Medicaid has limited coverage policies (LCPs) for certain laboratory tests. Tests subject to an LCP must meet medical necessity criteria in order to be covered.
When submitting lab orders, you must provide ICD-10 codes that indicate the patient’s condition and/or the reasons for ordering the test. If those reasons are not considered medically necessary by Medicaid, coverage may be denied.
Quest’s Medicaid coverage and coding reference guides can help you understand coverage limitation and find ICD-10 diagnosis codes that are most frequently ordered by physicians—preventing potential disruptions to your practice.
To get started, select a state or plan below.
Note: individual plans may vary. For the most up-to-date coverage policy for each patient, please contact the patient’s health plan.