Medicare Coverage and Coding Guide

Policies for JE Noridian

States covered under these policies include California, Hawaii and Nevada.

Jurisdiction is determined by the state in which your performing Quest lab is located.

Below is 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.

 

Medicare National Coverage Determination List
PDF Reference Guides
Medicare Local Coverage
Determination List–JE Noridian

PDF Reference Guides
 
 

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

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

 

Allergy Testing

B-type Natriuretic Peptide (BNP) Testing

Controlled Substance Monitoring and Drugs of Abuse Testing

Flow Cytometry

Vitamin D Assay Testing (Vitamin D;1,25 dihydroxy)

Vitamin D Assay Testing (Vitamin D;25 hydroxy)

Serum Magnesium

 
 
Medicare Local Coverage
Determination List–JE Noridian

Links to CMS site policies
 
 

Bladder/Urothelial Tumor Markers

MolDX: APC and MUTYH Gene Testing

MolDX: Biomarkers in Cardiovascular Risk Assessment

MolDX: BRCA1 and BRCA2 Genetic Testing

MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing

MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease

MolDX: Genetic Testing for Lynch Syndrome

MolDX: HLA-B*15:02 Genetic Testing

MolDX: MGMT Promoter Methylation Analysis

Non Covered Services

 

Non-covered ICD-10   
Codes for all lab NCDs
PDF Reference Guides

  


 

Medi-Cal and Other Health Plan Coverage and Coding Guides

 

Medi-Cal Limited Coverage List
PDF Reference Guides

 

 

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 hCG Prolactin policy

Medi-Cal Helicobacter pylori policy

Medi-Cal Hep C Genotype policy

Medi-Cal LH FSH Policy

Med-Cal Molecular Pathology Code Correlation Chart

Medi-Cal Nonspecific Diagnosis Codes

Medi-Cal Prenatal Cystic Fibrosis Screening

Medi-Cal Prenatal Testing Reminder

Med-Cal QuantiFERON TB Gold Reminder

Medi-Cal Update Cervical Screening

Medi-Cal Vitamin B12 Program

Presumptive Eligibility Program (PE4PW)

 

 

 

 

 

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