CPT CODES
The CPT codes provided are for your convenience and are informational only. Correct coding often varies from one carrier to another. Therefore, the codes presented here are intended as guidelines and should not be used without confirming with the applicable payer that their use is appropriate in each case. CPT codes provided are based on AMA guidelines and are the property of the AMA.
LIMITED COVERAGE TESTS and INVESTIGATIONAL PROCEDURES
Some of the individual tests and profile test components listed in this Directory of Services may be considered by Medicare or other insurance carriers to be limited coverage tests or investigational procedures. Therefore, the test(s) may not be payable by the carrier as a covered benefit for the patient. Medicare patients must be informed of this possibility when the physician orders tests that may fall into this category. Affected patients must be asked to sign an Advance Beneficiary Notice, agreeing to be financially responsible if the service is denied by the carrier. Additionally, for other insurance plans, physicians must inform the patient that the service(s) may not be covered by their private insurance plan and, if so, they will be financially responsible for payment. If the patient declines to accept financial responsibility, please do not order the tests.
To obtain a current list of limited coverage tests and a list of tests that may be considered investigational by Medicare or other insurance carriers, please contact your CLP representative.
PROFILE POLICY
While Clinical Laboratory Partners' policy is to provide convenience and flexibility to physicians wishing to order test combinations/profiles, please remember:
- When ordering tests for Medicare patients, the physician should order those tests the physician believes are medically necessary for each patient.
- Using a customized profile may result in ordering tests for which Medicare or Medicaid will deny payment.
- The physician should order individual tests or a less inclusive profile where not all the tests in the customized test combination/profile are medically necessary for an individual patient.
- Tests offered in any Clinical Laboratory Partners' panel or profile may be ordered individually using Clinical Laboratory Partners' Test Requisition.
- The Office of the Inspector General (OIG) has taken the position that a physician who orders medically unnecessary tests may be subject to civil penalties.
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