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            Services Laboratory Services Welcome to our Laboratory Services A-List

            Welcome to our Laboratory Services

            • A-List
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            A-LIST (ABN’s- Lab ICD-10 Search Tool)

            Additional Information

            What is the A-LIST?

            How do I find the diagnostic information I need?

            National Coverage Determination (NCD)– Complete Document (Published- July 2022)
            NCD documents appear in blue

            LCD – PLEASE READ CAREFULLY
            Local Coverage Determination (LCD) documents appear in orange. These documents are written differently than the NCD documents. Some test groups have specific coverage determinations for each test, and some test groups have special conditions.

            Preventative Services Chart (Quick Reference Chart contains only data for the following:)
            Stool-Colorectal Screen
            Pap Smear
            PSA Screen

            RESOURCES:
            Medicare NCDs
            Medicare Preventative Services Chart
            LCD-Active Test Group Index
            LCD-Laboratory Test List (Jurisdiction L- LCD)

            Test Group Coverage Determination CPT MMC Tests Details Date Published

            Acute Hepatitis Panel / Hepatitis Panel

            Acute Hepatitis Panel / Hepatitis Panel 80074 CODE LOOK UP

            Hepatitis Panel W/Rfx, Acute
            NCD July 2022

            Alpha-fetoprotein

            Alpha-fetoprotein 82105 CODE LOOK UP

            AFP Tumor Marker, Serum Integrated Screen Part 2 Maternal Quad Screen Maternal Serum AFP Maternal Serum Screen 5
            NCD July 2022

            Allergy Testing

            Allergy Testing 82785
            86003
            CODE LOOK UP

            Gammaglobulin (immunoglobulin); IgE
            Allergen specific IgE, each allergen
            LCD 07/11/21

            Assays for Vitamins and Metabolic Function

            Assays for Vitamins and Metabolic Function Code lists are different for each test group. CODE LOOK UP LCD 10/01/21
            82180 Assay of ascorbic acid
            82306 Vitamin D 25 hydroxy
            82379 Assay of carnitine
            82607 Vitamin B12
            82652 Vitamin D,1,25-Dihydroxy
            82746 Assay of folic acid serum
            83090 Assay of homocystine
            83698 Assay of lipoprotein pla2
            84207 Assay of vitamin B6
            84252 Assay of vitamin B2
            84425 Assay of vitamin B1
            84446 Assay of vitamin E
            84590 Assay of vitamin A
            84597 Assay of vitamin K
            85385 Fibrinogen antigen
            86352 Cell function assay w/ stim

            Biomarkers Overview

            Biomarkers Overview 81162 CODE LOOK UP

            BRCA 1&2 seq & full dup/del

            LCD

            12/21/2021

            81227 Cyp2c9 gene
            81240 F2 gene - Prothrombin gene
            81241 F5 gene - Factor V Leiden
            81291 Mthfr gene

            81376 81382

            HLA typing for celiac disease
            81381 HLA-B 5701
            81355 Vkorc1 gene

            Biomarkers for Oncology

            Biomarkers for Oncology 81206/81207 CODE LOOK UP

            BCR/ABL gene
            LCD

            12/13/2020
            81270 JAK2
            81402 MPL

            Blood Counts

            Blood Counts (This test group provides codes that DO NOT support medical necessity) 85007 CODE LOOK UP

            CBC w/ Manual Diff
            NCD July 2022
            85008 Peripheral Smear
            85013 Hematocrit (Spun), Body Fluid
            85014 Hematocrit (Spun), Body Fluid
            85018 Hemoglobin
            85025 CBC With Auto Diff
            85027 Complete Blood Count CBC Without Diff
            85048 White Blood Count Total Eosinophil WBC Autodiff Eosinophil Absolute
            85049 Platelet Count

            CA 15-3/CA 27.29 Tumor Antigen

            CA 15-3/CA 27.29Tumor Antigen by Immunoassay 86300 CODE LOOK UP

            Cancer AG 15-3 (CA15-3)

            CA 15-3, CSF

            Cancer Ag 27.29, Serum
            NCD July 2022

            CA 19-9 Tumor Antigen

            CA 19-9 Tumor Antigen by immunoassay 86301 CODE LOOK UP

            Carbohydrate AG 19-9(CA19-9) CA 19-9, CSF
            NCD July 2022

            CA 125 Tumor Antigen

            CA 125 Tumor Antigen by immunoassay 86301 CODE LOOK UP

            Cancer AG 125

            CA 125 CSF

            CA 125 Peritoneal Fluid

            CA 125 Pleural Fluid
            NCD July 2022

            Carcinoembryonic Antigen (CEA)

            Carcinoembryonic Antigen (CEA) 86301 CODE LOOK UP

            CEA

            CEA, CSF Fluid

            CEA, Pericardial Fluid

            CEA, Peritoneal Fluid

            CEA, Pleural Fluid
            NCD July 2022

            Collagen Crosslinks, Any Method

            Collagen Crosslinks, Any Method 82523 CODE LOOK UP

            Collegen Cross Linked, 24hr Ur Collagen Cross Linked,Random Collagen 1c-Telopep (CTX)
            NCD July 2022

            C-Reactive Protein (CRP)

