Billing and Coding

Medicare Coverage and Coding Guides

Policies for Medicare Region JM Palmetto

Below, you’ll find a list of Medicare Coverage Policies for tests or test groups applicable to your state. Diagnosis codes are required for all Medicare orders to document medical necessity.

Click on the links below to find the associated diagnosis codes and frequency information within the policy for the test you want to order. Some links will provide a concise Medicare Coverage and Coding Guide for the coverage policy, while others will direct you to the CMS website policy page. The full list can be viewed by clicking here.

*Disclaimer: This document serves as a summary of Medicare NCDs for laboratory tests performed by Med-Lake. The summary DOES NOT address all Medicare requirements for medically necessary laboratory testing. Instead, Med-Lake intends this summary to serve as quick reference to physicians and medical office staff for diagnosis coding and for determining whether it is necessary to provide a Medicare beneficiary with an ABN (Advance Beneficiary Notice). Diagnosis codes must be applicable to the patient’s symptoms or conditions and must be consistent with documentation in the patient’s medical record. Med-Lake Laboratory does not recommend any diagnosis codes and will only submit diagnosis information provided to us by the ordering physician or his/her designated staff. 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.