Medical Necessity Checking

  • Determine patient diagnosis.
  • Record the diagnosis code(s) in the appropriate space on the requisition form. ICD-10 codes are required.
  • Check the limited coverage test list below to determine whether the test is listed. If the test is not listed, no further action is required.
  • If the test is listed, click on the test and check the ICD-10 code provided with approved codes listed within the test coverage policy. If the ICD-10 code is listed, no further action is required.
  • Special Note: The reverse is true for the CBC coverage policy. The CBC policy lists codes that do NOT justify medical necessity.
  • Note: If all individual test of a panel are ordered, the lab will bill Medicare for the panel.

CMS Palmetto NC - Local Coverage Determination (LCD):

MolDX: Biomarkers in Cardiovascular Risk Assessment (L36129)

Flow Cytometry (L34513)

HbA1c (L33431)

CMS NationalCoverage Determination (NCD)

Reviewed by jcayless on July 25, 2018

Note: Reference ranges provided on this web site are for guidance only, and may not reflect the most recent changes. Refer to laboratory reports for current reference data.

UNC Hospitals
McLendon Clinical Laboratories
101 Manning Drive
Chapel Hill, NC 27514