HNL News

January 30, 2023

What You Need to Know About Vitamin D

Don’t you just loathe these dark winter days? Winter can be tough here in Pennsylvania, from slushy snow to frigid days, with darkness in between. Unfortunately, we have another reason to have the winter blues- Vitamin D deficiency.

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January 20, 2023

The Impact of Genomics on the Future of Lab Medicine

Genomics, the study and mapping of genomes or complete sets of DNA, offers unique and emerging medical applications that are now accessible to providers.
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January 16, 2023

Understanding Bloodborne Pathogens

Bloodborne pathogens are diseases that can be spread through blood or blood products.

Exposure to blood and other body fluids can be more common than you think, especially in occupations like waste and maintenance, emergency response, health care, and body artists.

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January 11, 2023

New HNL Lab Medicine Fleet Brings the Lab to You

HNL @Home is a service provided by HNL Lab Medicine that brings phlebotomy right to your doorstep.

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January 05, 2023

Local Blood Shortage - Donate Blood Today

Blood transfusions save more than 4 million Americans each year. To honor National Blood Donor Month and address the regional blood shortage, HNL Lab Medicine and Miller-Keystone Blood Center are partnering in January for an annual blood drive. 
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Healthcare Professionals

Medicare Test Frequency Limitations

Medicare Test Frequency Limitations

Test Name HNL Test Code CPT Frequency Limitations Descriptions Needs Lmn Or Supporting Dx? Medicare Policy Where to find policy
LIPID PANEL LIPAN 80061 Z13.6
Will cover once every 5 years
SUPPORTING DX Medicare Preventative Schedule Cardiovascular Disease Screening Tests
LIPID PANEL LIPAN 80061 Inability to stabilize lipid-lowering drug dosing (Z79.899)
Adverse reaction to lipid-lowering drug (Z79.899)
Pancreatitis (B25.2, K85.00, K85.01, K85.02, K85.10, K85.11, K85.12, K85.20, K85.21, K85.22, K85.30, K85.31, K85.32, K85.80, K85.81, K85.82, K85.90, K85.91, K85.92, K86.0, K86.1)
Monitoring of acitretin (i.e., Soriatane) therapy (Z79.899)

will cover no more than every two months
SUPPORTING DX L35099 Lipids Testing
VITAMIN C - ASSAY OF ASCORBIC ACID VITC 82180 Up to 1 times per year without diagnosis limitations applied at this time  LMN NEEDED L34914 Assays of Vitamins and Metabolic Function
OCCULT BLOOD -
screening
OCBSC 82270 Once every 12 months for patients age 50 & over LMN NEEDED A52378 Colorectal Cancer Screening
OCCULT BLOOD -
diagnostic
OCCLT 82272 In patients who are taking non-steroidal anti-inflammatory drugs and have a history of gastrointestinal bleeding but no other signs, symptoms, or complaints associated with gastrointestinal blood loss, testing for occult blood may generally be appropriate no more than once every three months. BOTH 190.34 Fecal Occult Blood Test
VITAMIN D; 25
HYDROXY
VTD 82306 Up to 3 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
CARCINOEMBRYONIC ANTIGEN (CEA) CEA 82378 Serum CEA determinations are generally not indicated more frequently than once per chemotherapy treatment cycle for patients with metastatic solid tumors which express CEA or every two months post-surgical treatment for patients who have had colorectal carcinoma. However, it may be proper to order the test more frequently in certain situations, for example, when there has been a significant change from prior CEA level or a significant change in patient status which could reflect disease progression or recurrence. Testing with a diagnosis of an in situ carcinoma is not reasonably done more frequently than once, unless the result is abnormal, in which case the test may be repeated once. BOTH 190.26 Carcinoembryonic Antigen
ASSAY OF CARNITINE CARN &
UCAR
82379 Up to 3 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
CHOLESTEROL CHOL 82465 Z13.6
Will cover once every 5 years
SUPPORTING DX Medicare Preventative Schedule Cardiovascular Disease Screening Tests
CHOLESTEROL CHOL 82465 Inability to stabilize lipid-lowering drug dosing (Z79.899)
Adverse reaction to lipid-lowering drug (Z79.899)
Pancreatitis (B25.2, K85.00, K85.01, K85.02, K85.10, K85.11, K85.12, K85.20, K85.21, K85.22, K85.30, K85.31, K85.32, K85.80, K85.81, K85.82, K85.90, K85.91, K85.92, K86.0, K86.1)
Monitoring of acitretin (i.e., Soriatane) therapy (Z79.899)

