, 81445, 81450, 81479, 81503, 81520, 81525, 81538, 81540, 81545
Biomarkers for Overview	0001U, 81161, 81200, 81201, 81202, 81203, 81205, 81209, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81228, 81229, 81240, 81241, 81242, 81243, 81244, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81265, 81266, 81267, 81268, 81269, 81277, 81288, 81290, 81291, 81295, 81296, 81297, 81298, 81299, 81300, 81302, 81303, 81304, 81317, 81318, 81319, 81324, 81325, 81326, 81330, 81331, 81332, 81355, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81425, 81426, 81427, 81430, 81431, 81434, 81439, 81440, 81442, 81460, 81465, 81470, 81471, 81490, 81595
Blood Count	85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032
Blood Glucose Test	82947, 82948, 82962
BRCA1 & BRCA2 Genetic Testing	81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433
Carcinoembryonic Antigen	82378
Collagen Cross Links	82523
Colorectal Cancer Screening	81528, 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0327, G0328
Comprehensive Stool Guideline aka Gastrointestinal Pathogen Panel	87505, 87506, 87507, 0097U
Controlled Substance/Monitoring and Drug Abuse	80305, 80306, 80307, 80159, 80171, 80173, 80183, 80184, 83789, 83992, 84999, G0480, G0481, G0482, G0483, G0659
C-Reactive Protein High Sensitivity Testing (HSCRP)	86141
Cytogenetic Studies	88230, 88233, 88235, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291
Digoxin (Therapeutic Drug Assay)	80162
Fecal Occult Blood	82272
Flow Cytometry	88182, 88184, 88185, 88187, 88188, 88189
FLU/COVID Policy	87636
Gamma Glutamyl Transferase	82977
GC Chlamydia Coverage Policy	87491
Glycated Hemoglobin/protein	82985, 83036
Hepatitis B Screening	86704, 86706, 87340, 87341, G0499
Hepatitis C Virus in Adults Screening	G0472
Histocompatibility Test	86812, 86813, 86816, 86817, 86821, 86825, 86826
HPV Guideline 1& 2	G0476
Human Chorionic Gonadotrpin (Beta HCG)	84702
Human Immunodeficiency Virus HIV Testing (diagnosis)	86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538
Human Immunodeficiency Virus HIV Testing (monitoring )	87536, 87539
Lipids Testing	80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478
Lymphocyte Mitogen Response Assays	86352, 86353
PAP Screening Guidelines	G0123, G0143, G0144, G0145, G0147, G0148, G0476, P3000, G0124, G0141, P3001, Q0091, H0101
Partial Thromboplastin Time (PTT)	85730
Prostate Cancer Screening Tests	G0102, G0103
Prostate Specific Antigen (PSA)	84153
Prothrombin Time (PT)	85610
Respiratory Pathogen Panel Testing	0240U, 0241U, 87428, 87631, 87636, 87637 & 0115U, 0202U, 0223U, 0225U, 87632, 87633
Serum Iron Study	82728, 83540, 83550, 84466
Sweat Test	82438, 89230
Thyroid Stimulating	84436, 84439, 84443, 84479
Tumor Antigen CA125	86304
Tumor Antigen CA 15-3, CA 27.29	86300
Tumor Antigen CA19-9	86301
Urine Culture, Bacterial	87086, 87088

