Transcription of Medicare Limited Coverage Policies Table of Contents ...
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Medicare Limited Coverage Policies Table of Contents ...
I Medicare Limited Coverage Policies Table of Contents Effective October 2019 This information is meant only as a guide. Please refer to the Center for Medicare & Medicaid Services (CMS) at or Noridian Medicare at for the most up-to-date Policies . You may also visit for electronic/printer-friendly versions of these Policies . Test Name CPT Code(s) Pages National Coverage Determination Policies Alpha-fetoprotein 82105 1-2 Blood Counts (CBC) 85004, 85007-8, 85013-14, 85018, 85025, 85027, 85032, 85048, 85049 3-6 Blood Glucose Testing 82947, 82948, 82962 7-8 Carcinoembryonic Antigen (CEA) 82378 9-10 Collagen Crosslinks 82523 11-12 Cytogenetic Studies 88230, 88235, 88237, 88249, 88262, 88263, 88264, 88269, 88271, 88273, 88274, 88275, 88280, 88289, 88291 13-14 Digoxin Therapeutic Drug Assay 80162 15-16 Fecal Occult Blood Test 82272 17-18 Gamma Glutamyl Transferase 82977 19-20 Glycated Hemoglobin/Glycated Protein 82985, 83036 21-22 Hepatitis Panel/Acute Hepatitis Panel 80074 23-24 Histocompatibility Testing 86812, 86816 25-26 Human Chorionic Gonadotropin Quantitative 84702 27-28 HIV Testing (Prognosis including monitoring) 87536, 87539 29-30 Human
Serum Magnesium 83735 93- 94 . Vitamin D Assay -Dihydroxy 82652 95- 96 ; Vitamin D Assay -Hydroxy 82306 97 -98 . Medicare National Coverage Determination Policy. Alpha-fetoprotein ... pre-eclampsia, neonate with maternal ITP, massive transfusion, recent platelet transfusion, cardiopulmonary bypass, hemolytic ...
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