Medicare Coverage Policies
The policies listed here are the Medicare Local Coverage Determinations (LCDs) and the National Coverage Determinations (NCDs) and are intended to be a quick reference, not a substitute for the complete LCDs, NCDs or the ICD-10 manual.
The complete policies may be accessed through Centers for Medicare and Medicaid Services.
For information on ICD-10 codes, as well as a complete, please refer to the provided ICD-10 resources.
Most Medicare Advantage Plans follow these coverage policies. Please consult the specific Medicare Advantage carrier for confirmation.
2024 Medicare Coverage Policies
| Medical Policy | CPT | Link |
| 4KScore Test | 81539 | Article - Billing and Coding: 4Kscore Test Algorithm (A56653) (cms.gov) |
| Acute Hep Panel/Hepatitis Panel | 80074 | NCD - Hepatitis Panel/Acute Hepatitis Panel (190.33) (cms.gov) |
| Allergy testing | 82785, 86001, 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076, 95079, 86003, 82785 | Article - Billing and Coding: Allergy Testing (A56558) (cms.gov) |
| Alpha-Fetoprotein | 82105 | NCD - Alpha-fetoprotein (190.25) (cms.gov) |
| Assays of Vitamins/Metabolic Function | 82180, 82306, 82379, 82607, 82652, 82746, 83090, 83698, 84207, 84252, 84255, 84425, 84446, 84590, 85497, 85385, 86352, 84255, 84591, 84999 | Article - Billing and Coding: Assays for Vitamins and Metabolic Function (A56416) (cms.gov) |
| Biomarkers for Oncology | 0002U, 0003U, 0005U, 0009U, 0013U, 0014U, 0016U, 0017U, 0022U, 0026U, 81120, 81121, 81170, 81175, 81176, 81206, 81207, 81208, 81210, 81218, 81219, 81235, 81245, 81246, 81261, 81262, 81263, 81270, 81272, 81273, 81275, 81276, 81287, 81292, 81293, 81294, 81301, 81310, 81311, 81313, 81314, 81315, 81316, 81321, 81322, 81323, 81327, 81334, 81340, 81342, 81350, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81435, 81436, 81437, 81438, 81445, 81450, 81479, 81503, 81520, 81525, 81538, 81540, 81545 | Article - Billing and Coding: Biomarkers for Oncology (A52986) (cms.gov) |
| Biomarkers Overview | 0001U , 81201 , 81202 , 81203 , 81240 , 81241 , 81242 , 81250 , 81251 , 81252 , 81253 , 81254 , 81255 , 81256 , 81257 , 81258 , 81259 , 81265 , 81266 , 81267 , 81268 , 81269 , 81288 , 81290 , 81295 , 81296 , 81297 , 81298 , 81299 , 81300 , 81317 , 81318 , 81319 , 81324 , 81325 , 81326 , 81329 , 81332 , 81336 , 81337 , 81370 , 81371 , 81372 , 81373 , 81375 , 81376 , 81378 , 81379 , 81380 , 81382 , 81490 , 81595 , | Article - Billing and Coding: Biomarkers Overview (A56541) (cms.gov) |
| Blood Count | 85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032 | NCD - Blood Counts (190.15) (cms.gov) |
| Blood Glucose Test | 82947, 82948, 82962 | NCD - Blood Glucose Testing (190.20) (cms.gov) |
| BRCA1 & BRCA2 Genetic Testing | 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433 | Article - Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542) (cms.gov) |
| Carcinoembryonic Antigen | 82378 | NCD - Carcinoembryonic Antigen (190.26) (cms.gov) |
| Collagen Cross Links | 82523 | NCD - Collagen Crosslinks, any Method (190.19) (cms.gov) |
| Comprehensive Stool Guideline aka Gastrointestinal Pathogen Panel | 87505, 87506, 87507, 0097U | Article - Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642) (cms.gov) |
