Lipid and Blood Glucose Testing (Modification of Code List to Implement Screening Benefit Added by Medicare Modernization Act (MMA)

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.

October 25, 2004

November 26, 2004

November 29, 2004