The lists of covered diagnosis codes for National and Local Medicare Limited Coverage Policies are provided as a guide for determining if the test is reimbursable by Medicare based on the patient's symptoms or medical condition as indicated by the appropriate ICD-CM code. Please note diagnosis codes are required for all Medicare orders to document medical necessity of the testing.
This diagnosis code reference guide is provided as an aid to providers and office staff in determining when an Advance Beneficiary Notice (ABN) is necessary. Diagnosis codes must be applicable to the patient's symptoms or conditions and must be consistent with documentation in the patient's medical record. HealthEast Medical Laboratory does not recommend any diagnosis codes and will only submit diagnosis information provided to us by the ordering provider or his/her designated staff.
Updated January 2018
Click on the link below, then go to the Table of Contents on pages xvii to xxii and click on the link for the desired section. The CPT/HCPCS and descriptions are listed under each NCD section. Scroll through the section to view the covered ICD-10 codes and descriptions. Please note: Under NCD 190.15 - Blood Counts the ICD-10 and descriptions listed are not covered by Medicare.
Local Coverage Determination (LCD)
Click a link below, then accept the "License Agreements" on the CMS.gov website. The CPT/HCPCS and descriptions are listed under each LCD ID. Scroll through the section to view the covered ICD-10 codes and descriptions.