About this policy
CMS National Coverage Determination | ncd_id=257 | manual_section=190.8 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
It is a covered test under Medicare when it is medically necessary to assess lymphocytic function in diagnosed immunodeficiency diseases and to monitor immunotherapy. It is not covered when it is used to monitor the treatment of cancer, because its use for that purpose is experimental.
Documentation requirements
Item/Service Description: The lymphocyte mitogen response assay measures the immune response of patient peripheral blood lymphocytes. Revision History: 05/2014 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/06/2014 Effective date: 10/1/2015. ( TN 1388 ) ( TN 1388 ) (CR 8691) 03/2013 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/07/2013 Effective date: 10/1/2015. ( TN 1199 ) ( TN 1199 ) (CR 8197) Benefit Categories: 18 - Diagnostic Laboratory Tests
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
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