Medicare National and Local Coverage …

1 Last Updated: Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third party marks - and - are the property of their respective owners. 2015 Quest Diagnostics Incorporated. All rights reserved Policies in this MLCP Reference Guide apply to testing performed at a Quest Diagnostics facility and apply to Medicare National Coverage Determination Policy. This diagnosis code reference guide is provided as an aid to physicians and office staff in determining when an ABN (Advance Beneficiary Notice) is necessary. Diagnosis codes must be applicable to the patient s symptoms or conditions and must be consistent with documentation in the patient s medical record. Quest Diagnostics does not recommend any diagnosis codes and will only submit diagnosis information provided to us by the ordering physician or his/her designated staff.

2 The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed. Please note this document has been updated with National Medicare changes effective 7/1/2015 Medicare National and Local Coverage Determination Policy FLORIDA 08/27/2015 Click policy below for Local MLCP Policy Tool Document contains the below Medicare Local MLCP Coverage Policies for lab testing performed in Florida Allergy Testing Aluminum B-Type Natriuretic Peptide (BNP) Circulating tumor cell testing Flow Cytometry Hepatic (Liver) Function Panel Hepatitis B Surface Antibody Hepatitis B Surface Antigen High Sensitivity C-Reactive Protein (hsCRP) Ionized Calcium Magnesium Molecular Pathology Procedures Non-Covered ICD 9 Parathormone, (Parathyroid Hormone) Qualitative Drug Screening Sedimentation Rate Serum Phosphorus Susceptibility Studies Syphilis Total, Calcium Vitamin D.

3 25 Hydroxy, includes Fraction(S) if performed Click here for National MLCP Policies Tool Document contains information on National Medicare Limited Coverage Policies Alpha-Fetoprotein Blood Counts Blood Glucose Testing Carcinoembryonic Antigen Collagen Crosslinks - Any Method Digoxin Therapeutic Drug Assay Fecal Occult Blood Gamma Glutamyl Transferase Glycated Hemoglobin - Glycated Protein Hepatitis Panel/Acute Hepatitis Panel Human Chorionic Gonadotropin Human Immunodeficiency Virus (HIV) Testing (Diagnosis) Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) Lipids Testing Partial Thromboplastin Time (PTT) Prostate Specific Antigen Prothrombin Time (PT) Serum Iron Studies Thyroid Testing Tumor Antigen by Immunoassay CA 15-3 CA Tumor Antigen by Immunoassay CA 19-9 Tumor Antigen by Immunoassay CA-125 Urine Culture, Bacterial Last Updated: This list was compiled from Medicare s Limited Coverage Policies for informational and reference purposes only.

4 For the most cu rrent information please reference Note: If the patient s medical record does not support one of the above ICD-9-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it. Source: Federal Registry Negotiated Rule-making, November 23, 2001 The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed. Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third party marks - and - are the property of their respective owners. 2015 Quest Diagnostics Incorporated. All rights reserved LCD Description: Allergy is a form of exaggerated sensitivity or hypersensitivity to a substance that is either inhaled, ingested, injected, or comes in contact with the skin or eye.

5 The term allergy is used to describe situations where hypersensitivity results from heightened or altered reactivity of the immune system in response to external substances. Allergic or hypersensitivity disorders may be manifested by generalized systemic reactions as well as localized reactions in any part of the body. The reactions may be acute, sub-acute, or chronic, immediate or delayed, and may be caused by a variety of offending agents; pollen, molds, mites, dust, feathers, animal fur or dander, venoms, foods, drugs, etc. Allergy testing is performed to determine a patient's immunologic sensitivity or reaction to particular allergens for the purpose of identifying the cause of the allergic state, and is based on findings during a complete medical and immunologic history and appropriate physical exam obtained by face-to-face contact with the patient.

6 ICD-9-CM Codes that Support Medical Necessity: The Allergy Testing test is determined to be medically necessary by Medicare only when it is ordered for patients with one of the conditions listed below. ICD-9 -CM codes that support medical necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-9 -CM code. The diagnosis must be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patient s medical record must support the medical necessity for the test(s). This list was compiled from the Medicare National Coverage Determination Policy. An ICD-D -9 -CM book should be used as a complete reference. Medicare Local Coverage Determination Policy Florida Allergy Testing (L31271) CPT Code 86003 * ICD-9-CM code should be used as a secondary code only and should not be billed as the primary diagnosis.

