Insurance & Coding Resources
HNL Lab Medicine collaborates with a variety of insurance providers.
Learn more about Medicare's frequency limitations for covered lab services.
Insurance Coverage Policies
Any diagnosis codes provided to HNL Lab Medicine must be documented in the patient’s medical record to support medical necessity and insurance coverage.
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: 4KScore Test
CPT: 81539
Billing and Coding: 4Kscore Test Algorithm (A56653)
Medical Policy: Acute Hep Panel / Hepatitis Panel
CPT: 80074
NCD-Acute Hepatitis Panel (190.33)
Medical Policy: Allergy Testing
CPT: 82785, 86001, 86003, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076, 95079
Billing and Coding: Allergy Testing (A56558)
Medical Policy: Alpha-Fetoprotein
CPT: 82105
NCD-Alpha-fetoprotein (190.25)
Medical Policy: Assays for Vitamins and Metabolic Function
CPT: 82180, 82306, 82379, 82607, 82652, 82746, 83090, 83698, 84207, 84252, 84255, 84425, 84446, 84590
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Medical Policy: Biomarkers for Oncology
CPT: 0002U, 0003U, 0005U, 0009U, 0013U, 0014U, 0016U, 0017U, 0022U, 0026U, 81120, 81121, 81170, 81210, 81235, 81301, 81400, 81445, 81503, 81520, 81525, 81538
Billing and Coding: Biomarkers for Oncology (A52986)
Medical Policy: Biomarkers Overview
CPT: 81240 ,81241
Billing and Coding: Biomarkers Overview (A56541)
Medical Policy: Blood Counts
CPT: 85004, 85007, 85025, 85027
NCD-Blood Counts (190.15)
Medical Policy: Blood Glucose Testing
CPT: 82947, 82948, 82962
NCD-Blood Glucose Testing (190.20)
Medical Policy: BRCA1 and BRCA2 Genetic Testing
CPT: 81162, 81211, 81213, 81214, 81215, 81216, 81217, 81432, 81433
Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542)
Medical Policy: Carcinoembryonic Antigen (CEA)
CPT: 82378
NCD-Carcinoembryonic Antigen (190.26)
Medical Policy: Collagen Cross Links
CPT: 82523
NCD-Collagen Cross Links (190.19)
Medical Policy: Comprehensive Stool Guideline aka Gastrointestinal Pathogen Panel (GIP)
CPT: 87505, 87506, 87507, 0097U
Billing and Coding: Gastrointestinal Pathogen Panels (A56642)
Medical Policy: Controlled Substance Monitoring and Drug Abuse Testing
CPT: 80305, 80306, 80307, G0480, G0481, G0482, G0483
Billing and Coding: Controlled Substance Monitoring (A56645)
Medical Policy: Cytogenetic Studies
CPT: 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)
Medical Policy: Digoxin (Therapeutic Drug Assay)
CPT:80162
NCD-DigoxinTherapeuticDrugAssay-190-3
Medical Policy: Fecal Occult Blood
CPT:82272
NCD-FecalOccultBloodTest-190-34
Medical Policy: FLU / COVID Policy
CPT: 87636
FLU/COVID - Respiratory Pathogen Panel Testing
Medical Policy: Gamma Glutamyl Transferase
CPT:82977
NCD-GammaGlutamylTransferase-190-32
Medical Policy: Genetic Testing for Oncology - Molecular Pathology
CPT: 88120, 88121, 81479, 0012M, 0013M, 0229U, 0287U, 0313U, 0315U, 0363U, 0420U
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Medical Policy: Glycated Hemoglobin (HbA1c)
CPT: 82985, 83036
NCD-Glycated Hemoglobin (190.21)
Medical Policy: Glycated Hemoglobin/protein
CPT: 82985, 83036
NCD-GlycatedHemoglobinGlycatedProtein-190-21
Medical Policy: Histocompatibility Test
CPT:86812, 86813, 86816, 86817, 86821, 86825, 86826
NCD - Histocompatibility Testing (190.1) (cms.gov)
Medical Policy: Human Chorionic Gonadotrpin (Beta HCG)
CPT:84702
NCD-HumanChorionicGonadotropin-190-27
Medical Policy: Human Immunodeficiency Virus HIV Testing (diagnosis)
