MEDICARE COVERAGE OF LABORATORY TESTING - ARUP Lab

Quarterly HOT LINE: Effective May 16, 2016

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:

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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.

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6

6

0060152

0020008

2005736

Acid-Fast Bacillus (AFB) Culture and AFB Stain

Alanine Aminotransferase, Serum or Plasma

Alkaline Phosphatase Isoenzymes, CSF

6

7

0021020

0060217

48

0055566

10

2013341

11

2013337

Alkaline Phosphatase Isoenzymes, Serum or Plasma

Antimicrobial Susceptibility, AFB/Mycobacteria

Apolipoprotein E (APOE) 2 Mutations,

Cardiovascular Risk

Apolipoprotein E (APOE) Genotyping, Alzheimer

Disease Risk

Apolipoprotein E (APOE) Genotyping,

Cardiovascular Risk

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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

Hot Line Page #

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.

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12

2013327

13

2013320

13

0095227

13

14

0020007

2008901

15

2008420

15

2005017

15

2005010

48

0055691

48

48

0051434

0051454

15

2011450

48

16

17

18

18

18

0021021

0040002

0040003

2012717

0060850

0080469

19

19

19

20

21

22

0060851

2013259

0020408

2013260

2013261

2013257

22

23

23

23

24

48

2013262

2013263

0060360

0020414

2001613

0055283

Aquaporin-4 Receptor Antibody by ELISA with

Reflex to Aquaporin-4 Receptor Antibody, IgG by

IFA

Aquaporin-4 Receptor Antibody, IgG by IFA with

Reflex to Titer, Serum

Arylsulfatase A, 24-Hour Urine

Chromogranin A

Clostridium difficile Cytotoxin Cell Assay

Comprehensive Kidney Biopsy Workup

Comprehensive Metabolic Panel

Comprehensive Muscle Biopsy Workup

Comprehensive Nerve Biopsy Workup

Inactive

New Test

Other Interface Change

Component Change

CPT Code

Note

Interpretive Data

x

x

x

x

x

Aspartate Aminotransferase, Serum or Plasma

B-Cell Memory and Naive Panel

BCR-ABL1 Mutation Analysis for Tyrosine Kinase

Inhibitor Resistance by Next Generation Sequencing

BCR-ABL1, Major (p210), Quantitative

BCR-ABL1, Qualitative with Reflex to BCR-ABL1

Quantitative

BIRC2-MALT1 (API2-MALT1) Translocation,

t(11;18) by RT-PCR

Bloom Syndrome (BLM) 1 Mutation, Fetal

Canavan Disease (ASPA) 4 Mutations, Fetal

Carisoprodol and Meprobamate, Serum or Plasma,

Quantitative

Carotenes, Fractionated, Plasma or Serum

CBC with Platelet Count

CBC with Platelet Count and Automated Differential

CHARGE Syndrome (CHD7) Sequencing, Fetal

Chlamydia trachomatis Culture

Reference Interval

Specimen Requirements

Performed/Reported Schedule

Methodology

Summary of Changes by Test Name

Name Change

Test Number

Hot Line Page #

Quarterly HOT LINE: Effective May 16, 2016

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x

x

x

x

x

x

Consultation, Head and Neck

Consultation, Neuropathology

Consultation, Surgical Pathology

Corynebacterium diphtheriae Culture

Creatine Kinase Isoenzymes

Crohn Disease Prognostic Panel

x

x

x

x

x

x

Cysticercosis Antibody, IgG by Western Blot

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x

48

0055282

48

2008920

48

24

24

0091589

2013294

2002247

25

2006621

48

0051464

27

2008603

27

27

2013277

2012695

48

0051469

48

48

48

0030140

0091509

0051439

48

28

28

28

28

0091353

0040080

0040085

0020416

0092522

29

2013333

29

2002899

30

30

31

48

48

31

0050980

0050981

2013270

0050567

0091530

0049110

31

0080200

Cysticercosis Antibody, IgG by Western Blot (CSF)

