Billing and Coding: Frequency of Laboratory Tests

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

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (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.