will cover no more than every two months
SUPPORTING DX L35099 Lipids Testing
COLLAGEN NTx X-LINK CNTXL 82523 Because of significant specimen to specimen collagen crosslink physiologic variability (15-20%), current recommendations for appropriate utilization include: one or two base-line assays from specified urine collections on separate days; followed by a repeat assay about 3 months after starting anti-resorptive therapy; followed by a repeat assay in 12 months after the 3-month assay; and thereafter not more than annually, unless there is a change in therapy in which circumstance an additional test may be indicated 3 months after the initiation of new therapy. BOTH 190.19 Collagen Crosslinks, Any Method
VITAMIN B12 VB12, ANCP2, VB12STAT 82607 Up to 2 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
VITAMIN D; 1, 25
DIHYDROXY
VD1 82652 Up to 2 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
ASSAY OF FOLIC ACID SERUM FOLATE, ANCP2 82746 Up to 3 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
REAGENT STRIP/BLOOD GLUCOSE HNL DOES NOT PERFORM 82948 Once per month unless with supporting dx  SUPPORTING DX L35099 Lipids Testing
GLUCOSE BLOOD TEST HNL DOES NOT PERFORM 82962 Once per month unless with supporting dx  SUPPORTING DX L35099 Lipids Testing
GAMMA GT GGT 82977 When used to assess liver dysfunction secondary to existing non-hepatobiliary disease with no change in signs, symptoms, or treatment, it is generally not necessary to repeat a GGT determination after a normal result has been obtained unless new indications are present. If the GGT is the only “liver” enzyme abnormally high, it is generally not necessary to pursue further evaluation for liver disease for this specific indication. When used to determine if other abnormal enzyme tests reflect liver abnormality rather than other tissue, it generally is not necessary to repeat a GGT more than one time per week. BOTH 190.32 Gamma Glutamyl Transferase
FRUCTOSAMINE FRUC 82985 Once per month  LMN L35099 Lipids Testing
HEMOGLOBIN A1c HA1CG 83036 Once per month  LMN L35099 Lipids Testing
ASSAY OF HOMOCYSTEINE HCYS, CVCP3, HCCP1 83090 Up to 1 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
ASSAY LIPOPROTEIN PLA2 MCHG83698 83698 Up to 1 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
HDL CHOLESTEROL,DIR HDLD 83718 Z13.6
Will cover once every 5 years
SUPPORTING DX Medicare Preventative Schedule Cardiovascular Disease Screening Tests
      Inability to stabilize lipid-lowering drug dosing (Z79.899)
Adverse reaction to lipid-lowering drug (Z79.899)
Pancreatitis (B25.2, K85.00, K85.01, K85.02, K85.10, K85.11, K85.12, K85.20, K85.21, K85.22, K85.30, K85.31, K85.32, K85.80, K85.81, K85.82, K85.90, K85.91, K85.92, K86.0, K86.1)
Monitoring of acitretin (i.e., Soriatane) therapy (Z79.899)

