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Medicare Medical Necessity

As an informational service to Labcorp accounts, this page contains certain Local Coverage Determinations (LCDs) issued by the Medicare Administrative Contractors (MACs) and National Coverage Determinations (NCDs) issued by the Centers for Medicare & Medicaid Services (CMS).

A claim submitted for payment of a test on a local or national list without a specific diagnosis code that indicates medical necessity based upon the local or national policies will result in denial of payment for these services. The Medicare program will allow the laboratory to bill the patient for denied LCD/NCD coverage services only if an Advance Beneficiary Notice of Non-coverage (ABN) is completed, signed and dated by the patient prior to service being rendered, and forwarded to the laboratory prior to testing. This policy applies to all Medicare Part B providers of clinical laboratory services. Diagnosis codes provided must be reflected in the patient's medical record.

To view an alphabetical index of NCDs, click here to visit the Centers for Medicare & Medicaid Services website. 

Download Local Coverage Determinations (LCDs) by Jurisdiction

To locate LCDs by MAC, click on the state in which the test is performed:

Jurisdiction J Jurisdiction K Jurisdiction 5 Jurisdiction F Jurisdiction E Jurisdiction H Jurisdiction 6 Jurisdiction 8 Jurisdiction 15 Jurisdiction N

Jurisdiction 5
Iowa • Kansas • Missouri • Nebraska

Jurisdiction 6
Illinois • Minnesota • Wisconsin

Jurisdiction 8
Indiana • Michigan

Jurisdiction 15
Kentucky • Ohio

Jurisdiction E
California • Hawaii • Nevada

Jurisdiction F
Alaska • Arizona • Idaho • Montana • North Dakota • Oregon • South Dakota • Utah • Washington • Wyoming

Jurisdiction H
Arkansas • Colorado • Louisiana • Mississippi • New Mexico • Oklahoma • Texas

Jurisdiction J
Alabama • Georgia • Tennessee

Jurisdiction K
Connecticut • Maine • New Hampshire • New York • Rhode Island • Vermont

Jurisdiction L
Delaware • Maryland • New Jersey • Pennsylvania

Jurisdiction M
North Carolina • South Carolina • Virginia • West Virginia

Jurisdiction N
Florida

 

There can be no representation or warranty as to the accuracy or completeness of the information or that use of this information will comply with the local or national policies. To ensure the accurate and appropriate use of the information, it is recommended that the Medicare Administrative Contractor be consulted. Primary sources (ie, Medicare Administrative Contractor publications, notices, and advice) should be consulted prior to the use of this information for purposes other than for submitting diagnosis codes to Labcorp. This is particularly important since information is often affected by ongoing developments.

NOTE: PRINTING THE MEDICAL NECESSITY INFORMATION

While every effort is made to provide information that is up-to-date, policy updates take place frequently and, as a result, retaining/using a printed version may not represent the most current information. Please also note that the LCD/NCD policy information is more than 700 pages in length.