Billing and Coding: Frequency of Laboratory Tests (A56420) (2024)

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Draft Article

Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A

Article ID
A56420

Original ICD-9 Article ID
Not Applicable

Article Title
Billing and Coding: Frequency of Laboratory Tests

Article Type
Billing and Coding

Original Effective Date
03/28/2019

Revision Effective Date
01/01/2023

Revision Ending Date
N/A

Retirement Date
N/A

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Please refer to the Local Coverage Determination (LCD) L35099, Frequency of Laboratory Tests.

Article Guidance

Article Text

Refer to the Novitas Local Coverage Determination (LCD) L35099, Frequency of Laboratory Tests, for reasonable and necessary requirements and frequency limitations.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Per CMS Medicare Learning Network (MLN) Medicare Matters number MM8863, the use of NCCI-associated modifiers should NOT be used to bypass a procedure-to-procedure (PTP) edit unless the proper criteria for use of the modifier are met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that is used. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Refer to the NCDs for the procedure code list of ICD-10-CM codes that are considered covered by Medicare at:

https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html

Coding Information

Bill Type Codes

CodeDescription
012xHospital Inpatient (Medicare Part B only)
013xHospital Outpatient
014xHospital - Laboratory Services Provided to Non-patients
018xHospital - Swing Beds
021xSkilled Nursing - Inpatient (Including Medicare Part A)
022xSkilled Nursing - Inpatient (Medicare Part B only)
023xSkilled Nursing - Outpatient
071xClinic - Rural Health
072xClinic - Hospital Based or Independent Renal Dialysis Center
085xCritical Access Hospital

N/A

Revenue Codes

CodeDescription
030XLaboratory - General Classification

N/A

CPT/HCPCS Codes

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Group 1

(13 Codes) >> Includes 84443

Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes

CodeDescription
80061Lipid panel
82465Assay bld/serum cholesterol
82948Reagent strip/blood glucose
82962Glucose blood test
82985Assay of glycated protein
83036Hemoglobin glycosylated a1c
83718Assay of lipoprotein
83721Assay of blood lipoprotein
84436Assay of total thyroxine
84439Assay of free thyroxine
84443Assay thyroid stim hormone
84478Assay of triglycerides
84479Assay of thyroid (t3 or t4)

N/A

CPT/HCPCS Modifiers

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Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(1 Code)

Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Medicare is establishing the following limited coverage for CPT/HCPCS codes 80061, 82465, 82948, 82962, 82985, 83036, 83718, 83721, 84436, 84439, 84443, 84478 and 84479:

Refer to the NCDs for the procedure code list of ICD-10-CM codes that are covered by Medicare at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html

Group 1 Codes

CodeDescription
XX000Not Applicable

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

(1 Code)

Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Refer to the NCDs for the procedure code list of ICD-10-CM codes that are considered non-covered or do not support medical necessity at:

https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html

Group 1 Codes

CodeDescription
XX000Not Applicable

N/A

ICD-10-PCS Codes

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Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typicallyused to report this service. Absence of a Bill Type does not guarantee that thearticle does not apply to that Bill Type. Complete absence of all Bill Types indicatesthat coverage is not influenced by Bill Type and the article should be assumed toapply equally to all claims.

CodeDescription
012xHospital Inpatient (Medicare Part B only)
013xHospital Outpatient
014xHospital - Laboratory Services Provided to Non-patients
018xHospital - Swing Beds
021xSkilled Nursing - Inpatient (Including Medicare Part A)
022xSkilled Nursing - Inpatient (Medicare Part B only)
023xSkilled Nursing - Outpatient
071xClinic - Rural Health
072xClinic - Hospital Based or Independent Renal Dialysis Center
085xCritical Access Hospital

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under otherRevenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicatesthat coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, for further guidance.


CodeDescription
030XLaboratory - General Classification

N/A

Other Coding Information

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Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

CodeDescriptor Generic NameDescriptor Brand NameExclusion Effective DateExclusion End DateReason for Exclusion
N/AN/A

N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

CodeDescriptor Generic NameDescriptor Brand NameExclusion Effective DateExclusion End DateReason for Exclusion

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2023R2

Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. For the following CPT code either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 83036 in Group 1 Codes.

11/07/2019R1

Article revised and published on 11/07/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2

Related Local Coverage Documents
LCDs
L35099 - Frequency of Laboratory Tests

Related National Coverage Documents
N/A

SAD Process URL 1
N/A

SAD Process URL 2
N/A

Statutory Requirements URLs

N/A

Rules and Regulations URLs

N/A

CMS Manual Explanations URLs

N/A

Other URLs

N/A

Public Versions

Updated OnEffective DatesStatus
01/20/202301/01/2023 - N/A Currently in EffectYou are here
Some older versions have been archived. Please visit theMCD Archive Site to retrieve them.

Keywords

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Billing and Coding: Frequency of Laboratory Tests (A56420) (2024)

FAQs

What is the CPT code range for laboratory tests? ›

Pathology and Laboratory Procedures CPT® Code range 80047- 89398.

What is the CPT code for repeat lab test? ›

CPT Modifier 91 'Repeat clinical diagnostic laboratory test': It may be necessary to repeat the same laboratory test on the same day to obtain multiple test results. In this case CPT modifier 91 should be used.

How are repeat diagnostic laboratory tests reported? ›

Modifier 91 is used when a clinical laboratory test must be repeated on the same date of service and the results are used to assist in managing the treatment of a patient.

Which type of CPT codes are used more frequently? ›

Category I is the most common and widely used set of codes within CPT. It describes most of the procedures performed by healthcare providers in inpatient and outpatient offices and hospitals.

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