Medicare Coverage and Coding Reference Guide

Med-Lake is pleased to provide Medicare coverage and coding reference guides to help you determine test coverage and find ICD-10 diagnostic codes to submit with your test orders.

Medicare has limited coverage policies (MLCPs) for certain laboratory tests. Tests subject to an MLCP must meet medical necessity criteria to be covered by Medicare. MLCP tested without a supportive ICD-10 code will not be covered by Medicare. These orders must be submitted with an Advanced Beneficiary Notice signed by your patient, which confirms they are responsible for the payment.

To get started, identify your state below where your testing is performed and select the corresponding color in the legend.

Local Coverage Determinations are issued by Medicare administrative contractors (MACs), and National Coverage Determinations are issued by the Centers for Medicare and Medicaid Services (CMS). The map above shows the regional MACs that have jurisdiction over testing. To view the full coverage policy for any National Coverage Determination from the CMS website, which includes a list of medically supportive ICD-10 codes, please click here.