Insurance & Coding Resources
Participating Insurance Plans
HNL Lab Medicine collaborates with a variety of insurance providers.
Medicare Test Frequency Limitations
Learn more about Medicare's frequency limitations for covered lab services.
2026 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. Most Medicare Advantage Plans follow these coverage policies. Please consult the specific Medicare Advantage carrier for confirmation.
| Medical Policy | CPT | Link |
| 4KScore Test | 81539 | Article - Billing and Coding: 4Kscore Test Algorithm (A56653) |
| Acute Hep Panel/Hepatitis Panel | 80074 | NCD-AcuteHepatitisPanel-190-33 |
| 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) |
| Alpha-Fetoprotein | 82105 | NCD-Alpha-fetoprotein-190-25 |
| 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) |
| 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, 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) |
| 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) |
| Blood Count | 85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032 | NCD-BloodCounts-190-15 |
| Blood Glucose Test | 82947, 82948, 82962 | NCD-BloodGlucoseTesting190.20 |
| 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) |
| Carcinoembryonic Antigen | 82378 | NCD-CarcinoembryonicAntigenCEA190-26 |
| Collagen Cross Links | 82523 | NCD-CollagenCrosslinkanymethod-190-19 |
| 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) |
| 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) |
| 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-DigoxinTherapeuticDrugAssay-190-3 |
| Fecal Occult Blood | 82272 | NCD-FecalOccultBloodTest-190-34 |
| FLU/COVID Policy | 87636 | Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) |
| Gamma Glutamyl Transferase | 82977 | NCD-GammaGlutamylTransferase-190-32 |
| Genetic Testing for Oncology | 88120, 88121, 81479, 0012M, 0013M, 0229U, 0287U, 0313U, 0315U, 0363U, 0420U | Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917) |
| Glycated Hemoglobin/protein | 82985, 83036 | NCD-GlycatedHemoglobinGlycatedProtein-190-21 |
| Histocompatibility Test | 86812, 86813, 86816, 86817, 86821, 86825, 86826 | NCD - Histocompatibility Testing (190.1) (cms.gov) |
| Human Chorionic Gonadotrpin (Beta HCG) | 84702 | NCD-HumanChorionicGonadotropin-190-27 |
| Human Immunodeficiency Virus HIV Testing (diagnosis) | 86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538 | NCD-HumanImmunodeficiencyVirusHIVTestingDiagnosis-190-14 |
| Human Immunodeficiency Virus HIV Testing (monitoring ) | 87536, 87539 | NCD-HumanImmunodeficiencyVirusHIVTestingPrognosisIncludingMonitoring-190-13 |
| Lipids Testing | 80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478 | NCD-LipidTesting-190-23 |
| Lymphocyte Mitogen Response Assays | 86352, 86353 | NCD - Lymphocyte Mitogen Response Assays (190.8) (cms.gov) |
| Molecular Pathology and Genetic Testing | 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81191, 81192, 81193, 81194, 81200, 81201, 81202, 81203, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 8123, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81245, 81246, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81261 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81269, 81270, 81271, 81272, 81273, 81274, 81275, 81276, 81277, 81278, 81279, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81305, 81306, 81307, 81308, 81309, 81310, 81311, 81312, 81313, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81338, 81339, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81347, 81348, 81349, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81362, 81363, 81364, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81314, 81415, 81416, 81417, 81418, 81419, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81441, 81442, 81443, 81445 81448, 81449, 81450, 81451, 81455, 81456, 81457, 81458, 81459, 81460, 81462, 81463, 81464, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81507, 81508, 81509, 81510, 81511, 81512, 81513, 81514, 81518, 81519, 81520, 81521, 81522, 81523, 81525, 81528, 81529, 81535, 81536, 81538, 81539, 81540, 81541, 81542, 81546, 81551, 81552, 81554, 81595, 81596, 81599, G0452 ,0004M, 0006M, 0007M, 0011M, 0012M, 0013M, 0016M, 0017M, 0001U, 0005U, 0007U, 0008U, 0009U, 0010U, 0016U, 0017U, 0018U, 0019U, 0022U, 0023U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0036U, 0037U, 