Medicare coverage & coding guides

Medicare has limited coverage policies (MLCPs) for certain laboratory tests. Tests subject to an MLCP must meet medical-necessity criteria in order to be covered by Medicare. MLCP tests ordered without a supportive ICD-10 code will not satisfy medical necessity and therefore will not be covered by Medicare. These orders must be submitted with an Advance Beneficiary Notice signed by your patient, which confirms they are responsible for payment.

We’re pleased to provide Medicare Coverage and Coding Reference Guides to help you more easily determine test coverage and find ICD-10 diagnosis codes to submit with your test order. By doing so, you can ensure your Medicare patients’ lab tests are performed without delay and prevent disruptions to your office.

To get started, click your state name from the list below or select your regional Medicare program to the right from the list to the right.