| Controlled Substance/Monitoring and Drug Abuse | 80305, 80306, 80307, 80159, 80171, 80173, 80183, 80184, 83789, 83992, 84999, G0480, G0481, G0482, G0483, G0659 | Article - Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645) (cms.gov) |
| C-Reactive Protein High Sensitivity Testing (HSCRP) | 86141 | Article - Billing and Coding: C-Reactive Protein High Sensitivity Testing (hsCRP) (A56643) (cms.gov) |
| Cytogenetic Studies | 88230, 88233, 88235, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291 | NCD - Cytogenetic Studies (190.3) (cms.gov) |
| Digoxin (Therapeutic Drug Assay) | 80162 | NCD - Digoxin Therapeutic Drug Assay (190.24) (cms.gov) |
| Fecal Occult Blood | 82272 | NCD - Fecal Occult Blood Test (190.34) (cms.gov) |
| FLU/COVID Policy | 87636 | Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) (cms.gov) |
| Gamma Glutamyl Transferase | 82977 | NCD - Gamma Glutamyl Transferase (190.32) (cms.gov) |
| Genetic Testing for Oncology | Article - Billing and Coding: Genetic Testing for Oncology (A59125) (cms.gov) | |
| Glycated Hemoglobin/protein | 82985, 83036 | NCD - Glycated Hemoglobin/Glycated Protein (190.21) (cms.gov) |
| Histocompatibility Test | 86812, 86813, 86816, 86817, 86821, 86825, 86826 | NCD - Histocompatibility Testing (190.1) (cms.gov) |
| Human Chorionic Gonadotrpin (Beta HCG) | 84702 | NCD - Human Chorionic Gonadotropin (190.27) (cms.gov) |
| Human Immunodeficiency Virus HIV Testing (diagnosis) | 86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538 | NCD - Human Immunodeficiency Virus (HIV) Testing (Diagnosis) (190.14) (cms.gov) |
| Human Immunodeficiency Virus HIV Testing (monitoring ) | 87536, 87539 | NCD - Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) (190.13) (cms.gov) |
| Lipids Testing | 80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478 | NCD - Lipid Testing (190.23) (cms.gov) |
| Lymphocyte Mitogen Response Assays | 86352, 86353 | NCD - Lymphocyte Mitogen Response Assays (190.8) (cms.gov) |
| Molecular Pathology and Genetic Testing | Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917) (cms.gov) | |
| Partial Thromboplastin Time (PTT) | 85730 | NCD - Partial Thromboplastin Time (PTT) (190.16) (cms.gov) |
| Pharmacogenomics Testing | 81220, 81225, 81418, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 81226, 0392U, 81227, 81231, 81323, 81247, 81283, 0286U, 81306, 81335, 81328, 81350, 81374, 81381, 81377, 81383, 81401, 81406, 81479, 0193U, 0029U, 0031U, 0032U, 0033U, 0117U, 0173U, 0175U, 81230, 81346, 81355, 81407, 81408 | Article - Billing and Coding: Pharmacogenomics Testing (A58801) (cms.gov) |
| Prostate Specific Antigen (PSA) | 84153 | NCD - Prostate Specific Antigen (190.31) (cms.gov) |
| Prothrombin-Time-(PT) | 85610 | NCD - Prothrombin Time (PT) (190.17) (cms.gov) |
| Respiratory Pathogen Panel Testing | 0240U, 0241U, 87428, 87631, 87636, 87637 & 0115U, 0202U, 0223U, 0225U, 87632, 87633 | Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) (cms.gov) |
| Serum Iron Study | 82728, 83540, 83550, 84466 | NCD - Serum Iron Studies (190.18) (cms.gov) |
| Sweat Test | 82438, 89230 | NCD - Sweat Test (190.5) (cms.gov) |
| Thyroid Testing | 84436, 84439, 84443, 84479 | NCD - Thyroid Testing (190.22) (cms.gov) |
