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 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 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
Prescription Medication and Illicit Drug Testing in the Outpatient Setting
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
Louisiana
North Carolina
Oregon
South Carolina
Texas
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.
Drug Alcohol Testing Reimbursement Policy
MG_Vitamin_D_Deficiency_Testing
Reimbursement Policy: Folate Testing - Lab Benefit Program (LBM)
Reimbursement Policy: Intracellular Micronutrient Analysis - Lab Benefit Program (LBM)
Reimbursement Policy: Prostate Specific Antigen (PSA) Testing - Lab Benefit Program (LBM)
Reimbursement Policy: Thyroid Disease Testing - Lab Benefit Program (LBM)
Below is a list of HealthFirst’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.
General Principles Laboratory Test Coverage
Cardiovascular Disease Risk Assessment
Prenatal Screening (Nongenetic)
Prescription Medication and Illicit Drug Testing in the Outpatient Setting
Urine Culture Testing for Bacteria
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
Commercial and Exchange
Note: individual plans may vary. For the most up-to-date coverage policy for each patient, please contact the patient’s health plan.
Contact a Quest representative at 1.866.MYQUEST (1.866.697.8378).
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