0040U, 0045U, 0046U, 0047U, 0048U, 0049U, 0050U, 0055U, 0060U, 0068U, 0069U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0078U, 0079U, 0084U, 0086U, 0087U, 0088U, 0089U, 0090U, 0094U, 0096U, 0101U, 0102U, 0103U, 0109U, 0111U, 0112U, 0113U, 0114U, 0118U, 0120U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0140U, 0141U, 0142U, 0152U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0170U, 0171U, 0172U, 0173U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0204U, 0205U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0219U, 0221U, 0222U, 0227U, 0229U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U, 0242U, 0244U, 0245U, 0246U, 0250U, 0252U, 0253U, 0254U, 0258U, 0260U, 0262U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U,0278U, 0282U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0296U, 0297U, 0298U, 0299U, 0300U, 0301U, 0302U, 0306U, 0307U, 0313U, 0314U, 0315U, 0317U, 0326U, 0329U, 0331U, 0332U, 0333U, 0334U, 0335U, 0336U, 0339U, 0340U, 0341U, 0343U, 0355U, 0356U, 0362U, 0363U, 0364U, 0368U, 0369U, 0370U, 0371U, 0372U, 0373U, 0374U, 0378U, 0379U, 0380U 0388U, 0389U, 0391U, 0392U, 0396U, 0398U, 0400U, 0403U, 0405U, 0409U, 0410U, 0411U, 0413U, 0417U, 0419U, 0420U, 0423U, 0424U, 0433U | Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917) |
| Partial Thromboplastin Time (PTT) | 85730 | NCD-PartialThromboplastinTime-PTT-190-16 |
| 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) |
| Prostate Specific Antigen (PSA) | 84153 | NCD-ProstateSpecificAntigen-190-31 |
| Prothrombin-Time-(PT) | 85610 | NCD-ProthrombinTime-PT-190-17 |
| 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) |
| Serum Iron Study | 82728, 83540, 83550, 84466 | NCD-SerumIronStudies-190-18 |
| Sweat Test | 82438, 89230 | NCD - Sweat Test (190.5) (cms.gov) |
| Thyroid Testing | 84436, 84439, 84443, 84479 | NCD-ThyroidTesting-190-22 |
| Tumor Antigen CA 15-3, CA 27.29 | 86300 | NCD-TumorAntigenbyImmunoassay-CA15-3_CA27-29190.29 |
| Tumor Antigen CA125 | 86304 | NCD-TumorAntigenbyImmunoassay-CA-125-190-28 |
| Tumor Antigen CA19-9 | 86301 | NCD-TumorAntigenbyImmunoassay-CA19-9-190.30 |
| Urine Culture, Bacterial | 87086, 87088 | NCD-Urine-Culture-Bacterial-190-12 |
Updated: 10/15/25
2025 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. Most Medicare Advantage Plans follow these coverage policies. Please consult the specific Medicare Advantage carrier for confirmation.
| Medical Policy | CPT | Link |
| 4KScore Test | 81539 | Article - Billing and Coding: 4Kscore Test Algorithm (A56653) (cms.gov) |
| Acute Hep Panel/Hepatitis Panel | 80074 | NCD-AcuteHepatitisPanel-190-33 |
| 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) |
| Alpha-Fetoprotein | 82105 | NCD-Alpha-fetoprotein-190-25 |
| 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) |
| 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) |
| 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) |
| Blood Count | 85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032 | NCD-BloodCounts-190-15 |
| Blood Glucose Test | 82947, 82948, 82962 | NCD-BloodGlucoseTesting190.20 |
| 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) |
| Carcinoembryonic Antigen | 82378 | NCD-CarcinoembryonicAntigenCEA190-26 |
| Collagen Cross Links | 82523 | NCD-CollagenCrosslinkanymethod-190-19 |
| 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) |
| 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) |
| 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-DigoxinTherapeuticDrugAssay-190-3 |
| Fecal Occult Blood | 82272 | NCD-FecalOccultBloodTest-190-34 |
| FLU/COVID Policy | 87636 | Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) |
| Gamma Glutamyl Transferase | 82977 | NCD-GammaGlutamylTransferase-190-32 |
