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Medicaid limited coverage policies

Medicaid coverage & coding guides

Medicaid has limited coverage policies (LCPs) for certain laboratory tests. Tests subject to an LCP must meet medical necessity criteria in order to be covered.

When submitting lab orders, you must provide ICD-10 codes that indicate the patient’s condition and/or the reasons for ordering the test. If those reasons are not considered medically necessary by Medicaid, coverage may be denied.

Navigating the complexities of Medicare policies can be complicated, but Quest is here to help.

Help to ensure lab tests are performed without disruptions

Quest’s Medicaid coverage and coding reference guides can help you understand coverage limitation and find ICD-10 diagnosis codes that are most frequently ordered by physicians—preventing potential disruptions to your practice.

To get started, select a state or plan below.

Below, you’ll find a list of Medicaid coverage policies for certain tests or test groups in California. Certain tests or test groups may follow Medicare coverage policies. Click on the link(s) to find the coverage limitations and indications for the test you want to order.

Medi-Cal Limited Coverage List

Every Woman Counts Program

Family PACT CT/NG Testing

Family PACT CPT Code Grid

Family PACT Order Code Grid

Medi-Cal CA 125 Policy

Medi-Cal Ferritin Policy

Medi-Cal Fragile X PCR Policy

Medi-Cal hCG Prolactin Policy

Medi-Cal Helicobacter Pylori Policy

Medi-Cal Hep C Genotype Policy

Medi-Cal LH FSH Policy

Medi-Cal Molecular Pathology Code Correlation Chart

Medi-Cal NIPT QNatal Policy

Medi-Cal Nonspecific Diagnosis Codes

Medi-Cal Prenatal Genetic Carrier Screening

Medi-Cal Prenatal Testing Reminder

Med-Cal QuantiFERON TB Gold Reminder

Medi-Cal Update Cervical Screening

Medi-Cal Vitamin B12 Program

Presumptive Eligibility Program (PE4PW)

Below is a list of CareSource of GA coverage policies for certain tests or test groups. Certain tests or test groups may follow Medicare coverage policies. Click on the link(s) to find the coverage limitations and indications for the test you want to order.

Vitamin D Testing

Hemoglobin A1C

Hepatitis Panel/Acute Hepatitis Panel

Testing for Diagnosis of Active or Latent Tuberculosis

Below, you’ll find a list of Medicaid coverage policies for certain tests or test groups in the UnitedHealthCare (UHC) Community Plan. Certain tests or test groups may follow Medicare coverage policies. Find the coverage limitations and indications for the test you want to order at the links below.

Acute Hepatitis Panel

Alpha-fetoprotein (AFP); Serum

Carcinoembryonic Antigen (CEA)

Collagen Crosslinks (Any Method)

Digoxin; Total

Ferritin

Fibrotest - Add-On Codes Policy, Facility - Reimbursement Policy

Fibrotest - Add-On Codes Policy, Professional - Reimbursement Policy

Fibrotest - Hepatitis Screening

Fibrotest - Hepatitis Screening (for Louisiana Only)

Fibrotest - Hepatitis Screening (for Nebraska Only)

Fibrotest - Hepatitis Screening (for New Jersey Only)

Fibrotest - Hepatitis Screening (for Tennessee Only)

Fibrotest - Laboratory Services Policy, Professional - Reimbursement Policy

Fibrotest - Molecular Diagnostic Infectious Disease Testing – Medicare Advantage Policy Guideline

Fibrotest - Maximum Frequency Per Day Policy, Professional - Reimbursement Policy

Fibrotest - Non-Covered Codes and Covered Codes Policy, Facility - Reimbursement Policy

Fibrotest - Non Covered and Covered Codes Policy, Professional - Reimbursement Policy

Fibrotest - Procedure to Place of Service Policy, Professional - Reimbursement Policy

Fibrotest - Professional / Technical Component Policy, Professional - Reimbursement Policy

Fibrotest - Viral Hepatitis Serology Testing Policy, Professional - Reimbursement Policy

Glutamyltransferase, Gamma (GGT)

Glycated Hemoglobin/Glycated Protein

Human Chorionic Gonadotropin (hCG)

Lipids Testing

Partial Thromboplastin Time (PTT)

Prostate-Specific Antigen

Prothrombin Time (PT)

Serum Iron

Thyroid Testing

Tumor Antigen by Immunoassay CA 125

Tumor Antigen by Immunoassay CA 19-9

Tumor Antigen by Immunoassay CA15-3/CA 27.29

Urine Culture, Bacterial

Vitamin D Testing

Below is a list of Medicaid coverage policies for certain tests or test groups in Washington state. Certain tests or test groups may follow Medicare coverage policies. Click on the link(s) to find the coverage limitations and indications for the test you want to order.

WA Medicaid Vitamin D Testing Policy

Note: individual plans may vary. For the most up-to-date coverage policy for each patient, please contact the patient’s health plan.

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