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
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
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
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
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
x
x
x
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x
x
x
x
x
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x
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x
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