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Lab NCDs

In accordance with section 4554 of the Balanced Budget Act of 1997, CMS entered into negotiated rulemaking proceedings to develop national coverage determinations (NCDs) for clinical diagnostic laboratory services.  Under the negotiations, we developed 23 laboratory NCDs.  These NCDs are different than most other Medicare NCDs in that they include lists of ICD-9-CM codes.  All codes are included on one of three lists--covered codes, not covered codes, and codes that do not support medical necessity.  The NCDs were published under the Administrative Procedures Act in the Federal Register of November 23, 2001.

CMS announced a mechanism for keeping the NCD code list current.  CMS updates the NCD code list quarterly as necessary to incorporate new codes, correct ministerial errors, incorporate the results of Coding Analysis published else where on this site, and incorporate reconsideration of the NCDs that alter covered indications.  The quarterly updates are published in the NCD Coding Policy Manual.  You can download the current and previous coding manuals from this site. Alternatively, you can access individual NCDs from the lab index list below.

Due to the Partial Code Freeze for ICD-9-CM and ICD-10, CMS anticipates there will be no code updates to the Lab Edit Module until ICD-9-CM to ICD-10-CM transition implementation, currently scheduled for October 1, 2014. The footers in the two documents, the Lab Edit Manual and Spreadsheet, reflect the latest update which was January 2013. For more details on the partial code freeze, please refer to the following website:

http://www.cms.gov/Medicare/Coding/ICD10/Statute_Regulations.html