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ICD-10 Medicare Limited Coverage Policies

Medicare Limited Coverage Policies

Reference Guide

The lists of covered diagnosis codes for National and Local Medicare Limited Coverage Policies are provided as links for determining if the test is reimbursable by Medicare based on the patient's symptoms or medical condition as indicated by the appropriate ICD-CM code. Please note diagnosis codes are required for all Medicare orders to document medical necessity of the testing.

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, CompuNet Clinical laboratories can seek reimbursement from the patient only when the patient has been notified in advance of the testing that Medicare is likely to deny payment for these services. If the patient chooses to have the test performed, they must complete an Advance Beneficiary Notice (ABN), confirming their understanding that they will be responsible for payment.

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.


National Coverage Determination (NCD) Policies

Local Medicare Policies

CareSource Reimbursement Policies