Blood Counts

Complete blood count (CBC) testing is covered when used to evaluate suspected abnormalities of red cells, white cells, or platelets or to assess bone marrow dysfunction from neoplasm, drugs, toxins, pregnancy, or specific inherited/toxic conditions (e.g., thalassemia, hemoglobinopathies, lead poisoning). Screening CBCs in asymptomatic individuals without expected hematologic abnormalities are not covered; hemoglobin/hematocrit-only requests cover only those tests. Repeat CBCs are generally limited to situations with abnormal prior results, a change in clinical condition, or ongoing risk for hematologic disease, and documentation of medical necessity is required (including special billing documentation for ESRD patients billed outside the ESRD rate).

"CBC/hemogram is indicated for evaluation of red blood cell, white blood cell, or platelet disorders (e."

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