7 Data Source: 10/3/11 ACUTE ATOPIC CONJUNCTIVITIS OTHER CHRONIC ALLERGIC CONJUNCTIVITIS ALLERGIC RHINITIS DUE TO POLLEN ALLERGIC RHINITIS DUE TO FOOD ALLERGIC RHINITIS, DUE TO ANIMAL (CAT) (DOG) HAIR AND DANDER ALLERGIC RHINITIS DUE TO OTHER ALLERGEN ALLERGIC RHINITIS CAUSE UNSPECIFIED EXTRINSIC ASTHMA UNSPECIFIED EXTRINSIC ASTHMA WITH STATUS ASTHMATICUS EXTRINSIC ASTHMA WITH (ACUTE) EXACERBATION ASTHMA UNSPECIFIED ASTHMA UNSPECIFIED TYPE WITH STATUS ASTHMATICUS ASTHMA UNSPECIFIED WITH (ACUTE) EXACERBATION OTHER ATOPIC DERMATITIS AND RELATED CONDITIONS CONTACT DERMATITIS AND OTHER ECZEMA UNSPECIFIED CAUSE DERMATITIS DUE TO DRUGS AND MEDICINES TAKEN INTERNALLY DERMATITIS DUE TO FOOD TAKEN INTERNALLY DERMATITIS DUE TO OTHER SPECIFIED SUBSTANCES TAKEN INTERNALLY DERMATITIS DUE TO UNSPECIFIED SUBSTANCE TAKEN INTERNALLY ALLERGIC URTICARIA DERMATOGRAPHIC URTICARIA OTHER SPECIFIED URTICARIA UNSPECIFIED URTICARIA RASH AND OTHER NONSPECIFIC SKIN ERUPTION TOXIC EFFECT OF VENOM TOXIC EFFECT OF LATEX OTHER ANAPHYLACTIC REACTION ANGIONEUROTIC EDEMA NOT ELSEWHERE CLASSIFIED UNSPECIFIED ADVERSE EFFECT OF UNSPECIFIED DRUG.

8 MEDICINAL AND BIOLOGICAL SUBSTANCE UNSPECIFIED ADVERSE EFFECT OF ANESTHESIA Last Updated: This list was compiled from Medicare s Limited Coverage Policies for informational and reference purposes only. For the most cu rrent information please reference Note: If the patient s medical record does not support one of the above ICD-9-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it. Source: Federal Registry Negotiated Rule-making, November 23, 2001 The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed. Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.

9 All third party marks - and - are the property of their respective owners. 2015 Quest Diagnostics Incorporated. All rights reserved LCD Description: Aluminum is the third most prevalent element in the earth s crust. The gastrointestinal tract is virtually impervious to aluminum, absorption being around 2%. Factors regulating aluminum s crossing of the blood-brain barrier are not well understood. Serum aluminum correlates with encephalopathy. Aluminum toxicity has been recognized in many settings where exposure is heavy or prolonged and/or where renal function is limited. ICD-9-CM Codes that Support Medical Necessity: The Aluminum test is determined to be medically necessary by Medicare only when it is ordered for patients with one of the conditions listed below. ICD-9-CM codes that support medical necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-9-CM code.

10 The diagnosis must be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patient s medical record must support the medical necessity for the test(s). This list was compiled from the Medicare National Coverage Determination Policy. An ICD-D-9-CM book should be used as a complete reference. Medicare Local Coverage Determination Policy - Florida Aluminum (L29058) CPT Code 82108 * These ICD-9-CM codes require dual diagnosis. ICD-9-CM code must be accompanied by the appropriate E diagnosis code to identify the toxic agent. Conversely, the E diagnosis codes must be billed with ICD-9-CM code to identify the indication of toxic myopathy. Data Source: 10/3/11 ACUTE ATOPIC CONJUNCTIVITIS OTHER CHRONIC ALLERGIC CONJUNCTIVITIS ALLERGIC RHINITIS DUE TO POLLEN ALLERGIC RHINITIS DUE TO FOOD ALLERGIC RHINITIS, DUE TO ANIMAL (CAT) (DOG) HAIR AND DANDER ALLERGIC RHINITIS DUE TO OTHER ALLERGEN ALLERGIC RHINITIS CAUSE UNSPECIFIED EXTRINSIC ASTHMA UNSPECIFIED EXTRINSIC ASTHMA WITH STATUS ASTHMATICUS EXTRINSIC ASTHMA WITH (ACUTE) EXACERBATION ASTHMA UNSPECIFIED ASTHMA UNSPECIFIED TYPE WITH STATUS ASTHMATICUS ASTHMA UNSPECIFIED WITH (ACUTE)