Medicare Limited Coverage Tests
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1 Iron Studies, Serum National Coverage Determination CPT Codes: Ferritin Iron Iron binding capacity Transferrin Numerical Sort: Typhoid and paratyphoid fevers Other salmonella infections Amebiasis Other protozoal intestinal diseases Intestinal infections due to other organisms Ill defined intestinal infections Tuberculosis bronchiectasis Tuberculosis of intestines, peritoneum, and mesenteric glands Tuberculosis of bones and joints Tuberculosis of kidney Tuberculosis of bladder Tuberculosis of ureter Tuberculosis of other urinary organs 042 Human immunodeficiency virus (HIV) disease Viral hepatitis Malignant neoplasm of lip, oral cavity, and pharynx Malignant neoplasm of digestive organs and peritoneum Malignant neoplasm of respiratory and intrathoracic organs Malignant neoplasm of bone, connective tissue, skin, and breast Malignant neoplasm of genitourinary organs Malignant neoplasm of other and unspecified sites Malignant neoplasm associated with transplanted organ Malignant neoplasm of lymphatic and hematopoietic tissue Neuroendocrine tumors Benign neoplasms Carcinoma in situ Neoplasms of uncertain behavior Neoplasms of unspecified nature Diabetes, secondary Diabetes mellitus Panhypopituitarism Iatrogenic pituitary disorders Other disorders of the pituitary and other syndromes of diencephalohypophysial origin Other ovarian failure Other testicular hypofunction 260 Kwashiorkor 261 Nutritional marasmus 262 Other severe, protein-calorie malnutrition Other and unspecified protein-calorie malnutrition Disorders of iron metabolism Disorders of porphyrin metabolism Iron deficiency anemias Other deficiency anemias Thalassemias Diseases, sickle-cell Disease, sickle-cell/hb-c with crisis Disease, other sickle-cell without crisis Disease, other sickle-cell with crisis Sideroblastic anemia January 2015 Medicare Limited Coverage Tests
2 285.2 Acute posthemorrhagic anemia Anemia of chronic disease Anemia due to antineoplastic chemotherapy Anemia, unspecified Coagulation defects Purpura and other hemorrhagic conditions Splenic sequestration Gastrointestinal Anorexia nervosa Other and unspecified disorders of eating Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease Hypertensive chronic kidney disease, unspecific, with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, malignant, without heart failure and with Hypertensive heart and chronic kidney disease, malignant, with heart failure and with Hypertensive heart and chronic kidney disease, benign, without heart failure and with Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with Hypertensive heart and chronic kidney disease, unspecified, with heart failure and Other primary cardiomyopathies Alcoholic cardiomyopathy Nutritonal and metabolic cardiomyopathy Cardiomyopathy in other diseases classified elsewhere Secondary cardiomyopathy, unspecified ,426.9 Conduction disorders Conduction disorders Cardiac dysrhythmias Heart failure Gastroesophageal laceration-hemorrhage syndrome Esophageal hemorrhage Gastric ulcer Duodenal ulcer Peptic ulcer, site unspecified Gastrojejunal ulcer Gastritis and duodenitis Disorders of function of stomach Angiodysplasia of stomach and duodenum with hemorrhage Dieulafoy lesion (hemorrhagic) of stomach and duodenum Regional enteritis Ulcerative colitis Acute vascular insufficiency of intestine Chronic vascular insufficiency of intestine Diverticulosis of small intestine with hemorrhage Diverticulitis of small intestine with hemorrhage Diverticulosis of colon with hemorrhage Diverticulitis of colon with hemorrhage Hemorrhage of rectum and anus Angiodysplasia of intestine with hemorrhage Dieulafoy lesion (hemorrhagic) of intestine Vomiting of fecal matter Medicare Limited Coverage Tests January 2015
