District of Columbia
Article ID Number: A56420 Status: A-Approved
Article Title: Billing and Coding: Frequency of Laboratory Tests
Original Article Effective Date:
Revision Effective Date:
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:
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.
Hospital Inpatient (Medicare Part B only)
Hospital - Laboratory Services Provided to Non-patients
Hospital - Swing Beds
Skilled Nursing - Inpatient (Including Medicare Part A)
Skilled Nursing - Inpatient (Medicare Part B only)
Skilled Nursing - Outpatient
Clinic - Rural Health
Clinic - Hospital Based or Independent Renal Dialysis Center
Critical Access Hospital
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.
Laboratory - General Classification
Laboratory - Chemistry
Laboratory - Immunology
Laboratory - Renal Patient (Home)
Laboratory - Non-Routine Dialysis
Laboratory - Hematology
Laboratory - Bacteriology & Microbiology
Laboratory - Urology
Laboratory - Other Laboratory
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:
LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DIRECT MEASUREMENT, HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) (83718) TRIGLYCERIDES (84478)
CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL
GLUCOSE; BLOOD, REAGENT STRIP
GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE
HEMOGLOBIN; GLYCOSYLATED (A1C)
LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)
LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL
THYROID STIMULATING HORMONE (TSH)
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
ICD-10 Codes That Are Not Covered
Revision History Information
Revision History Date
Revision History Number
Revision History Explanation
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.