Medicare Coverage and Coding Guide

Policies for J8 WPS

States covered under these policies include Indiana.

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–J8 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

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

Vitamin D Assay Testing
(Vitamin D; 25 hydroxy)

Vitamin D Assay Testing
(Vitamin D; 1, 25 dihydroxy)

 
Medicare Local Coverage
Determination List–J8 WPS

Links to CMS site policies
 
 

Flow Cytometry 

MolDX: 4Kscore Assay

ModDX: APC and MUTYHG Gene Testing

MolDX: Biomarkers in Cardiovascular Risk Assessment

MolDX: BRCA1 and BRCA2 Genetic Testing            

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

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