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 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 Panel87505, 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, 87633Serum 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 27.2986300 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 Panel87505, 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, 87633Serum 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 27.2986300 Tumor Antigen CA19-9 86301 Urine Culture, Bacterial 87086, 87088 -
2021
- Acute Hepatitis Panel 2021
- Allergy Testing 2021
- Alpha-fetoprotein (AFP) 2021
- Assays of Vitamins and Metabolic Function 2021
- Biomarkers for Oncology 2021
- Biomarkers Overview 2021
- Blood Counts 2021
- Blood Glucose Testing 2021
- Carcinoembryonic Antigen (CEA) 2021
- Collagen Crosslinks Any Method 2021
- Comprehensive Stool 2021
- Controlled Substance Monitoring and Drugs of Abuse Testing 2021
- C-Reactive Protein High Sensitivity Testing (hsCRP) 2021
- Cytogenetic Studies 2021
- Digoxin Therapeutic Drug Assay 2021
- Fecal Occult Blood Test 2021
- Flow Cytometry 2021
- Gamma Glutamyl Transferase 2021
- Gastrointestinal Pathogen Panel 2021
- Glycated Hemoglobin Glycated Protein (Ha1CG) 2021
- Histocompatibility Testing 2021
- HPV guideline 1
- HPV guideline 2
- Human Chorionic Gonadotropin (Beta hcg) 2021
- Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 2021
- Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) 2021
- Lipid Panel 2021
- Molecular Diagnostics Genitourinary Infectious Disease Testing 2021
- PAP guidelines
- Partial Thromboplastin Time (PTT) 2021
- Prostate Specific Antigen (PSA) 2021
- Prothrombin Time (PT) 2021
- Serum Iron Studies 2021
- Sweat Test 2021
- Thyroid Testing 2021
- Tumor Antigen by Immunoassay CA 125 2021
- Tumor Antigen by Immunoassay CA 15-3 CA27.29 2021
- Tumor Antigen by Immunoassay CA 19-9 2021
- Urine Culture, Bacterial 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 Panel87505, 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, Z86.16U0001, 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, 87633Serum 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 27.2986300 Tumor Antigen CA19-9 86301 Urine Culture, Bacterial 87086, 87088