Medicare Coverage and Coding Guide

Policies for J5 WPS

States covered under these policies include Iowa, Kansas, Missouri, and Nebraska.

Jurisdiction is determined by the state in which your performing Quest lab is located.

Below is a list of Medicare Coverage Policies for tests or test groups applicable to your state. Diagnosis codes are required for all Medicare orders to document medical necessity.

Click on the links below to find the associated diagnosis codes and frequency information within the policy for the test you want to order. Some links will provide a concise Medicare Coverage and Coding Guide for the coverage policy, while others will direct you to the CMS website policy page.

 

Medicare National Coverage Determination List PDF Reference Guides	Medicare Local Coverage Determination List–J5 WPS PDF Reference Guides
Alpha-fetoprotein Blood Counts Blood Glucose Testing Carcinoembryonic Antigen Collagen Crosslinks, Any Method Cytogenetic Studies Digoxin Therapeutic Drug Assay Fecal Occult Blood Test Gamma Glutamyl Transferase Glycated Hemoglobin/Glycated Protein Hepatitis Panel/Acute Hepatitis Panel Histocompatibility Testing Human Chorionic Gonadotropin Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) Human Immunodeficiency Virus (HIV) Testing (Diagnosis) Lipid Testing Lymphocyte Mitogen Response Assays Next Generation Sequencing (NGS) Partial Thromboplastin Time (PTT) Prostate Specific Antigen Prothrombin Time (PT) Serum Iron Studies Sweat Test Thyroid Testing Tumor Antigen by Immunoassay CA 15-3/CA 27.29 Tumor Antigen by Immunoassay CA 19-9 Tumor Antigen by Immunoassay CA 125 Urine Culture, Bacterial   Non-covered ICD-10    Codes for all lab NCDs PDF Reference Guides	Allergy Testing Drug Testing MOLDX Biomarker MOLDX Multiple Nucleic Acid Vitamin D Assay Testing (Vitamin D; 1, 25 dihydroxy) Vitamin D Assay Testing (Vitamin D; 25 hydroxy)   Medicare Local Coverage Determination List–J5 WPS Links to CMS site policies     Flow Cytometry Genetic Testing for CYP2C19, CYP2D6, CYP2C9, and VKORC1 Molecular Diagnostic Testing (L34762)    Retired 02 15 2017 MolDX: Biomarkers in Cardiovascular Risk Assessment MolDX: BRCA1 and BRCA2 Genetic Testing MolDX: Breast Cancer Assay: Prosigna MolDX: Breast Cancer Index℠ Genetic Assay  MolDX: Chromosome 1p/19q Deletion Analysis MolDX-CDD: Decipher® Prostate Cancer Classifier Assay MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay MolDX: GeneSight® Assay for Refractory Depression MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease MolDX: Genetic Testing for Lynch Syndrome MolDX: HLA-B*15:02 Genetic Testing MolDX: MGMT Promoter Methylation Analysis MolDX: Molecular RBC Phenotyping