83721
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- The medical record must document and satisfy the criteria required for any NCCI-associated modifier that is reported.
- Claims must follow NCCI coding guidelines and applicable code-combination rules prior to billing Medicare.
- Documentation supporting that tests meet 'reasonable and necessary' criteria and applicable frequency limits must be maintained per Novitas LCD L35099.
- Claims should be supported with documentation consistent with LCD L36129; this article provides billing and coding guidelines that complement that LCD and should be used alongside the LCD when submitting claims.
Key Coverage Criteria
- Laboratory tests are covered when they meet the reasonable and necessary clinical criteria and frequency limitations specified in Novitas LCD L35099.
- Procedure codes are covered for the ICD-10-CM diagnoses listed as covered in the Medicare NCDs referenced at the CMS NCD ICD-10 laboratory list.
- No clinical indications are specified in this article; coverage indications are determined by the referenced LCD L36362 (MolDX: Biomarkers in Cardiovascular Risk Assessment).
- This article contains billing and coding guidance only and does not itself define clinical indications; refer to MolDX: Biomarkers in Cardiovascular Risk Assessment LCD L36139 for covered clinical indications.
- A laboratory service is reasonable and necessary only when ordered by a physician who uses the test result in the management of the beneficiary's specific medical problem.
- A laboratory result must be reported promptly to the ordering physician and the physician must use that result prior to ordering a similar subsequent laboratory test to qualify for separate payment.
14 Active Policies
L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
A57559 — Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
A56420 — Billing and Coding: Frequency of Laboratory Tests
J12
L35099 — Frequency of Laboratory Tests
J12
A57037
Related Codes
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