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Billing and Coding: 4Kscore Test Algorithm
A56653
Policy Summary
Coverage for the 4Kscore test is determined by meeting the reasonable and necessary requirements in LCD L37792; refer to that LCD for specific clinical indications. Claims must be supported by complete, legible medical records including ICD-10 and CPT/HCPCS support, clinician signature, and documented shared decision-making (SDM) with the patient (SDM must be provided to the performing lab before testing). Do not bill Medicare for non-covered services as covered and, if billing non-covered services, submit the appropriate modifier.
Coverage Criteria Preview
Key requirements from the full policy
"4Kscore testing is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L37792."
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