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Quest Diagnostics

J5 WPS

Policies for Medicare Region J5 WPS

Iowa, Kansas, Missouri, and Nebraska are included under this policy. Jurisdiction is determined by the state in which your performing Quest lab is located.

Below, you’ll find a list of Medicare Coverage Policies for tests or test groups applicable to your state. Diagnosis codes are required for all Medicare orders to document medical necessity.

Click on the links below to find the associated diagnosis codes and frequency information within the policy for the test you want to order. Some links will provide a concise Medicare Coverage and Coding Guide for the coverage policy, while others will direct you to the CMS website policy page.

Find links to PDF Reference Guides for Medicare National Coverage Determination Lists below.

Alpha-fetoprotein

Blood Counts

Blood Glucose Testing

Carcinoembryonic Antigen

Collagen Crosslinks, Any Method

Cytogenetic Studies

Digoxin Therapeutic Drug Assay

Fecal Occult Blood Test

Gamma Glutamyl Transferase

Glycated Hemoglobin/Glycated Protein

Hepatitis Panel/Acute Hepatitis Panel

Histocompatibility Testing

Human Chorionic Gonadotropin

Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)

Human Immunodeficiency Virus (HIV) Testing (Diagnosis)

Lipid Testing

Lymphocyte Mitogen Response Assays

Next Generation Sequencing (NGS)

Partial Thromboplastin Time (PTT)

Prostate-Specific Antigen

Prothrombin Time (PT)

Serum Iron Studies

Sweat Test

Thyroid Testing

Tumor Antigen by Immunoassay CA 15-3/CA 27.29

Tumor Antigen by Immunoassay CA 19-9

Tumor Antigen by Immunoassay CA 125

Urine Culture, Bacterial
 

Non-covered ICD-10 codes apply to all lab National Coverage Determinations. See the PDF Reference Guide here.

Access PDF reference guides for Medicare region J5 WPS local coverage determination lists below.

Allergy Testing

Drug Testing

MolDX Biomarker

Vitamin D Assay Testing (Vitamin D; 25 hydroxy)

MOLDX Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

Access links to CMS Site Policies for Medicare region J5 WPS below.

MDS FISH

MolDX: Breast Cancer Assay: Prosigna®

MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)

MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease

MolDX: MGMT Promoter Methylation Analysis

MolDX: Minimal Residual Disease Testing for Cancer

MolDX: Repeat Germline Testing

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

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