Billing and Coding: Sedimentation Rate, Erythrocyte

ESR testing is covered only when reasonable and necessary per LCD L34021; ESRs ordered to assess medication adjustments in rheumatoid arthritis patients should be billed with medication-specific T-code diagnosis ranges. Documentation must be maintained and legible, include provider signature and patient identifiers, and must support the selected ICD-10-CM and CPT/HCPCS codes; non-covered services must be billed with the appropriate modifier.

"Erythrocyte sedimentation rate (ESR) testing is covered only when reasonable and necessary as defined by Local Coverage Determination L34021."

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