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Medicare Medical Necessity
As an informational service to LabCorp accounts, this page contains certain Local Coverage Determinations (LCDs) issued by the Medicare Administrative Contractors (MACs) and National Coverage Determinations (NCDs) issued by the Centers for Medicare & Medicaid Services (CMS).
A claim submitted for payment of a test on a local or national list—without a specific diagnosis code that indicates medical necessity based upon the local or national policies—will result in denial of payment for these services. The Medicare program will allow the laboratory to bill the patient for denied LCD/NCD coverage services only if an Advance Beneficiary Notice of Noncoverage (ABN) is completed, signed and dated by the patient prior to service being rendered, and forwarded to the laboratory prior to testing. This policy applies to all Medicare Part B providers of clinical laboratory services. Diagnosis codes provided must be reflected in the patient's medical record.
To view an alphabetical index of NCDs, click here to visit the Centers for Medicare & Medicaid Services website.