Medicare Coverage Limitations & Medical Necessity Requirements

Local Coverage Determinations (LCDs) issued by the Medicare Administrative Contractors and National Coverage Determinations (NCDs) issued by the Centers for Medicare & Medicaid Services (CMS) provide coverage limitations for certain laboratory tests. Claims for laboratory tests subject to these policies must include specific ICD-10 diagnosis codes to support medical necessity. Without such information, claims for these services will be denied payment. CPL can only bill the patient for denied services if an Advance Beneficiary Notice (ABN) is completed, signed and dated by your patient, before the patient's specimen is drawn. CPL accounts may access the link provided below to search coverage determination requirements regarding Texas Medicare Part B.

CPL Disclaimer of Warranties and Liabilities

This LCD/NCD SEARCH link and the information contained therein is provided without warranty or representation of its accuracy or completeness, or that the use of this information will comply with the local or national policies. CPL DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO THE USE OF THE LCD/NCD SEARCH LINK. In no event shall CPL be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of the LCD/NCD SEARCH link or the information contained therein. Please be advised that primary sources, including Medicare Administrative Contractor publications, notices, and advice should be consulted and used when submitting diagnosis codes to entities other than CPL.

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