MEDICARE COVERAGE OF LABORATORY TESTING

HOTLINE: Effective August 16, 2021

MEDICARE COVERAGE OF LABORATORY TESTING

Please remember when ordering laboratory tests that are billed to Medicare/Medicaid or other federally funded

programs, the following requirements apply:

1.

2.

3.

4.

5.

6.

Only tests that are medically necessary for the diagnosis or treatment of the patient should be ordered.

Medicare does not pay for screening tests except for certain specifically approved procedures and may not

pay for non-FDA approved tests or those tests considered experimental.

If there is reason to believe that Medicare will not pay for a test, the patient should be informed. The patient

should then sign an Advance Beneficiary Notice (ABN) to indicate that he or she is responsible for the cost

of the test if Medicare denies payment.

The ordering physician must provide an ICD-10 diagnosis code or narrative description, if required by the

fiscal intermediary or carrier.

Organ- or disease-related panels should be billed only when all components of the panel are medically

necessary.

Both ARUP- and client-customized panels should be billed to Medicare only when every component of the

customized panel is medically necessary.

Medicare National Limitation Amounts for CPT codes are available through the Centers for Medicare &

Medicaid Services (CMS) or its intermediaries. Medicaid reimbursement will be equal to or less than the

amount of Medicare reimbursement.

The CPT Code(s) for test(s) profiled in this bulletin are for informational purposes only. The codes reflect our

interpretation of CPT coding requirements, based upon AMA guidelines published annually. CPT codes are provided

only as guidance to assist you in billing. ARUP strongly recommends that clients reconfirm CPT code information with

their local intermediary or carrier. CPT coding is the sole responsibility of the billing party.

50

2007994

50

2014011

7

3003923

8

3003924

Aggressive B-Cell Lymphoma Reflex Panel by

FISH, Tissue

Allergen, Food, Alpha-Gal (galactose-alpha-1,3galactose) IgE

Allergen, Food, Alpha-Gal (galactose-alpha-1,3galactose) Panel

Allergen, Food, Alpha-Gal (galactose-alpha-1,3galatose) IgE

Allergen, Food, Alpha-Gal (galactose-alpha-1,3galatose) Panel

Page 1

Inactive

New Test

x

Other Interface Change

x

Component Change

Interpretive Data

Reference Interval

Specimen Requirements

Performed/Reported Schedule

Methodology

CPT Code

3001495

Note

6

Summary of Changes by Test Name

Name Change

Test Number

Hotline Page #

The regulations described above are only guidelines. Additional procedures may be required by your fiscal intermediary

or carrier.

x

x

x

x

9

3002685

50

2002398

9

0020471

10

3003745

50

2006480

11

2012232

50

2002068

50

11

0050811

3003747

12

50

12

3004090

0055654

0050100

50

3003058

13

3004070

50

0060182

14

2012201

15

15

15

16

16

17

2012213

0020063

0020229

3003824

0080392

3003992

17

3002508

17

0050170

18

18

18

18

3003648

0050503

3000479

2006267

Alport Syndrome Panel, Sequencing and

Deletion/Duplication

Alport Syndrome, X-linked (COL4A5) Sequencing

and Deletion/Duplication

Amylase, Urine

ANCA-Associated Vasculitis Profile

(ANCA/MPO/PR3)

