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Commercial coverage & coding guidelines

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.

Navigating the complexities of Commercial health care policies can be complicated, but Quest Diagnostics is here to help.

Understand coverage policies and help limit disruptions in your practice

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 EmblemHealth’s limited coverage policies for certain tests or test groups. Click on the link to find the coverage limitations and indications within the policy for the test you want to order.

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, you’ll find a list of CareSource of GA 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.

Hepatitis Panel/Acute Hepatitis Panel

Testing for Diagnosis of Active or Latent Tuberculosis

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

Alaska/Washington State

Arkansas

North Carolina

Oregon

South Carolina

Below, you’ll find a list of EmblemHealth’s limited coverage policies for certain tests or test groups. Click on the link to find the coverage limitations and indications within the policy for the test you want to order.

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.

Medicare Advantage

Community Plan

Note: individual plans may vary. For the most up-to-date coverage policy for each patient, please contact the patient’s health plan.

MAKING A DIFFERENCE

For more information about how Quest can help you streamline your practice, download our commercial limited coverage policy brochure.
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