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Coding Analysis for Labs (CAL) Tracking Sheet for Lipid and Blood Glucose Testing (Modification of Code List to Implement Screening Benefit Added by Medicare Modernization Act (MMA) (CAG-00266N)



The current negotiated national coverage determinations (NCDs) for all clinical diagnostic laboratory tests include a list of codes that are not covered by Medicare for any services.  This non-covered code list includes codes V81.0, V81.1, V81.2 and V77.1 as these codes are for screening services.  The MMA added two new benefits to Medicare to include coverage of screening cardiovascular testing and screening diabetes testing.  In accordance with notice and comment under the Administrative Procedures Act, we have developed policies implementing these new statutory benefits.  Under the laboratory coding analysis process that we proposed on December 24, 2003, we are seeking public comment specifically regarding the appropriateness of removing the above diagnosis codes from the non-covered code list.  Further, we intend to add the V81.0-V81.2 codes as covered codes for lipid tests 80061, 82465, 83718, and 84478.  We are proposing to add code V77.1 to the list of covered codes for 82947.  Comments should be limited to the appropriateness of this strategy for implementation of the screening benefit as determined in the "Federal Register".  Substantive comments regarding other tests or diagnosis codes that should be covered under the screening benefit are not appropriate responses to this solicitation.

Diagnostic Laboratory Tests
Requestor Name(s)Internally generated
Formal Request Accepted and Review Initiated10/25/2004
Expected NCA Completion Date12/06/2004
Public Comment Period10/25/2004 - 11/24/2004
Decision Memo Released11/29/2004
Lead Analyst(s)
  • Jackie Sheridan-Moore

October 25, 2004

Posted notice of CAL to Internet for public comments

November 26, 2004

Published implementing instructions  in transmittal 380 or pub 100-4 (CR3429)

November 29, 2004

Posted final decision memorandum  to Internet.
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