Cytochrome P450 Pain Management Panel,

CYP2D6, CYP2C9, CYP2C19 - Common Variants

Darvocet, Urine

Dengue Virus (1-4) Subtype by PCR

Disaccharidase, Tissue

Drug Detection Panel, Umbilical Cord Tissue,

Qualitative

Dysautonomia, Familial (IKBKAP) 2 Mutations,

Fetal

ERBB2 (HER2/neu) Gene Amplification by FISH,

Tissue

Esterase, Non-Specific Cytochemical Stain Only

Ethyl Glucuronide Screen Only, Urine

Fanconi Anemia, Group C (FANCC) 2 Mutations,

Fetal

Fibrin/Fibrinogen Degradation Split Products

Formic Acid, Urine

Gaucher Disease (GBA) 8 Mutations, Fetal

Glyburide Quantitative, Serum or Plasma

Hematocrit

Hemoglobin

Hepatic Function Panel

Histoplasma Antigen by EIA, Serum

Human Immunodeficiency Virus (HIV) Combo

Antigen/Antibody (HIV-1/O/2) by ELISA, with

Reflex to HIV-1/HIV-2 Antibody Differentiation,

Supplemental

Human Papillomavirus (HPV), High Risk by in situ

Hybridization, Paraffin

Humoral Immunity Panel I

Humoral Immunity Panel II

Inflammatory Bowel Disease Differentiation Panel

Inflammatory Bowel Disease Differentiation Profile

Inhalants Panel, Solvents, Serum or Plasma

Iron Stain

Lecithin-Sphingomyelin Ratio

Inactive

New Test

Other Interface Change

Component Change

CPT Code

Note

Interpretive Data

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Page 3

Reference Interval

Specimen Requirements

Performed/Reported Schedule

Methodology

Summary of Changes by Test Name

Name Change

Test Number

Hot Line Page #

Quarterly HOT LINE: Effective May 16, 2016

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2005661

32

33

33

33

33

0040005

0081293

0081150

0081062

2013305

34

2011521

48

0051449

34

48

48

48

34

2013273

2012535

0051459

2008868

2008767

35

2007479

35

2009288

35

35

35

35

35

2012603

0091260

2010481

0090141

0040235

35

2003040

35

2002871

36

0095044

36

2008509

37

2013352

38

38

39

2013355

0040270

0040263

Liver Fibrosis, Chronic Viral Hepatitis (Echosens

FibroMeter)

Manual Differential

Maternal Screening, Sequential, Specimen #1

Maternal Serum Screen, First Trimester

Maternal Serum Screening, Integrated, Specimen #1

Page 4

Inactive

New Test

Other Interface Change

Component Change

CPT Code

Note

Interpretive Data

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x

Meningitis/Encephalitis Panel by PCR

Meprobamate, Serum or Plasma, Quantitative

Mucolipidosis, Type IV (MCOLN1) 2 Mutations,

Fetal

Myeloperoxidase, Cytochemical Stain Only

Nerve Fiber Density Analysis, Intraepidermal

Niemann-Pick, Type A (SMPD1) 4 Mutations, Fetal

Nonalcoholic steatohepatitis (NASH) FibroSURE

Opioid Receptor, mu OPRM1 Genotype, 1 Variant

Pain Management Drug Panel by High-Resolution

Time-of-Flight Mass Spectrometry and Enzyme

Immunoassay, Urine

Pain Management Drug Screen with Interpretation

by High-Resolution Time-of-Flight Mass

Spectrometry and Enzyme Immunoassay, Urine

PAX8-PPARG Translocations Detection by PCR

Phenol Exposure Quantitative, Urine

Phenytoin, Free

Phenytoin, Free and Total

Platelets

PM/Scl-100 Antibody, IgG by Immunoblot with

Reflex to ANA IFA (Pricing Change Only)

PML-RARA Translocation, t(15;17) by RT-PCR,

Quantitative

Prenatal Reflexive Panel

Progesterone Quantitative by HPLC-MS/MS, Serum

or Plasma

Pyridoxine-Dependent Epilepsy Panel, Serum or

Plasma

Pyridoxine-Dependent Epilepsy Panel, Urine

Red Blood Cell Count

Reticulocyte, Hemoglobin Panel

Reference Interval

Specimen Requirements

Performed/Reported Schedule

Methodology

Summary of Changes by Test Name

Name Change

Test Number

Hot Line Page #

Quarterly HOT LINE: Effective May 16, 2016

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42

0050725

43

2005779

44

2008919

45

2013325

46

2013275

48

46

47

0051429

2013335

2013290

48

48

47

2011025

2008116

2005413

48

2004175

47

47

48

0080380

0040320

2011127

Reticulocytes, Percent and Number

S100B, CSF

Scleroderma Antibodies Panel

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Inactive

New Test

Other Interface Change

Component Change

CPT Code

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Note

x

Interpretive Data

Performed/Reported Schedule

Methodology

Reference Interval

0040022

2013358

2006462

2013251

Specimen Requirements

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40

48

41

Summary of Changes by Test Name

Name Change

Test Number

Hot Line Page #

Quarterly HOT LINE: Effective May 16, 2016

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STAT6 by Immunohistochemistry

Streptococcus pneumoniae Antibodies, IgG (14

Serotypes)

Streptococcus pneumoniae Antibodies, IgG (23

Serotypes)

Streptococcus pneumoniae Antibodies, IgG (9

Serotypes)

Systemic Scleroderma Comprehensive Panel

Tartrate-Resistant Acid Phosphatase, Cytochemical

Stain Only

Tay-Sachs Disease (HEXA) 7 Mutations, Fetal

Thrombopoietin (TPO), Serum

Tropheryma whipplei PCR

Tropheryma whipplei Detection by PCR, Blood

Urine Culture, Invasive Collection

Urticaria-Inducing Activity

Vascular Endothelial Growth Factor C (VEGF-C)

by Immunohistochemistry

Vitamin C (Ascorbic Acid), Plasma

White Blood Cell Count

Zolpidem and Metabolites Quantitative, Urine

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