            C-Reactive Protein (CRP) 86141 CODE LOOK UP

            Cardio CRP

            CRP, High Sensitivity
            LCD 11/07/19

            Digoxin Therapeutic Drug Assay

            Digoxin Therapeutic Drug Assay 80162 CODE LOOK UP

            Digoxin
            NCD July 2022

            Drug Testing

            Drug Testing G0480/G0481 G0482/G0483

            80305/80306 80307


            83789

            CODE LOOK UP

            Each drug classification-confirmation
            Drug Scrn Qualitive High Compl Urine Drug Screen-Conf (C.O.C) Alcohol Ethanol Except Breath

            UDS Mult Drug Classes


            Iodine

            LCD 10/17/19

            Fecal Occult Blood Test

            Fecal Occult Blood Test 86301 Stool Occult Blood

            Occult Blood-Colorectal Screen
            Chart NCD July 2022
            82272 CODE LOOK UP

            Stool Occ Blood Non Screening

            Gamma Glutamyl Transferase (GGT)

            Gamma Glutamyl Transferase (GGT) 82977 CODE LOOK UP

            GGTP
            NCD July 2022

            Glucose (Blood) Testing

            Glucose (Blood) Testing 82962 CODE LOOK UP

            Glucose Meter
            NCD July 2022
            83036 Glucose 2 Hr P P Glucose

            Glycated Hemoglobin(A1C)/ Glycated Protein

            Glycated Hemoglobin(A1C)/ Glycated Protein 82985 CODE LOOK UP

            Fructosamine

            NCD July 2022

            83036 A1C Hemoglobin

            Histocompatibility Testing

            Histocompatibility Testing 86812 CODE LOOK UP

            HLA-B27 Antigen
            NCD Feb 2017

            Human Chorionic Gonadotropin (HCG)

            Human Chorionic Gonadotropin (HCG) 84702 CODE LOOK UP

            Total HCG

            Integrated Screen Part 2

            Maternal Quad Screen

            Maternal Serum Screen 5

            HCG Total, Non Pregnant
            NCD July 2022

            Human Immunodeficiency Virus (HIV) Testing (Diagnosis)

            Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 86689 CODE LOOK UP

            HIV AB

            HIV1 WB W/Rflx TO HIV2

            HIV-1 AB, Western Blot, Serum
            NCD July 2022
            86703 HIV1/HIV2 AB, EIA SCR W/Rflx
            87535 HIV-1 RNA, QL TMA

            Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)

            Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)

            87536

            87539

            CODE LOOK UP

            HIV1 RNA QN, PCR

            HIV1 RNA QN, BDNA
            NCD July 2022

            Iron (Serum) Studies

            Iron (Serum) Studies 82728 CODE LOOK UP

            Ferritin
            NCD July 2022
            86301 Iron Total Iron, 24hr Urine Mayo Iron, Liver Tissue
            83550 Total Iron Binding Cap & Iron

            Iron & TIBC W/% Saturation
            84466 Transferrin, Serum

            Carbohydrate Def Transferrin

            Lipid Testing

            Lipid Testing 80061 CODE LOOKUP

            Lipid Panel
            NCD July 2022
            82465 Cholesterol

            Lipoprotein Fractionation

            Lipid Phenotype Profile
            83700 Lipid Phenotype Profile
            83701 VAP TM Cholesterol

            Lipoprotein Fractionation
            83718 HDL Cholesterol
            84478 Triglycerides

            VAP Tm Cholesterol

            Lipoprotein Fractionation

            Lipid Phenotype Profile

            VLDL Cholesterol
            83721 LDL Cholesterol, Direct

            Pap Smear

            Pap Smear P3000 Pap Smear Chart NCD July 2022
            G0123 Thin Prep Pap Screen Thin Prip Pap W/Rfx HPV
            G0145 T Prep Screen Rfx/Hpv (Imaged) Thin Prep Pap-Screen (Imaged)

            Partial Thromboplastin Time (PTT)

            Partial Thromboplastin Time (PTT) 85730 CODE LOOK UP

            DIC Screen (ITXM)

            ITXM Lup Anti-Coag Pnl (ITXM) Lupus Anticoagulant Evaluation Lupus Coag Screen (ITXM) Mixing/Correction Studies

            Partial Thromb Time PTT

            Von Willebrand Panel

            Von Willebrand Screen (ITXM)
            NCD July 2022

            Prostate Specific Antigen

            Prostate Specific Antigen 84153 CODE LOOK UP

            Prostatic Specific Antigen

            PSA, Free & Total

            PSA, Post-Prostatectomy
            NCD July 2022
            G0103

            CODE LOOK UP

            Prostatic Specific Antigen, Screen

            Chart
            *See side bar information .

            Prothrombin Time (PT)

            Prothrombin Time (PT) 86301 CODE LOOK UP

            INR DIC Screen (ITXM)

            ITXM Lup Anti-Coag Pnl (ITXM) Lupus Coag Screen (ITXM) Mixing/Correction Studies
            NCD July 2022

            Thyroid Testing

            Thyroid Testing 84436 CODE LOOKUP

            Thyroxine (T4)
            NCD July 2022
            86301 Free T4

            T4, Free Direct Dialysis
            84443 TSH

            TSH 3rd Generation (High Sens) TSH With Reflex
            84479 T3 Uptake

            T-Uptake (TBI)

            Urine Culture, Bacterial

            Urine Culture, Bacterial 87086 CODE LOOK UP

            Urine Culture
            NCD July 2022

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