3 570 Acute and subacute necrosis of liver Chronic liver disease and cirrhosis Liver abscess and sequelae of chronic liver disease Other disorders of liver Gastrointestinal hemorrhage Celiac disease, tropical sprue, blind loop syndrome, other and unspecified postsurgical nonabsorption Intestinal malabsorption, other specified and unspecified Nephrotic syndrome Chronic kidney disease 586 Renal failure, unspecified Atrophy of testis Disorders of menstruation and other abnormal bleeding from female genital tract Premenopausal menorrhagia Postmenopausal bleeding Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium; anemia Pruritus and related conditions Alopecia Other disorders of skin and subcutaneous tissue, dyschromia, vitiligo, and other Arthropathy associated with other endocrine and metabolic disorders Other and unspecified arthropathies Pain in joint Hemolytic disease due to other and unspecified isoimmunization Hydrops fetalis due to isoimmunization Kernicterus due to isoimmunization Late anemia due to isoimmunization Other symptoms concerning nutrition, metabolism, and development Abnormality of red blood cells Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase (LDH) Other nonspecific abnormal serum enzyme levels Other abnormal blood chemistry Cachexia Poisoning by agents primarily affecting blood constitutents, iron compounds Toxic effect of lead and its compounds (including fumes) Complications of transplanted of bone marrow Complications, transfusion Complications, transfusion, hemolytic, incompatibility unspecified; acute, delayed Complications, transfusion, hemolysis V08 Asymptomatic human immunodeficiency virus (HIV) infection status V12.1 Nutritional deficiency V12.3 Diseases of blood and blood-forming organs V15.1 Surgery to heart and great vessels V15.21-V15.29 History; surgery to other major organs V43.21-V43.22 Heart replaced by other means V43.3 Organ or tissue replaced by other means; heart valve V43.4 Organ or tissue replaced by other means; blood vessel V43.60 Organ or tissue replaced by other means; unspecified joint V56.0 Extracorporeal dialysis V56.8 Other dialysis Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations January 2013 Coding Policy Manual and Change Report January 2015 Medicare Limited Coverage Tests
4 Iron Studies, Serum, Continued Alphabetical Sort: Abnormal; abnormality of red blood cells Abnormal; other abnormal blood chemistry Abnormal; other nonspecific abnormal serum enzyme levels Abscess; liver abscess and sequelae of chronic liver disease Alopecia Amebiasis Anemia; acute posthemorrhagic anemia Anemia, antineoplastic chemotherapy induced Anemia; hemolytic disease due to other and unspecified isoimmunization Anemia; hydrops fetalis due to isoimmunization Anemia of chronic disease Anemia; kernicterus due to isoimmunization Anemia; late anemia due to isoimmunization Anemia; other deficiency anemias Anemia; sideroblastic anemia Anemia; unspecified Angiodysplasia of intestine with hemorrhage Angiodysplasia of stomach and duodenum with hemorrhage Anorexia nervosa Arthritis; arthropathy associated with other endocrine and metabolic disorders Arthropathy; other and unspecified arthropathies Atrophy of testis Cachexia Cardiomyopathy; alcoholic cardiomyopathy Cardiomyopathy; cardiomyopathy in other diseases classified elsewhere Cardiomyopathy; nutritional and metabolic cardiomyopathy Cardiomyopathy; other primary cardiomyopathies Cardiomyopathy; secondary cardiomyopathy, unspecified Celiac disease, tropical sprue, blind loop syndrome, other and unspecified postsurgical nonabsorption Chronic vascular insufficiency of intestine Cirrhosis; chronic liver disease and cirrhosis Colitis; ulcerative colitis Complications of transplanted of bone marrow Complictions, transfusion Complications, transfusion, hemolytic, incompatibility unspecified; acute, delayed Complications, transfusion, hemolysis Deficiency; iron deficiency anemias Diabetes; complication, diabetes mellitus Diabetes, secondary Disease, sickle-cell Disease, sickle-cell, other with crisis Disease; sickle cell/hb-c with crisis Disease; sickle cell without crisis, other V56.0 Dialysis; extracorporeal dialysis V56.8 Dialysis; other dialysis Disease; gastrointestinal Disease, kidney, chronic Disease; other disorders of liver Disorder; eating, other and unspecified disorders of eating Disorder; gastric, disorders of function of stomach Disorder; iatrogenic pituitary disorders Disorder; other disorders of the pituitary and other syndromes of diencephalohypophysial origin Disorder; panhypopituitarism Medicare Limited Coverage Tests January 2015