2021

Go to This Policy	CPT
Acute Hep Panel/Acute Hep Panel	80074
Allergy testing	82785, 86001, 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076, 95079, 86003, 82785
Alpha-Fetoprotein	82105
Assays of Vitamins/Metabolic Function	82180, 82306, 82379, 82607, 82652, 82746, 83090, 83698, 84207, 84252, 84255, 84425, 84446, 84590, 85497, 85385, 86352, 84255, 84591, 84999
Biomarkers for Oncology	0002U, 0003U, 0005U, 0009U, 0013U, 0014U, 0016U, 0017U, 0022U, 0026U, 81120, 81121, 81170, 81175, 81176, 81206, 81207, 81208, 81210, 81218, 81219, 81235, 81245, 81246, 81261, 81262, 81263, 81270, 81272, 81273, 81275, 81276, 81287, 81292, 81293, 81294, 81301, 81310, 81311, 81313, 81314, 81315, 81316, 81321, 81322, 81323, 81327, 81334, 81340, 81342, 81350, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81435, 81436, 81437, 81438, 81445, 81450, 81479, 81503, 81520, 81525, 81538, 81540, 81545
Biomarkers for Overview	0001U, 81161, 81200, 81201, 81202, 81203, 81205, 81209, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81228, 81229, 81240, 81241, 81242, 81243, 81244, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81265, 81266, 81267, 81268, 81269, 81277, 81288, 81290, 81291, 81295, 81296, 81297, 81298, 81299, 81300, 81302, 81303, 81304, 81317, 81318, 81319, 81324, 81325, 81326, 81330, 81331, 81332, 81355, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81425, 81426, 81427, 81430, 81431, 81434, 81439, 81440, 81442, 81460, 81465, 81470, 81471, 81490, 81595
Blood Count	85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032
Blood Glucose Test	82947, 82948, 82962
BRCA1 & BRCA2 Genetic Testing	81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433
Carcinoembryonic Antigen	82378
Collagen Cross Links	82523
Colorectal Cancer Screening	81528, 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0327, G0328
Comprehensive Stool Guideline aka Gastrointestinal Pathogen Panel	87505, 87506, 87507, 0097U
Controlled Substance/Monitoring and Drug Abuse	80305, 80306, 80307, 80159, 80171, 80173, 80183, 80184, 83789, 83992, 84999, G0480, G0481, G0482, G0483, G0659
COVID TESTING supporting dx Z03.818, Z20.828, Z11.59, Z11.52, Z20.822, Z86.16	U0001, U0002, U0003, U0004, 87635, 87426, 87636, 87637, 87811, 0225U, 0226U, 86318, 86328, 86769, G2023, G2024
C-Reactive Protein High Sensitivity Testing (HSCRP)	86141
Cytogenetic Studies	88230, 88233, 88235, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291
Digoxin (Therapeutic Drug Assay)	80162
Fecal Occult Blood	82272
Flow Cytometry	88182, 88184, 88185, 88187, 88188, 88189
Gamma Glutamyl Transferase	82977
Glycated Hemoglobin/protein	82985, 83036
Histocompatibility Test	86812, 86813, 86816, 86817, 86821, 86825, 86826
HPV Guideline 1& 2	G0476
Human Chorionic Gonadotrpin (Beta HCG)	84702
Human Immunodeficiency Virus HIV Testing (diagnosis)	86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538
Human Immunodeficiency Virus HIV Testing (monitoring )	87536, 87539
Lipids Testing	80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478
Molecular Diagnostics Genitourinary Infectious Disease Testing	87480, 87481, 87490, 87491, 87510, 87590, 87591, 87660, 87798
PAP guidelines	G0123, G0143, G0144, G0145, G0147, G0148, G0476, P3000, G0124, G0141, P3001, Q0091, H0101
Partial Thromboplastin Time (PTT)	85730
Prostate Specific Antigen (PSA)	84153
Prothrombin Time (PT)	85610
Respiratory Pathogen Panel Testing	0240U, 0241U, 87428, 87631, 87636, 87637 & 0115U, 0202U, 0223U, 0225U, 87632, 87633
Serum Iron Study	82728, 83540, 83550, 84466
Sweat Test	82438, 89230
Thyroid Stimulating	84436, 84439, 84443, 84479
Tumor Antigen CA125	86304
Tumor Antigen CA 15-3, CA 27.29	86300
Tumor Antigen CA19-9	86301
Urine Culture, Bacterial	87086, 87088

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