Commercial health plans publish limited coverage policies (LCPs) for certain laboratory tests. Tests subject to a commercial LCP must meet medical necessity criteria in order to be covered by the plan.
When submitting lab orders for a test included in commercial payer policies, please ensure that all ICD-10 codes provided represent the signs, symptoms, or conditions that prompted the request. If the indications and limitations of the payer's policy are not met, your patient may be responsible for payment.
Quest’s Commercial Coverage and Coding Reference Guides can help you understand coverage limitations and which ICD-10 codes are most frequently ordered by physicians. Understanding these coverage limitations may help prevent administrative disruptions to your practice.
To get started, choose a health plan below.
Below, you’ll find a list of aetna’s limited coverage policies for certain tests or test groups. Click on the links to find the coverage limitations and indications within the policy for the test you want to order.
Below, you’ll find a list of Cigna’s limited coverage policies for certain tests or test groups. Click on the links to find the coverage limitations and indications within the policy for the test you want to order.
Below is a list of limited coverage policies for certain tests or test groups. Click on the link to find your patient's Blue Cross Blue Shield home plan coverage limitations and indications within the BCBS policy.
Alabama
Arkansas
North Carolina
South Carolina
Below, you’ll find a list of EmblemHealth’s limited coverage policies for certain tests or test groups. Click on the links to find the coverage limitations and indications within the policy for the test you want to order.
Healthfirst follows the Medicare Region JK NGS policies. Please click on the link for more information.
Below, you’ll find a list of UnitedHealthcare’s limited coverage policies for certain tests or test groups. Click on the links to find the coverage limitations and indications within the policy for the test you want to order.
Note: individual plans may vary. For the most up-to-date coverage policy for each patient, please contact the patient’s health plan.
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