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Medicare LCD/NCD Policy

The documents below are provided as an aid to physicians and office staff in determining when an ABN (Advance Beneficiary Notice) is necessary. Norton Healthcare/CPA Lab does not recommend any diagnosis codes and will only submit diagnosis information provided to us by the ordering physician or his/ her designated staff. The lists of covered diagnosis codes for National and Local Medicare Limited Coverage Policies are provided as a guide for determining if the test is reimbursable by Medicare based on the patient's symptoms or medical condition as indicated by the appropriate ICD-9-CM code. Please note diagnosis codes are required for all Medicare orders to document medical necessity of the testing.

Diagnosis codes must be applicable to the patient's symptoms or conditions and must be consistent with documentation in the patient's medical record. If the diagnosis provided does not meet the reimbursement rules, or if the frequency limit on test procedures has been exceeded, payment may be denied. In that case, The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed. This list was compiled from Medicare’s Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov. If the patient’s medical record does not support the referenced ICD-9 codes, please ask the patient to read and sign an Advance Beneficiary Notice. Source: Federal Registry Negotiated Rulemaking, November 23, 2001.

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