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Medicaid limited coverage policies

Medicaid coverage & coding guides

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.

Navigating the complexities of Medicaid policies can be complicated, but Quest is here to help.

Help to ensure lab tests are performed without disruptions

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.

Below, you’ll find a list of Medicaid coverage policies for certain tests or test groups in California. Certain tests or test groups may follow Medicare coverage policies. Click on the link(s) to find the coverage limitations and indications for the test you want to order.

Medi-Cal Limited Coverage List

Every Woman Counts Program

Family PACT CT/NG Testing

Family PACT CPT Code Grid

Family PACT Order Code Grid

Medi-Cal CA 125 Policy

Medi-Cal Ferritin Policy

Medi-Cal Fragile X PCR Policy

Medi-Cal hCG Prolactin Policy

Medi-Cal Helicobacter Pylori Policy

Medi-Cal Hep C Genotype Policy

Medi-Cal Latent Tuberculosis Testing

Medi-Cal LH FSH Policy

Medi-Cal Molecular Pathology Code Correlation Chart

Medi-Cal Prenatal Genetic Carrier Screening

Medi-Cal Prenatal Testing Reminder

Medi-Cal Update Cervical Screening

Medi-Cal Vitamin B12 Program

PE For Pregnant Women (PE4PW)

Below is a list of CareSource of GA coverage policies for certain tests or test groups. Certain tests or test groups may follow Medicare coverage policies. Click on the link(s) to find the coverage limitations and indications for the test you want to order.

Vitamin D Testing

Hepatitis Panel/Acute Hepatitis Panel

Testing for Diagnosis of Active or Latent Tuberculosis

Below is a list of Medicaid coverage policies for certain tests or test groups in Washington state. Certain tests or test groups may follow Medicare coverage policies. Click on the link(s) to find the coverage limitations and indications for the test you want to order.

WA Medicaid Vitamin D Testing Policy

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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