National Coverage and Medical Review Policy

The Centers for Medicare and Medicaid Services (CMS) has established National Coverage Determinations (NCD) and allows local carriers to establish Local Coverage Determinations (LCD). Certain tests are then "targeted" and subsequently require proof of medical necessity in the form of specific ICD-10-CM diagnosis code(s). CMS has authorized Medicare carriers to deny payment for laboratory services on the basis of NCD and LCD guidelines.

Please contact our Client Service Department for the latest list of "targeted" tests, approved diagnoses and frequency guidelines.

Medicare Local Coverage Determinations (LCD)


Medical Necessity Requirements by Payer


CareSource Reimbursement Policies