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Laboratory Charge Capture & Compliance

Contact Information

Direct Line:  (585) 922-1167

Fax: (585) 922-1168

Manager: Shirley Slater: (585) 922-1164

Medical Necessity for Ordering Lab Tests

Any test ordered through the Department of Pathology and Laboratory Medicine must be accompanied by signs and symptoms or a diagnosis indicating the reason for ordering each test.  Requisitions must be signed by a provider. 

Tips for Requisition Completion

  • A diagnosis or signs and symptoms must be placed on the requisition relating to each test ordered. Provide all codes or narrative data that are appropriate for the tests ordered. ALL insurances require diagnostic information on claims for laboratory services.
     
  • ICD-9 codes must contain all digits as specified in the current ICD-9 code book ( i.e., 272 is not a valid code). It must be written with a fourth digit code (Example: 272.0).
     
  • R/O, screening, up or down arrows, +, -, or possible before a narrative diagnosis are not acceptable. 
     
  • Medicare does not pay for laboratory testing for screening purposes except as specifically allowed by regulation. Appropriate screening diagnoses must be provided when allowed screening tests are requested.

Thank you for your cooperation and assistance in helping us provide quality laboratory testing to your patients.

Medical Necessity Policies (National or Local Coverage Decisions)

Medicare has established medical necessity criteria for a variety of tests through local or national coverage decisions. This medical necessity criteria may also be followed by private insurers who offer HMO or managed care coverage to medicare-eligible individuals.

If laboratory tests are requested without covered diagnoses on the requisition, the patient will be asked to sign an Advance Beneficiary Notice (ABN), or your office will be contacted for additional diagnostic information.

Click here for the current information on Medicare coverage decisions.

View or print the entire NCD manual

Medical Necessity Policies Type
Acid Phosphatase (discontinued January 2013) LCD
Alpha-fetoprotein (revised July 2012) NCD
Amylase (discontinued June 2007) LCD
Beta2 Microglobulin (added November 2008) LCD
Blood Counts (revised July 2012) NCD
Blood Glucose Testing (revised July 2012) NCD 
B-type Natriuretic Peptide (BNP) Testing (revised February 2009) LCD
Carcinoembryonic Antigen (revised July 2012) NCD
Chloride, Blood (discontinued June 2007) LCD
Collagen Crosslinks, Any Method (revised July 2012) NCD
Urine Culture (Bacterial Urine Culture) (revised July 2012) NCD
Digoxin Therapeutic Drug Assay (revised July 2012) NCD
Erythrocyte Sedimentation Rate (ESR) (revised October 2009) LCD
Fecal Occult Blood (revised July 2012) NCD
Flow Cytometry (revised October 2010) LCD
Gamma Glutamyl Transferase (revised July 2012) NCD
Glycated Hemoglobin/Glycated Protein (revised July 2012) NCD
Helicobacter Pylori Tests (discontinued June 2007) LCD 
Hepatic Function Panel (discontinued December 2011) LCD
Hepatitis Panel/Acute Hepatitis Panel (revised July 2012) NCD
High Sensitivity C-Reactive Protein (hsCRP) Testing (discontinued April 2012) LCD 
Homocysteine Level, Serum (revised October 2009) LCD
Human Chorionic Gonadotropin (revised July 2012) NCD
Human Immunodeficiency Virus Testing (Diagnosis) (revised July 2012) NCD
Human Immunodeficiency Virus Testing (Prognosis including monitoring) (revised July 2012) NCD
Ionized Calcium (added November 2008) LCD
Lipid Testing (revised July 2012) NCD
Pap Smear of the Cervical or Vaginal Mucosa (discontinued June 2007) LCD
Parathormone (Parathyroid Hormone, PTH) (discontinued April 2012) LCD
Partial Thromboplastin Time (PTT) (revised July 2012) NCD
Phosphorus inorganic (phosphate) (discontinued June 2007) LCD
Potassium (Serum) Levels (discontinued June 2007) LCD
Prostate Specific Antigen (revised July 2012) NCD
Prothrombin Time (PT) (revised July 2012) NCD
Qualitative Drug Screen (revised August 2011) LCD
RAST Type Tests (revised October 2009) LCD
Reticulocyte Counts (discontinued June 2007) LCD
Serum Iron Studies (revised July 2012) NCD 
Serum Magnesium (discontinued May 2012) LCD

Syphilis Tests (revised January 2010)

LCD
Thyroid Testing (revised July 2012) NCD
Tumor Antigen by Immunoassay CA 19-9 (revised July 2012) NCD
Tumor Antigen by Immunoassay CA15-3/CA 27.29 (revised July 2012) NCD
Tumor Antigen by Immunoassay CA125 (revised July 2012) NCD
Urinalysis (discontinued June 2007) LCD
Viral Hepatitis Serology Tests (discontinued December 2011) LCD
Vitamin D25-OH (added September 2009) LCD