| Tumor Antigen CA 15-3, CA 27.29 | 86300 | NCD - Tumor Antigen by Immunoassay - CA 15-3/CA 27.29 (190.29) (cms.gov) |
| Tumor Antigen CA125 | 86304 | NCD - Tumor Antigen by Immunoassay - CA 125 (190.28) (cms.gov) |
| Tumor Antigen CA19-9 | 86301 | NCD - Tumor Antigen by Immunoassay - CA 19-9 (190.30) (cms.gov) |
| Urine Culture, Bacterial | 87086, 87088 | NCD - Urine Culture, Bacterial (190.12) (cms.gov) |
2023 Medicare Coverage Policies
| Medical Policy | CPT | Link |
| 4KScore Test | 81539 | Article - Billing and Coding: 4Kscore Test Algorithm (A56653) (cms.gov) |
| Acute Hep Panel/Hepatitis Panel | 80074 | NCD - Hepatitis Panel/Acute Hepatitis Panel (190.33) (cms.gov) |
| Allergy testing | 82785, 86001, 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076, 95079, 86003, 82785 | Article - Billing and Coding: Allergy Testing (A56558) (cms.gov) |
| Alpha-Fetoprotein | 82105 | NCD - Alpha-fetoprotein (190.25) (cms.gov) |
| Assays of Vitamins/Metabolic Function | 82180, 82306, 82379, 82607, 82652, 82746, 83090, 83698, 84207, 84252, 84255, 84425, 84446, 84590, 85497, 85385, 86352, 84255, 84591, 84999 | Article - Billing and Coding: Assays for Vitamins and Metabolic Function (A56416) (cms.gov) |
| Biomarkers for Oncology | 0002U, 0003U, 0005U, 0009U, 0013U, 0014U, 0016U, 0017U, 0022U, 0026U, 81120, 81121, 81170, 81175, 81176, 81206, 81207, 81208, 81210, 81218, 81219, 81235, 81245, 81246, 81261, 81262, 81263, 81270, 81272, 81273, 81275, 81276, 81287, 81292, 81293, 81294, 81301, 81310, 81311, 81313, 81314, 81315, 81316, 81321, 81322, 81323, 81327, 81334, 81340, 81342, 81350, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81435, 81436, 81437, 81438, 81445, 81450, 81479, 81503, 81520, 81525, 81538, 81540, 81545 | Article → |
| Biomarkers Overview | 0001U , 81201 , 81202 , 81203 , 81240 , 81241 , 81242 , 81250 , 81251 , 81252 , 81253 , 81254 , 81255 , 81256 , 81257 , 81258 , 81259 , 81265 , 81266 , 81267 , 81268 , 81269 , 81288 , 81290 , 81295 , 81296 , 81297 , 81298 , 81299 , 81300 , 81317 , 81318 , 81319 , 81324 , 81325 , 81326 , 81329 , 81332 , 81336 , 81337 , 81370 , 81371 , 81372 , 81373 , 81375 , 81376 , 81378 , 81379 , 81380 , 81382 , 81490 , 81595 , | Article - Billing and Coding: Biomarkers Overview (A56541) (cms.gov) |
| Blood Count | 85004, 85007, 85008, 85013, 85014, 85018, 85025, 85027, 85032 | NCD - Blood Counts (190.15) (cms.gov) |
| Blood Glucose Test | 82947, 82948, 82962 | NCD - Blood Glucose Testing (190.20) (cms.gov) |
| BRCA1 & BRCA2 Genetic Testing | 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433 | Article - Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542) (cms.gov) |
| Carcinoembryonic Antigen | 82378 | NCD - Carcinoembryonic Antigen (190.26) (cms.gov) |
| Collagen Cross Links | 82523 | NCD - Collagen Crosslinks, any Method (190.19) (cms.gov) |
| Colorectal Cancer Screening | 81528, 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0327, G0328 | NCD - Colorectal Cancer Screening Tests (210.3) (cms.gov) |
| Comprehensive Stool Guideline aka Gastrointestinal Pathogen Panel | 87505, 87506, 87507, 0097U | Article - Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642) (cms.gov) |
