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Laboratory & Pathology

General Content

Charge Capture Compliance

Contact Information

Direct Line: (585) 922-1167

Fax: (585) 922-1168

Manager: Shirley Slater - (585) 922-1164

Medical Necessity for Ordering Lab Tests

Any test ordered through the Department of Pathology and Laboratory Medicine must be accompanied by signs and symptoms or a diagnosis indicating the reason for ordering each test. Requisitions must be signed by a provider.

Tips for Requisition Completion

  • A diagnosis or signs and symptoms must be placed on the requisition relating to each test ordered. Provide all codes or narrative data that are appropriate for the tests ordered. ALL insurances require diagnostic information on claims for laboratory services.
  • ICD-10 codes must contain all digits as specified in the current ICD-10 book, and be as specific as possible.
  • R/O, screening, up or down arrows, +, -, or possible before a narrative diagnosis are not acceptable.
  • Medicare does not pay for laboratory testing for screening purposes except as specifically allowed by regulation. Appropriate screening diagnoses must be provided when allowed screening tests are requested.

Thank you for your cooperation and assistance in helping us provide quality laboratory testing to your patients.

Medical Necessity Policies (National or Local Coverage Decisions)

Medicare has established medical necessity criteria for a variety of tests through local or national coverage decisions. This medical necessity criteria may also be followed by private insurers who offer HMO or managed care coverage to medicare-eligible individuals.

If laboratory tests are requested without covered diagnoses on the requisition, the patient will be asked to sign an Advance Beneficiary Notice (ABN), or your office will be contacted for additional diagnostic information.

View the current information on Medicare coverage decisions

View or print the entire 2017 NCD manual

Medical Necessity Policies Type
Acid Phosphatase (discontinued January 2013) LCD
Alpha-fetoprotein (revised October 2015) NCD
Amylase (discontinued June 2007) LCD
Beta2 Microglobulin (discontinued March 2012) LCD
Blood Counts (revised October 2015) NCD
Blood Glucose Testing (revised October 2015) NCD 
B-type Natriuretic Peptide (BNP) Testing (revised October 2015) LCD
Carcinoembryonic Antigen (revised October 2015) NCD
Chloride, Blood (discontinued June 2007) LCD
Collagen Crosslinks, Any Method (revised October 2015) NCD
Digoxin Therapeutic Drug Assay (revised October 2015) NCD
Erythrocyte Sedimentation Rate (ESR) (discontinued October 2011) LCD
Fecal Occult Blood (revised October 2015) NCD
Flow Cytometry (discontinued November 2011) LCD
Gamma Glutamyl Transferase (revised July 2012) NCD
Glycated Hemoglobin/Glycated Protein (revised October 2015) NCD
Helicobacter Pylori Tests (discontinued June 2007) LCD 
Hepatic Function Panel (discontinued December 2011) LCD
Hepatitis Panel/Acute Hepatitis Panel (revised October 2015) NCD
Heavy Metals (revised January 2017) LCD
High Sensitivity C-Reactive Protein (hsCRP) Testing (discontinued April 2012) LCD 
Homocysteine Level, Serum (discontinued February 2012) LCD
Human Chorionic Gonadotropin (revised October 2015) NCD
Human Immunodeficiency Virus Testing (Diagnosis) (revised October 2015) NCD
Human Immunodeficiency Virus Testing (Prognosis including monitoring) (revised October 2015) NCD
Ionized Calcium (discontinued March 2012) LCD
Lipid Testing (revised October 2015) NCD
Molecular Pathology (revised January 2017) LCD
Pap Smear of the Cervical or Vaginal Mucosa (discontinued June 2007) LCD
Parathormone (Parathyroid Hormone, PTH) (discontinued April 2012) LCD
Partial Thromboplastin Time (PTT) (revised January 2016) NCD
Phosphorus inorganic (phosphate) (discontinued June 2007) LCD
Potassium (Serum) Levels (discontinued June 2007) LCD
Prostate Specific Antigen (revised October 2015) NCD
Prothrombin Time (PT) (revised January 2016) NCD
Qualitative Drug Screen (discontinued December 2015) LCD
RAST Type Tests (revised October 2015) LCD
Reticulocyte Counts (discontinued June 2007) LCD
Serum Iron Studies (revised July 2016) NCD 
Serum Magnesium (discontinued May 2012) LCD
Syphilis Tests (discontinued December 2011) LCD
Thyroid Testing (revised January 2016) NCD
Tumor Antigen by Immunoassay CA 19-9 (revised October 2015) NCD
Tumor Antigen by Immunoassay CA15-3/CA 27.29 (revised October 2015) NCD
Tumor Antigen by Immunoassay CA125 (revised October 2015) NCD
Urinalysis (discontinued June 2007) LCD
Urine Culture (Bacterial Urine Culture) (revised January 2016) NCD

Urine Drug Testing (revised January 2017)

Viral Hepatitis Serology Tests (discontinued December 2011) LCD
Vitamin D25-OH (revised December 2015) LCD
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