Blood Count Lab Tests

Affected Providers

Physicians and other non-physician practitioners who write prescriptions or orders for complete blood count (CBC) lab tests.

HCPCS & CPT Codes

National Coverage Determination (NCD): Blood Counts (190.15) has the current HCPCS and CPT codes.

Background

According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for blood count lab tests is 12.1%, with a projected improper payment amount of $26.4 million.

A CBC is a common lab test that includes a hemogram and a differential white blood count (WBC). The hemogram includes a count of red blood cells, white blood cells, and platelets, as well as results of hemoglobin, hematocrit, and indicators.

You must meet the provisions in NCD 190.15.

Denial Reasons

No denial reasons were listed in the 2024 Comprehensive Error Rate Testing report for blood counts. Insufficient documentation accounted for 92.2% of improper payments for blood count lab tests during the 2023 reporting period, while incorrect coding (0.3%) and other errors (3.5%) also caused improper payments. Other errors include duplicate payment, non-covered or unallowable service, or ineligible Medicare patient errors.

Preventing Denials