5 Disorders of iron metabolism Disorders of porphyrin metabolism Disorders; Dieulafoy lesion (hemorrhagic) of intestine Disorders; Dieulafoy lesion (hemorrhagic) of stomach and duodenum ,426.9 Disturbance; heart, functional, conduction disorders Disturbance; heart, functional, conduction disorders Diverticulitis of colon with hemorrhage Diverticulitis of small intestine with hemorrhage Diverticulosis of colon with hemorrhage Diverticulosis of small intestine with hemorrhage Dysrythmias; cardiac dysrhythmias Enteritis; regional enteritis Esophageal hemorrhage Failure; heart failure Failure; other ovarian failure 586 Failure; renal failure, unspecified Fibrinolysis; coagulation defects Findings; abnormal, nonspecific elevation of levels of transaminase or lactic acid dehydrogenase (LDH) Gastritis and duodenitis Gastroesophageal laceration-hemorrhage syndrome Gastrojejunal ulcer Hemorrhage of rectum and anus Hemorrhage; gastrointestinal hemorrhage Hepatitis; viral hepatitis V12.3 History; disorder, diseases of blood and blood-forming organs V12.1 History; nutritional deficiency V15.1 History; surgery to heart and great vessels V15.21-V15.29 History; surgery to other major organs 042 Human immunodeficiency virus (HIV) disease V08 Human immunodeficiency virus; asymptomatic human immunodeficiency virus (HIV) infection status Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease Hypertensive chronic kidney disease, unspecific, with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, malignant, without heart failure and with Hypertensive heart and kidney disease, malignant, with heart failure and chronic kidney disease Hypertensive heart and chronic kidney disease, benign, without heart failure and with Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with Hypertensive heart and chronic kidney disease, unspecified, with heart failure and Hypofunction; other testicular hypofunction Infection; ill-defined intestinal infections Infection; intestinal infections due to other organisms Infection; other protozoal intestinal diseases Infection; other salmonella infections 260 Kwashiorkor Malabsorption; intestinal malabsorption, other specified and unspecified Malnutrition; other and unspecified protein-calorie malnutrition 262 Malnutrition; other severe, protein-calorie malnutrition 261 Marasmus; nutritional marasmus January 2015 Medicare Limited Coverage Tests
6 627.1 Menorrhagia; postmenopausal bleeding Menorrhagia; premenopausal menorrhagia Menstruation: disorders of menstruation and other abnormal bleeding from female genital tract 570 Necrosis, necrotic; acute and subacute necrosis of liver Neoplasm; benign neoplasms Neoplasm; carcinoma in situ Neoplasm, malignant, associated with transplanted organ Neoplasm; malignant, primary, bone, connective tissue, skin, and breast Neoplasm; malignant, primary, digestive organs and peritoneum Neoplasm; malignant, primary, genitourinary organs Neoplasm; malignant, primary, lip, oral cavity, and pharynx Neoplasm; malignant, primary, lymphatic and hematopoietic tissue Neoplasm; malignant, primary, other and unspecified sites Neoplasm; malignant, primary, respiratory and intrathoracic organs Neoplasms of uncertain behavior Neoplasms of unspecified nature Nephritis; nephrotic syndrome Pain in joint Poisoning by agents primarily affecting blood constituents, iron compounds (See Table of Drugs and Chemicals: poisoning) Pregnancy; other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium; anemia Pruritus and related conditions Purpura and other hemorrhagic conditions V43.4 Replacement by artificial; organ or tissue replaced by other means; blood vessel V43.21-V43.22 Replacement by artificial; organ or tissue replaced by other means; heart V43.3 Replacement by artificial; organ or tissue replaced by other means; heart valve V43.60 Replacement by artificial; organ or tissue replaced by other means; unspecified joint Splenic sequestration Symptoms; other symptoms concerning nutrition, metabolism, and development Syndrome; acute vascular insufficiency of intestine Thalassemias Toxic effect of lead and its compounds, including fumes, (See Table of Drugs and Chemicals: poisoning) Tuberculosis bronchiectasis Tuberculosis of bladder Tuberculosis of bones and joints Tuberculosis of intestines, peritoneum, and mesenteric glands Tuberculosis of kidney Tuberculosis of other urinary organs Tuberculosis of ureter Tumor, endocrine Typhoid and paratyphoid fevers Ulcer; duodenal ulcer Ulcer; peptic ulcer, site unspecified Ulcer; stomach, gastric ulcer Vitiligo; other disorders of skin and subcutaneous tissue, dyschromia, vitiligo, and other Vomiting of fecal matter Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations January 2013 Coding Policy Manual and Change Report Medicare Limited Coverage Tests January 2015
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