Laboratory National Coverage Determinations included for Laboratory Customers

CPT Policy Number Title Original Effective Date Last Revised
80061 190.23 Lipids Testing 11/25/2002 10/1/2009
80074 190.33 Hepatitis Panel/Acute Hepatitis Panel 11/25/2002 10/1/2009
80162 190.24 Digoxin Therapeutic Drug Assay 11/25/2002 10/1/2009
82105 190.25 Alpha-fetoprotein 11/25/2002 10/1/2009
82270 190.34 Fecal Occult Blood Test 11/25/2002 7/1/2008
82272 190.34 Fecal Occult Blood Test 11/25/2002 10/1/2009
82378 190.26 Carcinoembryonic Antigen 11/25/2002 10/1/2009
82465 190.23 Lipids Testing 11/25/2002 10/1/2009
82523 190.19 Collagen Crosslinks, Any Method 11/25/2002
82728 190.18 Serum Iron Studies 11/25/2002 1/1/2010
82947 190.2 Blood Glucose Testing 11/25/2002 4/1/2009
82948 190.2 Blood Glucose Testing 11/25/2002 4/1/2009
82962 190.2 Blood Glucose Testing 11/25/2002 4/1/2009
82977 190.32 Gamma Glutamyl Transferase 11/25/2002 1/1/2010
82985 190.21 Glycated Hemoglobin/Glycated Protein 11/25/2002 1/1/2009
83036 190.21 Glycated Hemoglobin/Glycated Protein 11/25/2002 1/1/2009
83540 190.18 Serum Iron Studies 11/25/2002 1/1/2010
83550 190.18 Serum Iron Studies 11/25/2002 1/1/2010
83700 190.23 Lipids Testing 11/25/2002 10/1/2009
83701 190.23 Lipids Testing 11/25/2002 10/1/2009
83704 190.23 Lipids Testing 11/25/2002 10/1/2009
83718 190.23 Lipids Testing 11/25/2002 10/1/2009
83721 190.23 Lipids Testing 11/25/2002 10/1/2009
84153 190.31 Prostate Specific Antigen 11/25/2002 10/1/2008
84436 190.22 Thyroid Testing 11/25/2002 10/1/2009
84439 190.22 Thyroid Testing 11/25/2002 10/1/2009
84443 190.22 Thyroid Testing 11/25/2002 10/1/2009
84466 190.18 Serum Iron Studies 11/25/2002 1/1/2010
84478 190.23 Lipids Testing 11/25/2002 10/1/2009
84479 190.22 Thyroid Testing 11/25/2002 10/1/2009
84702 190.27 Human Chorionic Gonadotropin 11/25/2002 1/1/2007
85004 190.15 Blood Counts 11/25/2002 7/1/2008
85007 190.15 Blood Counts 11/25/2002 7/1/2008
85008 190.15 Blood Counts 11/25/2002 7/1/2008
85013 190.15 Blood Counts 11/25/2002 7/1/2008
85014 190.15 Blood Counts 11/25/2002 7/1/2008
85018 190.15 Blood Counts 11/25/2002 7/1/2008
85025 190.15 Blood Counts 11/25/2002 7/1/2008
85027 190.15 Blood Counts 11/25/2002 7/1/2008
85032 190.15 Blood Counts 11/25/2002 7/1/2008
85048 190.15 Blood Counts 11/25/2002 7/1/2008
85049 190.15 Blood Counts 11/25/2002 7/1/2008
85610 190.17 Prothrombin Time (PT) 11/25/2002 10/1/2009
85730 190.16 Partial Thromboplastin Time (PTT) 11/25/2002 10/1/2009
86300 190.29 Tumor Antigen by Immunoassay CA 15-3/CA 27.29 11/25/2002 10/1/2006
86301 190.3 Tumor Antigen by Immunoassay CA 19-9 11/25/2002 10/1/2006
86304 190.28 Tumor Antigen by Immunoassay CA 125 11/25/2002 10/10/2006
86689 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
86701 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
86702 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
86703 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87086 190.12 Urine Culture, Bacterial 11/25/2002 10/1/2009
87088 190.12 Urine Culture, Bacterial 11/25/2002 10/1/2009
87390 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87391 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87534 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87535 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87536 190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) 11/25/2002 10/1/2008
87537 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87538 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87539 190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) 11/25/2002 10/1/2008
G0103 210.1 Prostate Cancer Screening Tests 11/25/2002
G0123 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002
G0124 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0141 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0143 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0144 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0145 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0147 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0148 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0248 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management 11/25/2002 3/19/2008
G0249 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management 11/25/2002 3/19/2008
G0250 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management 11/25/2002 3/19/2008
G0328 210.3 Colorectal Cancer Screening Tests 11/25/2002
P3000 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
P3001 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
Q0091 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007