Billing and Coding: Frequency of Laboratory Tests (A56420)


Related Local Coverage Determination (LCD)
L35099-Frequency of Laboratory Tests


Contractor NameContract NumberStates
Novitas Solutions, Inc. 04111 - A and B MAC Colorado
04112 - A and B MAC Colorado
04211 - A and B MAC New Mexico
04212 - A and B MAC New Mexico
04311 - A and B MAC Oklahoma
04312 - A and B MAC Oklahoma
04411 - A and B MAC Texas
04412 - A and B MAC Texas
04911 - A and B MAC Colorado
New Mexico
Oklahoma
Texas
07101 - A and B MAC Arkansas
07102 - A and B MAC Arkansas
07201 - A and B MAC Louisiana
07202 - A and B MAC Louisiana
07301 - A and B MAC Mississippi
07302 - A and B MAC Mississippi
12101 - A and B MAC Delaware
12102 - A and B MAC Delaware
12201 - A and B MAC District of Columbia
12202 - A and B MAC District of Columbia
12301 - A and B MAC Maryland
12302 - A and B MAC Maryland
12401 - A and B MAC New Jersey
12402 - A and B MAC New Jersey
12501 - A and B MAC Pennsylvania
12502 - A and B MAC Pennsylvania
12901 - A and B MAC Delaware
District of Columbia
Maryland
New Jersey
Pennsylvania

Article Information

Article ID Number: A56420 Status: A-Approved

Article Title: Billing and Coding: Frequency of Laboratory Tests

Original Article Effective Date: 03/28/2019

Revision Effective Date: 11/07/2019

Article Text:

Refer to the Novitas Local Coverage Determination (LCD) L35099, Frequency of Laboratory Tests, for reasonable and necessary requirements and frequency limitations.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Per CMS Medicare Learning Network (MLN) Medicare Matters number MM8863, the use of NCCI-associated modifiers should NOT be used to bypass a procedure-to-procedure (PTP) edit unless the proper criteria for use of the modifier are met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that is used. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Refer to the NCDs for the procedure code list of ICD-10-CM codes that are considered covered by Medicare at:

https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html 

Coding Information
Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

12Hospital Inpatient (Medicare Part B only)
13Hospital Outpatient
14Hospital - Laboratory Services Provided to Non-patients
18Hospital - Swing Beds
21Skilled Nursing - Inpatient (Including Medicare Part A)
22Skilled Nursing - Inpatient (Medicare Part B only)
23Skilled Nursing - Outpatient
71Clinic - Rural Health
72Clinic - Hospital Based or Independent Renal Dialysis Center
85Critical Access Hospital

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

0300 Laboratory - General Classification
0301 Laboratory - Chemistry
0302 Laboratory - Immunology
0303 Laboratory - Renal Patient (Home)
0304 Laboratory - Non-Routine Dialysis
0305 Laboratory - Hematology
0306 Laboratory - Bacteriology & Microbiology
0307 Laboratory - Urology
0309 Laboratory - Other Laboratory

CPT/HCPCS Codes:

Group 1 Paragraph:

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.



Group 1 CPT Codes:
80061 LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DIRECT MEASUREMENT, HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) (83718) TRIGLYCERIDES (84478)
82465 CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL
82948 GLUCOSE; BLOOD, REAGENT STRIP
82962 GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE
82985 GLYCATED PROTEIN
83036 HEMOGLOBIN; GLYCOSYLATED (A1C)
83718 LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)
83721 LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL
84436 THYROXINE; TOTAL
84439 THYROXINE; FREE
84443 THYROID STIMULATING HORMONE (TSH)
84478 TRIGLYCERIDES
84479 THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)


ICD-10 Codes That Are Covered

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Medicare is establishing the following limited coverage for CPT/HCPCS codes 80061, 82465, 82948, 82962, 82985, 83036, 83718, 83721, 84436, 84439, 84443, 84478 and 84479:

Refer to the NCDs for the procedure code list of ICD-10-CM codes that are covered by Medicare at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html

XX000 Not Applicable
ICD-10 Codes That Are Not Covered

XX000


Revision History Information
Revision History DateRevision History NumberRevision History Explanation
11/07/2019
R1

Article revised and published on 11/07/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.