Billing and Coding: Frequency of Laboratory Tests

Coverage for laboratory tests is allowed when tests meet the reasonable and necessary clinical criteria and frequency limits specified in Novitas LCD L35099 and when billed with ICD-10-CM codes recognized by Medicare NCDs. CPT/HCPCS codes are subject to NCCI edits, and NCCI-associated modifiers must not be used to bypass PTP edits unless their specific criteria are met; supporting documentation in the medical record is required for modifier use and to demonstrate medical necessity.

"Laboratory tests are covered when they meet the reasonable and necessary clinical criteria and frequency limitations specified in Novitas LCD L35099."

Sign up to see full coverage criteria, indications, and limitations.