Most Medicare Advantage Plans follow these coverage policies. Please consult the specific Medicare Advantage carrier for confirmation.
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2024
Medical Policy CPT Link 4KScore Test 81539 Article - Billing and Coding: 4Kscore Test Algorithm (A56653) (cms.gov) Acute Hep Panel/Hepatitis Panel 80074 NCD - Hepatitis Panel/Acute Hepatitis Panel (190.33) (cms.gov) Allergy testing 82785, 86001, 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076, 95079, 86003, 82785 Article - Billing and Coding: Allergy Testing (A56558) (cms.gov) Alpha-Fetoprotein 82105 NCD - Alpha-fetoprotein (190.25) (cms.gov) 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 Article - Billing and Coding: Assays for Vitamins and Metabolic Function (A56416) (cms.gov) 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 Article - Billing and Coding: Biomarkers for Oncology (A52986) (cms.gov) 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 , Article - Billing and Coding: Biomarkers Overview (A56541) (cms.gov) Blood Count 85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032 NCD - Blood Counts (190.15) (cms.gov) Blood Glucose Test 82947, 82948, 82962 NCD - Blood Glucose Testing (190.20) (cms.gov) BRCA1 & BRCA2 Genetic Testing 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433 Article - Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542) (cms.gov) Carcinoembryonic Antigen 82378 NCD - Carcinoembryonic Antigen (190.26) (cms.gov) Collagen Cross Links 82523 NCD - Collagen Crosslinks, any Method (190.19) (cms.gov) Comprehensive Stool Guideline aka Gastrointestinal Pathogen Panel 87505, 87506, 87507, 0097U Article - Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642) (cms.gov) Controlled Substance/Monitoring and Drug Abuse 80305, 80306, 80307, 80159, 80171, 80173, 80183, 80184, 83789, 83992, 84999, G0480, G0481, G0482, G0483, G0659 Article - Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645) (cms.gov) C-Reactive Protein High Sensitivity Testing (HSCRP) 86141 Article - Billing and Coding: C-Reactive Protein High Sensitivity Testing (hsCRP) (A56643) (cms.gov) 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 NCD - Cytogenetic Studies (190.3) (cms.gov) Digoxin (Therapeutic Drug Assay) 80162 NCD - Digoxin Therapeutic Drug Assay (190.24) (cms.gov) Fecal Occult Blood 82272 NCD - Fecal Occult Blood Test (190.34) (cms.gov) FLU/COVID Policy 87636 Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) (cms.gov) Gamma Glutamyl Transferase 82977 NCD - Gamma Glutamyl Transferase (190.32) (cms.gov) Genetic Testing for Oncology Article - Billing and Coding: Genetic Testing for Oncology (A59125) (cms.gov) Glycated Hemoglobin/protein 82985, 83036 NCD - Glycated Hemoglobin/Glycated Protein (190.21) (cms.gov) Histocompatibility Test 86812, 86813, 86816, 86817, 86821, 86825, 86826 NCD - Histocompatibility Testing (190.1) (cms.gov) Human Chorionic Gonadotrpin (Beta HCG) 84702 NCD - Human Chorionic Gonadotropin (190.27) (cms.gov) Human Immunodeficiency Virus HIV Testing (diagnosis) 86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538 NCD - Human Immunodeficiency Virus (HIV) Testing (Diagnosis) (190.14) (cms.gov) Human Immunodeficiency Virus HIV Testing (monitoring ) 87536, 87539 NCD - Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) (190.13) (cms.gov) Lipids Testing 80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478 NCD - Lipid Testing (190.23) (cms.gov) Lymphocyte Mitogen Response Assays 86352, 86353 NCD - Lymphocyte Mitogen Response Assays (190.8) (cms.gov) Molecular Pathology and Genetic Testing Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917) (cms.gov) Partial Thromboplastin Time (PTT) 85730 NCD - Partial ThromboplastinTime (PTT) (190.16) (cms.gov) Pharmacogenomics Testing 81220, 81225, 81418, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 81226, 0392U, 81227, 81231, 81323, 81247, 81283, 0286U, 81306, 81335, 81328, 81350, 81374, 81381, 81377, 81383, 81401, 81406, 81479, 0193U, 0029U, 0031U, 0032U, 0033U, 0117U, 0173U, 0175U, 81230, 81346, 81355, 81407, 81408 Article - Billing and Coding: Pharmacogenomics Testing (A58801) (cms.gov) Prostate Specific Antigen (PSA) 84153 NCD - Prostate Specific Antigen (190.31) (cms.gov) Prothrombin-Time-(PT) 85610 NCD - Prothrombin Time (PT) (190.17) (cms.gov) Respiratory Pathogen Panel Testing 0240U, 0241U, 87428, 87631, 87636, 87637 & 0115U, 0202U, 0223U, 0225U, 87632, 87633 Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) (cms.gov) Serum Iron Study 82728, 83540, 83550, 84466 NCD - Serum Iron Studies (190.18) (cms.gov) Sweat Test 82438, 89230 NCD - Sweat Test (190.5) (cms.gov) Thyroid Testing 84436, 84439, 84443, 84479 NCD - Thyroid Testing (190.22) (cms.gov) Tumor Antigen CA 15-3, CA 27.29 86300 NCD - Tumor Antigen by Immunoassay - CA 15-3/CA 27.29 (190.29) (cms.gov) Tumor Antigen CA125 86304 NCD - Tumor Antigen by Immunoassay - CA 125 (190.28) (cms.gov) Tumor Antigen CA19-9 86301 NCD - Tumor Antigen by Immunoassay - CA 19-9 (190.30) (cms.gov) Urine Culture, Bacterial 87086, 87088 NCD - Urine Culture, Bacterial (190.12) (cms.gov) -
