ALERT: Are you Getting Medical Necessity Denials for Claims for One of the 23 Laboratory NCDs?
Are you getting medical necessity denials for claims for one of the 23 Laboratory National Coverage Determinations (NCDs)? It has been brought to our attention that lab services that were previously allowed are now being denied for medical necessity. This is a national issue and it is being researched to identify a resolution. In the meantime, please be sure you are indicating the primary payable diagnosis on the detail line. Please include the diagnoses in priority order in Item 21 [ANSI 837 4010 equivalent is Loop 2300 segment 2-231-H101-02 (BK)] and point to the primary diagnosis in item 24E (Loop 2400 2-370-SV107-1). Please refer to the index of Lab NCDs for more information on payable diagnoses at the Centers for Medicare & Medicaid Services (CMS) Website.
