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

Additional Information

What is the A-LIST?

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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