2023
Medical Policy CPT Link 4KScore Test 81539 Article - Billing and Coding: 4Kscore Test Algorithm (A56653) (cms.gov) Acute Hep Panel/Hepatitis Panel 80074 NCD - Hepatitis Panel/Acute Hepatitis Panel (190.33) (cms.gov) Allergy testing 82785, 86001, 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076, 95079, 86003, 82785 Article - Billing and Coding: Allergy Testing (A56558) (cms.gov) Alpha-Fetoprotein 82105 NCD - Alpha-fetoprotein (190.25) (cms.gov) 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 Article - Billing and Coding: Assays for Vitamins and Metabolic Function (A56416) (cms.gov) 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 Article → 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 , Article - Billing and Coding: Biomarkers Overview (A56541) (cms.gov) Blood Count 85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032 NCD - Blood Counts (190.15) (cms.gov) Blood Glucose Test 82947, 82948, 82962 NCD - Blood Glucose Testing (190.20) (cms.gov) BRCA1 & BRCA2 Genetic Testing 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433 Article - Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542) (cms.gov) Carcinoembryonic Antigen 82378 NCD - Carcinoembryonic Antigen (190.26) (cms.gov) Collagen Cross Links 82523 NCD - Collagen Crosslinks, any Method (190.19) (cms.gov) Colorectal Cancer Screening 81528, 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0327, G0328 NCD - Colorectal Cancer Screening Tests (210.3) (cms.gov) Comprehensive Stool Guideline aka Gastrointestinal Pathogen Panel 87505, 87506, 87507, 0097U Article - Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642) (cms.gov) Controlled Substance/Monitoring and Drug Abuse 80305, 80306, 80307, 80159, 80171, 80173, 80183, 80184, 83789, 83992, 84999, G0480, G0481, G0482, G0483, G0659 Article - Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645) (cms.gov) C-Reactive Protein High Sensitivity Testing (HSCRP) 86141 Article - Billing and Coding: C-Reactive Protein High Sensitivity Testing (hsCRP) (A56643) (cms.gov) 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 NCD - Cytogenetic Studies (190.3) (cms.gov) Digoxin (Therapeutic Drug Assay) 80162 NCD - Digoxin Therapeutic Drug Assay (190.24) (cms.gov) Fecal Occult Blood 82272 NCD - Fecal Occult Blood Test (190.34) (cms.gov) Flow Cytometry 88182, 88184, 88185, 88187, 88188, 88189 Article - Billing and Coding: Flow Cytometry (A56676) (cms.gov) FLU/COVID Policy 87636 Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) (cms.gov) Gamma Glutamyl Transferase 82977 NCD - Gamma Glutamyl Transferase (190.32) (cms.gov) Glycated Hemoglobin/protein 82985, 83036 NCD - Glycated Hemoglobin/Glycated Protein (190.21) (cms.gov) Histocompatibility Test 86812, 86813, 86816, 86817, 86821, 86825, 86826 NCD - Histocompatibility Testing (190.1) (cms.gov) Human Chorionic Gonadotrpin (Beta HCG) 84702 NCD - Human Chorionic Gonadotropin (190.27) (cms.gov) Human Immunodeficiency Virus HIV Testing (diagnosis) 86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538 NCD - Human Immunodeficiency Virus (HIV) Testing (Diagnosis) (190.14) (cms.gov) Human Immunodeficiency Virus HIV Testing (monitoring ) 87536, 87539 NCD - Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) (190.13) (cms.gov) Lipids Testing 80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478 NCD - Lipid Testing (190.23) (cms.gov) Lymphocyte Mitogen Response Assays 86352, 86353 NCD - Lymphocyte Mitogen Response Assays (190.8) (cms.gov) Molecular Pathology and Genetic Testing Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917) (cms.gov) Partial Thromboplastin Time (PTT) 85730 NCD - Partial ThromboplastinTime (PTT) (190.16) (cms.gov) Prothrombin-Time-(PT) 85610 NCD - Prothrombin Time (PT) (190.17) (cms.gov) Prostate Specific Antigen (PSA) 84153 NCD - Prostate Specific Antigen (190.31) (cms.gov) Respiratory Pathogen Panel Testing 0240U, 0241U, 87428, 87631, 87636, 87637 & 0115U, 0202U, 0223U, 0225U, 87632, 87633 Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) (cms.gov) Serum Iron Study 82728, 83540, 83550, 84466 NCD - Serum Iron Studies (190.18) (cms.gov) Sweat Test 82438, 89230 NCD - Sweat Test (190.5) (cms.gov) Thyroid Testing 84436, 84439, 84443, 84479 NCD - Thyroid Testing (190.22) (cms.gov) Tumor Antigen CA125 86304 NCD - Tumor Antigen by Immunoassay - CA 125 (190.28) (cms.gov) Tumor Antigen CA 15-3, CA 27.29 86300 NCD - Tumor Antigen by Immunoassay - CA 15-3/CA 27.29 (190.29) (cms.gov) Tumor Antigen CA19-9 86301 NCD - Tumor Antigen by Immunoassay - CA 19-9 (190.30) (cms.gov) Urine Culture, Bacterial 87086, 87088 NCD - Urine Culture, Bacterial (190.12) (cms.gov)