LCDActive
Frequency of Laboratory Tests
L35099
Novitas Solutions, Inc. (J12)
Effective: November 7, 2019
Updated: December 31, 2025
Policy Summary
Medicare covers laboratory tests only when ordered by a physician who promptly receives and uses the test result to manage the beneficiary's specific medical problem; standing orders do not qualify for separate payment. Frequency limits apply to lipid, thyroid, glucose, and glycated hemoglobin/protein testing per the Utilization Guidelines, glucose monitoring devices are covered under Part B DME only when used in the home, and routine glucose monitoring in SNFs is never covered.
Coverage Criteria Preview
Key requirements from the full policy
"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."
Sign up to see full coverage criteria, indications, and limitations.