| Genetic Testing for Oncology | 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81479, 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81216, 0138U, 81215, 81217, 81308, 81432, 0102U, 0129U, 0131U, 81433, 81202, 81435, 81436, 0101U, 0130U, 0162U, 0238U, 81437, 81438, 81445, 81449, 0048U, 0244U, 0250U, 0334U, 0379U, 81450, 81451, 81301, 81261, 81262, 81264, 81263, 81340, 81341, 81342, 81209, 81242, 81277, 81415, 81416, 81417, 81425, 81426, 81427, 0036U, 0329U, 81518, 81519, 81520, 81521, 81522, 81523, 0009U, 0155U, 0177U, 81541, 81542, 0047U, 0133U, 81313, 81551, 0005U, 0113U, 0339U, 81552, 81525, 81120, 81121, 81170, 81175, 81176, 81201, 81203, 0157U, 81210, 81218, 81219, 81338, 81339, 81233, 81320, 81235, 0179U, 81236, 81237, 81245, 81246, 0046U, 0023U, 0050U, 81270, 81279, 0017U, 0027U, 81272, 81273, 81275, 81276, 81287, 81292, 81294, 81295, 81297, 81298, 81300, 81317, 81319, 0158U, 0159U, 0160U, 0161U, 81293, 81296, 81299, 81318, 81305, 81307, 0137U, 81309, 81310, 0049U, 81311, 81314, 81321, 81322, 81323, 0235U, 81334, 81345, 81347, 81348, 81351, 81352, 81353, 81357, 81360, 0154U, 81168, 81191, 81192, 81193, 81194, 81206, 81207, 81208, 0016U, 0040U, 81278, 81315, 81316, 0211U, 0297U, 0298U, 0103U, 0132U, 0134U, 0135U, 0136U, 81546, 0018U, 0026U, 0245U, 0204U, 0090U, 0314U, 0364U, 0326U, 88358, 88364, 8365, 88366, 88367, 88368, 88369, 88373, 88374, 88377, 81504, 81529, 81540, 88120, 88121, 0006M, 0007M, 0011M, 0012M, 0013M, 0016M, 0017M, 0019U, 0045U, 0053U, 0069U, 0089U, 0120U, 0153U, 0171U, 0229U, 0262U, 0285U, 0287U, 0288U, 0296U, 0299U, 0300U, 0306U, 0307U, 0313U, 0315U, 0317U, 0331U, 0332U, 0333U, 0340U, 0343U, 0356U, 0362U, 0363U, 0368U | Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917) |
| Glycated Hemoglobin/protein | 82985, 83036 | NCD-GlycatedHemoglobinGlycatedProtein-190-21 |
| Histocompatibility Test | 86812, 86813, 86816, 86817, 86821, 86825, 86826 | NCD - Histocompatibility Testing (190.1) (cms.gov) |
| Human Chorionic Gonadotrpin (Beta HCG) | 84702 | NCD-HumanChorionicGonadotropin-190-27 |
| Human Immunodeficiency Virus HIV Testing (diagnosis) | 86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538 | NCD-HumanImmunodeficiencyVirusHIVTestingDiagnosis-190-14 |
| Human Immunodeficiency Virus HIV Testing (monitoring ) | 87536, 87539 | NCD-HumanImmunodeficiencyVirusHIVTestingPrognosisIncludingMonitoring-190-13 |
| Lipids Testing | 80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478 | NCD-LipidTesting-190-23 |
| Lymphocyte Mitogen Response Assays | 86352, 86353 | NCD - Lymphocyte Mitogen Response Assays (190.8) (cms.gov) |
| Molecular Pathology and Genetic Testing | 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81191, 81192, 81193, 81194, 81200, 81201, 81202, 81203, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 8123, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81245, 81246, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81261 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81269, 81270, 81271, 81272, 81273, 81274, 81275, 81276, 81277, 81278, 81279, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81305, 81306, 81307, 81308, 81309, 81310, 81311, 81312, 81313, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81338, 81339, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81347, 81348, 81349, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81362, 81363, 81364, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81314, 81415, 81416, 81417, 81418, 81419, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81441, 81442, 81443, 81445 81448, 81449, 81450, 81451, 81455, 81456, 81457, 81458, 81459, 81460, 81462, 81463, 81464, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81507, 81508, 81509, 81510, 81511, 81512, 81513, 81514, 81518, 81519, 81520, 81521, 81522, 81523, 81525, 81528, 81529, 81535, 81536, 81538, 81539, 81540, 81541, 81542, 81546, 81551, 81552, 81554, 81595, 81596, 81599, G0452 ,0004M, 0006M, 0007M, 0011M, 0012M, 0013M, 0016M, 0017M, 0001U, 0005U, 0007U, 0008U, 0009U, 0010U, 0016U, 0017U, 0018U, 0019U, 0022U, 0023U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0036U, 0037U, 0040U, 0045U, 0046U, 0047U, 0048U, 0049U, 0050U, 0055U, 0060U, 0068U, 0069U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0078U, 0079U, 0084U, 0086U, 0087U, 0088U, 0089U, 0090U, 0094U, 0096U, 0101U, 0102U, 0103U, 0109U, 0111U, 0112U, 0113U, 0114U, 0118U, 0120U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0140U, 0141U, 0142U, 0152U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0170U, 0171U, 0172U, 0173U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0204U, 0205U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0219U, 0221U, 0222U, 0227U, 0229U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U, 0242U, 0244U, 0245U, 0246U, 0250U, 0252U, 0253U, 0254U, 0258U, 0260U, 0262U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U,0278U, 0282U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0296U, 0297U, 0298U, 0299U, 0300U, 0301U, 0302U, 0306U, 0307U, 0313U, 0314U, 0315U, 0317U, 0326U, 0329U, 0331U, 0332U, 0333U, 0334U, 0335U, 0336U, 0339U, 0340U, 0341U, 0343U, 0355U, 0356U, 0362U, 0363U, 0364U, 0368U, 0369U, 0370U, 0371U, 0372U, 0373U, 0374U, 0378U, 0379U, 0380U 0388U, 0389U, 0391U, 0392U, 0396U, 0398U, 0400U, 0403U, 0405U, 0409U, 0410U, 0411U, 0413U, 0417U, 0419U, 0420U, 0423U, 0424U, 0433U | Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917) |