| Controlled Substance/Monitoring and Drug Abuse | 80305, 80306, 80307, 80159, 80171, 80173, 80183, 80184, 83789, 83992, 84999, G0480, G0481, G0482, G0483, G0659 | Article - Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645) (cms.gov) |
| C-Reactive Protein High Sensitivity Testing (HSCRP) | 86141 | Article - Billing and Coding: C-Reactive Protein High Sensitivity Testing (hsCRP) (A56643) (cms.gov) |
| Cytogenetic Studies | 88230, 88233, 88235, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291 | NCD - Cytogenetic Studies (190.3) (cms.gov) |
| Digoxin (Therapeutic Drug Assay) | 80162 | NCD - Digoxin Therapeutic Drug Assay (190.24) (cms.gov) |
| Fecal Occult Blood | 82272 | NCD - Fecal Occult Blood Test (190.34) (cms.gov) |
| Flow Cytometry | 88182, 88184, 88185, 88187, 88188, 88189 | Article - Billing and Coding: Flow Cytometry (A56676) (cms.gov) |
| FLU/COVID Policy | 87636 | Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) (cms.gov) |
| Gamma Glutamyl Transferase | 82977 | NCD - Gamma Glutamyl Transferase (190.32) (cms.gov) |
| Glycated Hemoglobin/protein | 82985, 83036 | NCD - Glycated Hemoglobin/Glycated Protein (190.21) (cms.gov) |
| Histocompatibility Test | 86812, 86813, 86816, 86817, 86821, 86825, 86826 | NCD - Histocompatibility Testing (190.1) (cms.gov) |
| Human Chorionic Gonadotrpin (Beta HCG) | 84702 | NCD - Human Chorionic Gonadotropin (190.27) (cms.gov) |
| Human Immunodeficiency Virus HIV Testing (diagnosis) | 86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538 | NCD - Human Immunodeficiency Virus (HIV) Testing (Diagnosis) (190.14) (cms.gov) |
| Human Immunodeficiency Virus HIV Testing (monitoring ) | 87536, 87539 | NCD - Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) (190.13) (cms.gov) |
| Lipids Testing | 80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478 | NCD - Lipid Testing (190.23) (cms.gov) |
| Lymphocyte Mitogen Response Assays | 86352, 86353 | NCD - Lymphocyte Mitogen Response Assays (190.8) (cms.gov) |
| Molecular Pathology and Genetic Testing | Article - Billing and Coding: Molecular Pathology and Genetic Testing (A58917) (cms.gov) | |
| Partial Thromboplastin Time (PTT) | 85730 | NCD - Partial ThromboplastinTime (PTT) (190.16) (cms.gov) |
| Prothrombin-Time-(PT) | 85610 | NCD - Prothrombin Time (PT) (190.17) (cms.gov) |
| Prostate Specific Antigen (PSA) | 84153 | NCD - Prostate Specific Antigen (190.31) (cms.gov) |
| Respiratory Pathogen Panel Testing | 0240U, 0241U, 87428, 87631, 87636, 87637 & 0115U, 0202U, 0223U, 0225U, 87632, 87633 | Article - Billing and Coding: Respiratory Pathogen Panel Testing (A58575) (cms.gov) |
| Serum Iron Study | 82728, 83540, 83550, 84466 | NCD - Serum Iron Studies (190.18) (cms.gov) |
| Sweat Test | 82438, 89230 | NCD - Sweat Test (190.5) (cms.gov) |
| Thyroid Testing | 84436, 84439, 84443, 84479 | NCD - Thyroid Testing (190.22) (cms.gov) |
| Tumor Antigen CA125 | 86304 | NCD - Tumor Antigen by Immunoassay - CA 125 (190.28) (cms.gov) |
| Tumor Antigen CA 15-3, CA 27.29 | 86300 | NCD - Tumor Antigen by Immunoassay - CA 15-3/CA 27.29 (190.29) (cms.gov) |
| Tumor Antigen CA19-9 | 86301 | NCD - Tumor Antigen by Immunoassay - CA 19-9 (190.30) (cms.gov) |
| Urine Culture, Bacterial | 87086, 87088 | NCD - Urine Culture, Bacterial (190.12) (cms.gov) |