CPT:86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538
NCD-HumanImmunodeficiencyVirusHIVTestingDiagnosis-190-14
Medical Policy: Human Immunodeficiency Virus HIV Testing (monitoring )
CPT:87536, 87539
NCD-HumanImmunodeficiencyVirusHIVTestingPrognosisIncludingMonitoring-190-13
Medical Policy: Lipid Testing
CPT: 80061, 82465, 83718, 84478
NCD-Lipid Testing (190.23)
Medical Policy: Lymphocyte Mitogen Response Assays
CPT: 86352, 86353
NCD - Lymphocyte Mitogen Response Assays (190.8) (cms.gov)
Medical Policy: Partial Thromboplastin Time (PTT)
CPT: 85730
NCD-PTT (190.16)
Medical Policy: Prothrombin Time (PT)
CPT: 85610
NCD-Prothrombin Time (190.17)
Medical Policy: Pharmacogenomics Testing
CPT: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
Billing and Coding: Pharmacogenomics Testing (A58801)
Medical Policy: PSA (Prostate Specific Antigen)
CPT: 84153
NCD-ProstateSpecificAntigen-190-31
Medical Policy: Respiratory Pathogen Panel Testing
CPT: 87636, 87631, 87632, 87633
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
Medical Policy: Serum Iron Studies
CPT: 82728, 83540, 83550
NCD-Serum Iron Studies (190.18)
Medical Policy: Thyroid Testing
CPT: 84436, 84439, 84443
NCD-Thyroid Testing (190.22)
Medical Policy: Tumor Antigen CA 15-3, CA 27.29
CPT: 86300
NCD-TumorAntigenbyImmunoassay-CA15-3_CA27-29190.29
Medical Policy: Tumor Antigen CA125
CPT: 86304
NCD-TumorAntigenbyImmunoassay-CA-125-190-28
Medical Policy: Tumor Antigen CA19-9
CPT: 86301
NCD-TumorAntigenbyImmunoassay-CA19-9-190.30
Medical Policy: Urine Culture, Bacterial
CPT: 87086, 87088
NCD-Urine Culture (190.12)
Medicare Preventive Services
Medical Policy: Cardiovascular Disease Screening Test
CPT: 80061
MLN006559 – Medicare Preventive Services
Medical Policy: Cervical Cancer Screening Test
CPT: G0476
MLN006559 – Medicare Preventive Services
Medical Policy: Colorectal Cancer Screening Test
CPT: 00812, 81528, 82270, G0104, G0105, G0106, G0120, G0121, G0327, G0328
MLN006559 – Medicare Preventive Services
Medical Policy: Diabetes Screening
CPT: 82947, 82950, 82951, 83036
MLN006559 – Medicare Preventive Services
Medical Policy: Hepatitis B Screening
CPT: G0499, 86704, 86706, 87340, 87341
MLN006559 – Medicare Preventive Services
Medical Policy: Hepatitis C Screening
CPT: G0472
MLN006559 – Medicare Preventive Services
Medical Policy: HIV Screening
CPT: 80081, G0432, G0433, G0435, G0475
MLN006559 – Medicare Preventive Services
Medical Policy: Prostate Cancer Screening
CPT: G0102, G0103
MLN006559 – Medicare Preventive Services
Medical Policy: Pap Test Screening
CPT: G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001
MLN006559 – Medicare Preventive Services
Medical Policy: Pelvic Exam Screening
CPT: G0101
MLN006559 – Medicare Preventive Services
Medical Policy: STI Screening
CPT: 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, 87800, 87590, 87591, 87850, 87800, 0402U, 0455U, 86592, 86593, 86780, G0445
MLN006559 – Medicare Preventive Services
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
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: 7/13/25
Common Codes by Specialty
The policies listed here include commonly used ICD-10-cm diagnosis codes related to specific Specialties. It does not establish, confirm, or imply medical necessity. Medical necessity must always be supported by the patient’s clinical documentation, and the applicable medical policy must be reviewed to ensure coverage criteria are met.