| Partial Thromboplastin Time (PTT) | 85730 | NCD-PartialThromboplastinTime-PTT-190-16 |
| 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) |
| Prostate Specific Antigen (PSA) | 84153 | NCD-ProstateSpecificAntigen-190-31 |
| Prothrombin-Time-(PT) | 85610 | NCD-ProthrombinTime-PT-190-17 |
| 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) |
| Serum Iron Study | 82728, 83540, 83550, 84466 | NCD-SerumIronStudies-190-18 |
| Sweat Test | 82438, 89230 | NCD - Sweat Test (190.5) (cms.gov) |
| Thyroid Testing | 84436, 84439, 84443, 84479 | NCD-ThyroidTesting-190-22 |
| Tumor Antigen CA 15-3, CA 27.29 | 86300 | NCD-TumorAntigenbyImmunoassay-CA15-3_CA27-29190.29 |
| Tumor Antigen CA125 | 86304 | NCD-TumorAntigenbyImmunoassay-CA-125-190-28 |
| Tumor Antigen CA19-9 | 86301 | NCD-TumorAntigenbyImmunoassay-CA19-9-190.30 |
| Urine Culture, Bacterial | 87086, 87088 | NCD-Urine-Culture-Bacterial-190-12 |
| Cardiovascular Disease Screening Test | 80061 | MLN006559 – Medicare Preventive Services |
| Cervical Cancer Screening Test | G0476 | MLN006559 – Medicare Preventive Services |
| Colorectal Cancer Screening Test | 00812, 81528, 82270, G0104, G0105, G0106, G0120, G0121, G0327, G0328 | MLN006559 – Medicare Preventive Services |
| Diabetes Screening | 82947, 82950, 82951, 83036 | MLN006559 – Medicare Preventive Services |
| Hepatitis B Screening | G0499, 86704, 86706, 87340, 87341 | MLN006559 – Medicare Preventive Services |
| Hepatitis C Screening | G0472 | MLN006559 – Medicare Preventive Services |
| HIV Screening | 80081, G0432, G0433, G0435, G0475 | MLN006559 – Medicare Preventive Services |
| Prostate Cancer Screening | G0102, G0103 | MLN006559 – Medicare Preventive Services |
| Pap Test Screening | G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001 | MLN006559 – Medicare Preventive Services |
| Pelvic Exam Screening | G0101 | MLN006559 – Medicare Preventive Services |
| STI Screening | 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, 87800, 87590, 87591, 87850, 87800, 0402U, 0455U, 86592, 86593, 86780, G0445 | MLN006559 – Medicare Preventive Services |
| Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM) *January 2025 | 2025100-ICD-10-NCD-Manual-20241022-508 |
Updated: 5/15/25
Medicare Screening Tests
| Medical Policy | CPT | Link |
| Cardiovascular Disease Screening Test | 80061 | MLN006559 – Medicare Preventive Services |
| Cervical Cancer Screening Test | G0476 | MLN006559 – Medicare Preventive Services |
| Colorectal Cancer Screening Test | 00812, 81528, 82270, G0104, G0105, G0106, G0120, G0121, G0327, G0328 | MLN006559 – Medicare Preventive Services |
| Diabetes Screening | 82947, 82950, 82951, 83036 | MLN006559 – Medicare Preventive Services |
| Hepatitis B Screening | G0499, 86704, 86706, 87340, 87341 | MLN006559 – Medicare Preventive Services |
| Hepatitis C Screening | G0472 | MLN006559 – Medicare Preventive Services |
| HIV Screening | 80081, G0432, G0433, G0435, G0475 | MLN006559 – Medicare Preventive Services |
| Prostate Cancer Screening | G0102, G0103 | MLN006559 – Medicare Preventive Services |
| Pap Test Screening | G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001 | MLN006559 – Medicare Preventive Services |
| Pelvic Exam Screening | G0101 | MLN006559 – Medicare Preventive Services |
| STI Screening | 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, 87800, 87590, 87591, 87850, 87800, 0402U, 0455U, 86592, 86593, 86780, G0445 | MLN006559 – Medicare Preventive Services |
Updated: 11-22-24
Payor Medical Policies
Welcome to our comprehensive directory of payor medical policies. In this section, you will find links to the medical policies of different insurance providers, enabling you to stay updated on coverage guidelines and requirements. Please click on the links below to access detailed information from each payor.
For additional questions, please contact hnlbillinggeneral@healthnetworklabs.com or contact the payor directly.
Updated: 6/3/25