Medicare Coverage and Coding Guide

Policies for JE Noridian

States covered under these policies include California, Hawaii and Nevada.

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–JE Noridian 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	Allergy Testing B-type Natriuretic Peptide (BNP) Testing Controlled Substance Monitoring and Drugs of Abuse Testing Flow Cytometry Helicobacter Pylori Infection Testing Serum Magnesium Vitamin D Assay Testing (Vitamin D;1,25 dihydroxy) Vitamin D Assay Testing (Vitamin D;25 hydroxy)   Medicare Local Coverage Determination List–JE Noridian Links to CMS site policies     Bladder/Urothelial Tumor Markers MolDX: APC and MUTYH Gene Testing MolDX: Biomarkers in Cardiovascular Risk Assessment MolDX: BRCA1 and BRCA2 Genetic Testing MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing 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: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels MolDX: NRAS Genetic Testing Non Covered Services

 

Non-covered ICD-10    Codes for all lab NCDs PDF Reference Guides

  

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Medi-Cal and Other Health Plan Coverage and Coding Guides

 

Medi-Cal Limited Coverage List

 

Other Health Plan Policies PDF Reference Guides and Links

  

Screening for Vitamin D Deficiency in Average Risk Individuals