Limited Coverage Policies
Health plans publish limited coverage policies (LCPs) for certain laboratory tests. In order to be covered by the plan, the tests that are determined to merit an LCP must meet medical necessity criteria.
When submitting lab orders, please ensure that all ICD-10 codes provided represent the symptoms or conditions that warrant the test request. If the indications and/or limitations of the payer’s policy are not met, your patient may be financially responsible for the test.
Avoid Disruptions in Your Office: Navigating Coverage Policies
The complexities of commercial coverage policies can be arduous and time consuming. BioReference is able to help. Utilizing the guides below can help you understand the coverage limitations on some of the tests that are most frequently ordered, and which ICD-10 codes are most frequently ordered. (It is the ordering provider’s responsibility to select the most appropriate ICD-10 code for each patient). Understanding these coverage limitations may help prevent administrative disruptions to your practice.