will cover no more than every two months
SUPPORTING DX L35099 Lipids Testing
LDL CHOLESTEROL,
DIRECT
LDL 83721 No more than every 2 months unless with supporting dx  SUPPORTING DX L35099 Lipids Testing
PSA,TOTAL,
PROSTATE SPECIFIC
ANTIGEN - diagnostic
PSA 84153 Generally, for patients with lower urinary tract signs or symptoms, the test is performed only once per year unless there is a change in the patient’s medical condition. Testing with a diagnosis of in situ carcinoma is not reasonably done more frequently than once, unless the result is abnormal, in which case the test may be repeated once. BOTH 210.1 Prostate Cancer Screening Tests
ASSAY OF VITAMIN B6 VTB6 84207 Up to 1 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
ASSAY OF VITAMIN B2 VITB2 84252 Up to 1 times per year without diagnosis limitations applied at this time  LMN L34914 Assays of Vitamins and Metabolic Function
ASSAY OF VITAMIN B1 VB1, WBVB1 84425 Up to 1 times per year without diagnosis limitations applied at this time  LMN L34914 Assays of Vitamins and Metabolic Function
T4, THYROXINE;
TOTAL
TH7 84436 Up to 4 times per year for most patients,  unless with supporting dx  SUPPORTING DX L35099 Lipids Testing
T4 FREE,
THYROXINE; FREE
FT4 84439 Up to 4 times per year for most patients,  unless with supporting dx  SUPPORTING DX L35099 Lipids Testing
THYROID
STIMULATING
HORMONE (TSH)
TSH 84443 Up to 4 times per year for most patients,  unless with supporting dx  SUPPORTING DX L35099 Lipids Testing
ASSAY OF VITAMIN E VAECP, VITAE 84446 Up to 1 times per year without diagnosis limitations applied at this time LMN L34914 Assays of Vitamins and Metabolic Function
TRIGLYCERIDE TRIG 84478 Z13.6
Will cover once every 5 years
SUPPORTING DX Medicare Preventative Schedule Cardiovascular Disease Screening Tests
      Inability to stabilize lipid-lowering drug dosing (Z79.899)
Adverse reaction to lipid-lowering drug (Z79.899)
Pancreatitis (B25.2, K85.00, K85.01, K85.02, K85.10, K85.11, K85.12, K85.20, K85.21, K85.22, K85.30, K85.31, K85.32, K85.80, K85.81, K85.82, K85.90, K85.91, K85.92, K86.0, K86.1)
Monitoring of acitretin (i.e., Soriatane) therapy (Z79.899)

will cover no more than every two months
SUPPORTING DX L35099 Lipids Testing
T3, Uptake T3U 84479 Up to 4 times per year for most patients,  unless with supporting dx  SUPPORTING DX L35099 Lipids Testing
ASSAY OF VITAMIN A VAECP, VITAB 84590 Up to 1 times per year without diagnosis limitations applied at this time  LMN L34914 Assays of Vitamins and Metabolic Function
ASSAY OF VITAMIN K VITK 84597 Up to 1 times per year without diagnosis limitations applied at this time  LMN L34914 Assays of Vitamins and Metabolic Function
BETA HCG, SERUM BHCGH 84702 It is not reasonable and necessary to perform hCG testing more than once per month for diagnostic purposes. It may be performed as needed for monitoring of patient progress and treatment. Qualitative hCG assays are not appropriate for medically managing patients with known or suspected germ cell neoplasms. BOTH 190.27 Human Chorionic Gonadotropin
FIBRONOGEN ANTIGEN   85385 Up to 3 times per year with supporting dx  BOTH L34914 Assays of Vitamins and Metabolic Function
ALLERGEN IGE Various Codes 86003 CPT code 86003 will be covered for only thirty (30) units in a year. BOTH L36241 Allergy Testing
C-REACTIVE PROTEIN
HIGH SENSITIVITY TESTING
HSCRP 86141 It is considered reasonable and necessary to perform no more than 3 hsCRP services per patient lifetime. BOTH L34856 C-Reactive Protein High Sensitivity Testing (hsCRP)
HUMAN
PAPILLOMAVIRUS
HPV 87624 HPV testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test. (Use ICD-10 code Z12.4 and Z11.51). BOTH   Screening Pap Tests & Pelvic Exams
GLUCOSE TESTS FOR
DIABETIC SCREENING
  82947
82950
82951
1 screening every 6 months for patients diagnosed with pre-diabetes

1 screening every 12 months if previously tested but not diagnosed with pre-diabetes or if never tested

(Use ICD-10 code Z13.1).
BOTH   Diabetes Screening
PSA, TOTAL,
PROSTATE SPECIFIC
ANTIGEN - screening
PSAST G0103 Annually. All male Medicare beneficiaries aged 50 and older (coverage begins the day after 50th birthday, Z12.5) BOTH NCD 210.1 National Coverage Determination (NCD) for Prostate Cancer Screening Tests 
PAP SCREEN N/A G0123
G0145
P3000
Annually if at high risk for developing cerv or vag CA, or childbearing age with abnormal PAP within past 3 yrs, every 24 months for all other women. (Use ICD-10 codes: High risk – Z77.22, Z77.9, Z91.89, Z72.89, Z72.51, Z72.52, AND Z72.53 / Low risk – Z01.411, Z01.419, Z12.4, Z12.72, Z12.79, and Z12.89). BOTH NCD 210.2 National Coverage Determination (NCD) for Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 
HPV SCREEN N/A G0476 Once every 5 years BOTH NCD 210.2.1 Screening for Cervical Cancer with Human Papillomavirus
(HPV) Tests