ANCA-Associated Vasculitis Profile

(ANCA/MPO/PR3) with Reflex to ANCA Titer

Angelman Syndrome and Prader-Willi Syndrome by

Methylation-Sensitive PCR, Fetal

Anti-Neutrophil Cytoplasmic Antibody with Reflex

to Titer and MPO/PR3 Antibodies

Anti-Neutrophil Cytoplasmic Antibody, IgG

Anti-Neutrophil Cytoplasmic Antibody, IgG by IFA

Carbamylated Protein (CarP) Antibody, IgG

Clobazam and Metabolite, Quantitative, Serum or

Plasma

Coccidioides Antibody by CF

COVID-19 IgG, Semi-Quantitative by CIA

Coxsackie A9 Virus Antibodies by CF

Criteria Systemic Sclerosis Panel

Cytogenomic SNP Microarray Buccal Swab

Page 2

Inactive

New Test

Other Interface Change

Component Change

CPT Code

Note

Interpretive Data

Reference Interval

x

x

x

x

x

x

x

x

x

Apixaban Level

Apolipoprotein B (APOB) Mutation Detection

Aspergillus Antibody by CF

Autoimmune Neurologic Disease Reflexive Panel,

Serum

Autoimmune Neurologic Disease Reflexive Panel,

Serum

Bacterial Strain Characterization by Pulsed-Field Gel

Electrophoresis

Barbiturates, Serum or Plasma, Quantitative

Barbiturates, Urine, Quantitative

Beta-hCG, Serum Qualitative

Beta-hCG, Urine Qualitative

Brachyury by Immunohistochemistry

Cancer Antigen 27.29

Specimen Requirements

Performed/Reported Schedule

Methodology

Summary of Changes by Test Name

Name Change

Test Number

Hotline Page #

HOTLINE: Effective August 16, 2021

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x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

19

20

3003917

3004092

21

3001839

21

22

2002378

0082024

22

50

50

23

23

23

3004075

2012678

2013577

0020476

0040085

3001842

24

24

3002682

0050625

50

2009256

50

50

2004457

2002805

25

3000870

26

3003853

50

0055670

50

3001242

50

3001238

26

3002134

27

50

27

28

28

28

3003748

2013270

0070068

2013566

0070064

0070066

Distal Arthrogryposis Panel, Sequencing

Edoxaban Level

Emery-Dreifuss Muscular Dystrophy Panel,

Sequencing

Eosinophilia Panel by FISH (Pricing Change)

Inactive

New Test

Other Interface Change

Component Change

CPT Code

Note

Interpretive Data

Reference Interval

Specimen Requirements

Performed/Reported Schedule

Methodology

Summary of Changes by Test Name

Name Change

Test Number

Hotline Page #

HOTLINE: Effective August 16, 2021

x

x

x

x

Fetal Fibronectin

FGFR1 Gene Amplification by FISH

Gastrointestinal Bacterial Panel by PCR

Gastrointestinal Viral Panel by PCR

Glucose, Urine

Hemoglobin

x

Hereditary Myeloid Neoplasms Panel, Sequencing

Heterotaxy and Situs Inversus Panel, Sequencing

Histoplasma Antibodies by CF

HIV1 Genotype and Integrase Inhibitor Resistance

by Sequencing

HIV-1 Integrase Inhibitor Resistance by Sequencing

HLA Antibody Detection

Human Immunodeficiency Virus 1 (HIV-1) by

Quantitative NAAT with Reflex to HIV-1 Drug

Resistance by Next Generation Sequencing

Human Immunodeficiency Virus 1 Drug Resistance

by Next Generation Sequencing

Human Immunodeficiency Virus 1, Genotype by

Sequencing

Human Immunodeficiency Virus Type 1 (HIV-1)

GenoSure MG

Human Immunodeficiency Virus Type 1 (HIV-1)

GenoSure PRIme

IDH1 R132H Point Mutation by

Immunohistochemistry with Reflex to IDH1 and

IDH2 Mutation Analysis, Exon 4

Inflammatory Bowel Disease Differentiation Panel

Inflammatory Bowel Disease Differentiation Panel

Insulin, 120 Minutes

Insulin, 180 Minutes

Insulin, 30 Minutes

x

x

x

x

x

x

x

Insulin, 60 Minutes

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

Page 3

x

28

28

29

0070067

0070063

0070155

29

29

30

0070022

0070107

3004046

31

3003800

32

3003801

50

0051245

50

2012084

50

2012085

32

0055167

32

0020407

50

2008347

50

2002705

33

34

35

3003947

0020765

3002688

35

2003996

36

3003729

36

2003935

37

3003741

37

3003971

Insulin, 90 Minutes

Insulin, Fasting

x

x

Insulin, Free and Total

Insulin, Other

Insulin, Random

JAK2 (V617F) Mutation by ddPCR, Qualitative

JAK2 (V617F) Mutation by ddPCR, Qualitative with

Reflex to CALR (Calreticulin) Exon 9 Mutation

Analysis by PCR with Reflex to MPL Mutation

Detection

JAK2 (V617F) Mutation by ddPCR, Qualitative with

Reflex to JAK2 Exon 12 Mutation Analysis by PCR

JAK2 Gene, V617F Mutation, Qualitative (Inactive

as of 8/16/2021, refer to 3004046)

