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.
Collagen Crosslinks, Any Method
Digoxin Therapeutic Drug Assay
Glycated Hemoglobin/Glycated Protein
Hepatitis Panel/Acute Hepatitis Panel
Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
Lymphocyte Mitogen Response Assays
Next Generation Sequencing (NGS)
Partial Thromboplastin Time (PTT)
Tumor Antigen by Immunoassay CA 15-3/CA 27.29
Tumor Antigen by Immunoassay CA 19-9
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.
Genetic Testing for BCR ABL Negative Myeloproliferative Disease
Vitamin D Assay Testing (Vitamin D; 1, 25 dihydroxy)
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.
MolDX: Breast Cancer Assay: Prosigna®
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
MolDX: MGMT Promoter Methylation Analysis
MolDX: Minimal Residual Disease Testing for Cancer
MolDX: Repeat Germline Testing
Have a billing question? Contact customer service
Medicare coverage & coding guides
Contact a Quest representative at 1.866.MYQUEST (1.866.697.8378).
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