Medicare has limited coverage policies (MLCPs) for certain laboratory tests. Tests subject to an MLCP must meet medical-necessity criteria in order to be covered by Medicare. MLCP tests ordered without a supportive ICD-10 code will not satisfy medical necessity and therefore will not be covered by Medicare. These orders must be submitted with an Advance Beneficiary Notice signed by your patient, which confirms they are responsible for payment.
We’re pleased to provide Medicare Coverage and Coding Reference Guides to help you more easily determine test coverage and find ICD-10 diagnosis codes to submit with your test order. By doing so, you can ensure your Medicare patients’ lab tests are performed without delay and prevent disruptions to your office.
To get started, identify your state below where your Quest testing is performed and select the corresponding color in the legend.
Local Coverage Determinations are issued by Medicare administrative contractors (MACs), and National Coverage Determinations are issued by the Centers for Medicare and Medicaid Services (CMS). The map above shows the regional MACs that have jurisdiction over testing.
To view the full coverage policy for any National Coverage Determination from the CMS website, which will include a complete list of medically supportive ICD-10 codes, click here.