JAK2 Gene, V617F Mutation, Qualitative with

Reflex to CALR (Calreticulin) Exon 9 Mutation

Analysis by PCR with Reflex to MPL Mutation

Detection (Inactive as of 8/16/2021, refer to

3003800)

JAK2 Gene, V617F Mutation, Qualitative with

Reflex to JAK2 Exon 12 Mutation Analysis by PCR

Kappa/Lambda Quantitative Free Light Chains with

Ratio, Serum

Lactose Tolerance

Legius Syndrome (SPRED1) Sequencing and

Deletion/Duplication

Loeys-Dietz Syndrome (TGFBR1 and TGFBR2)

Sequencing

Loeys-Dietz Syndrome Core Panel, Sequencing

Macroprolactin

Malignant Hyperthermia Panel, Sequencing

Melan A by Immunohistochemistry (DAB

Detection)

Melan A by Immunohistochemistry (Red Detection)

Melanoma Antibody, HMB45 by

Immunohistochemistry (DAB Detection)

Melanoma Antibody, HMB45 by

Immunohistochemistry (Red Detection)

Multiple Myeloma, Daratumamab, Immunofixation

x

x

x

Page 4

Inactive

New Test

Other Interface Change

Component Change

CPT Code

Note

Interpretive Data

Reference Interval

Specimen Requirements

Performed/Reported Schedule

Methodology

Summary of Changes by Test Name

Name Change

Test Number

Hotline Page #

HOTLINE: Effective August 16, 2021

x

x

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50

2012182

38

3003746

50

2007159

50

2007154

39

3003927

40

40

0092356

2011697

40

3001309

40

3002135

41

2006247

41

41

0030235

0060043

41

2007961

41

42

42

43

43

43

2014041

3001621

0070115

0020724

2002930

0060764

44

50

3004055

2003277

45

3004056

50

2003278

46

3004094

46

2004127

47

3003733

Myeloid Malignancies Somatic Mutation and Copy

Number Analysis Panel

Myeloperoxidase (MPO) Antibody and Serine

Proteinase 3 (PR3) Antibody with Reflex to AntiNeutrophil Cytoplasmic Antibody, IgG by IFA

Neurofibromatosis Type 1 (NF1) Sequencing

Neurofibromatosis Type 1 (NF1) Sequencing and

Deletion/Duplication

Neurofibromatosis Type 1 Sequencing and

Deletion/Duplication and Legius Syndrome

Sequencing Panel

Nicotine and Metabolites, Urine, Quantitative

Oxalate, Plasma

Respiratory Virus Mini Panel by PCR

Rheumatoid Arthritis Panel

Rheumatoid Arthritis Panel

Rheumatoid Arthritis Panel with Reflex to

Rheumatoid Factors, IgA, IgG, and IgM by ELISA

Rheumatoid Arthritis Panel with Reflex to

Rheumatoid Factors, IgA, IgG, and IgM by ELISA

Rivaroxaban Level

S-100 Protein by Immunohistochemistry (DAB

Detection)

S-100 Protein by Immunohistochemistry (Red

Detection)

Page 5

Inactive

New Test

Other Interface Change

Component Change

CPT Code

Note

Interpretive Data

x

x

x

x

x

x

x

1p/19q Deletion by FISH

1p19q Deletion by FISH and IDH1 R132H Point

Mutation by Immunohistochemistry with Reflex to

IDH1 and IDH2 Mutation Analysis, Exon 4

Parainfluenza 1-4 by PCR

Partial Thromboplastin Time

Parvovirus B19 by Qualitative PCR

PCCA/ANNA by IFA with Reflex to Titer and

Immunoblot

Potassium, Total, RBC

Primary Ciliary Dyskinesia Panel, Sequencing

Prolactin

Prolactin, Dilution Study

Prostate Specific Antigen, Complexed

Reference Interval

Specimen Requirements

Performed/Reported Schedule

Methodology

Summary of Changes by Test Name

Name Change

Test Number

Hotline Page #

HOTLINE: Effective August 16, 2021

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