Laboratory Tests - CRD Patients

CMS National Coverage Determination | ncd_id=181 | manual_section=190.10 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False

Laboratory tests are essential to monitor the progress of CRD patients. The following list and frequencies of tests constitute the level and types of routine laboratory tests that are covered. Bills for other types of tests are considered nonroutine. Routine tests at greater frequencies must include medical justification. Nonroutine tests generally are justified by the diagnosis. The routinely covered regimen includes the following tests. Per Dialysis All hematocrit or hemoglobin and clotting time tests furnished incident to dialysis treatments. Per Week Prothrombin time for patients on anticoagulant therapy Serum Creatinine Per Week or Thirteen Per Quarter BUN Monthly CBC Serum Calcium Serum Potassium Serum Chloride Serum Bicarbonate Serum Phosphorous Total Protein Serum Albumin Alkaline Phospatase AST, SGOT LDH Guidelines for tests other than those routinely performed include: Serum Aluminum - one every 3 months Serum Ferritin - one every 3 months The following tests for hepatitis B are covered when patients first enter a dialysis facility: Hepatitis B surface antigen (HBsAg), Anti-HBs. Coverage of future testing in these patients depends on their serologic status and on whether they have been successfully immunized against hepatitis B virus. The following table summarizes the frequency of serologic surveillance for hepatitis B. Tests furnished according to this table do not require additional documentation and are paid separately because payment for maintenance dialysis treatments does not take them into account. Frequency of Screening Vaccination and Serologic Status HBsAg Patients Anti-HBs Patients Unvaccinated Susceptible Monthly Semiannually Unvaccinated HBsAg Carrier Annually None Unvaccinated Anti-HBs-Positive 1 None Annually Vaccinated Anti-HBs-Positive 1 None Annually Vaccinted Low Level or No Anti-HBs Monthly Semiannually 1 At least 10 sample ration units by radioimmunoassay or positive by enzyme immunoassay. Patients who are in the process of receiving hepatitis B vaccines, but have not received the complete series, should continue to be routinely screened as susceptible. Between one and six months after the third dose, all vaccines should be tested for anti-HBs to confirm their response to the vaccine. Patients who have a level of anti-HBs of at least 10 sample ratio units (SRUs) by radioimmunoassay (RIA) or who are positive by enzyme immunoassay (EIA) are considered adequate responders to vaccine and need only be tested for anti-HBs annually to verify their immune status. If anti-HBs drops below 10 SRUs by RIA or is negative by EIA, a booster dose of hepatitis B vaccine should be given. Laboratory tests are subject to the normal coverage requirements. If the laboratory services are performed by a free-standing facility, be sure it meets the conditions of coverage for independent laboratories.

Revision History: 06/1997 - Clarified existing policy that Medicare will only pay separately for tests in excess of number included in computation of composit payment rate. Effective date 10/01/1997. (TN 101) 02/1997 - Eliminated certain tests from list of separately billable lab tests that are covered routinely without documentation of medial necessity. Effective date 07/01/1997. (TN 91) 10/1991 - Included hemoglobin as routinely covered test for CRD patient. Effective date 11/12/1991. (TN 53) Benefit Categories: 18 - Diagnostic Laboratory Tests Transmittal: transmittal_number=101 | transmittal_issue_date=1997-06-01