Compliance Info
| Name | Downloads |
|---|---|
| POLICY: ABN and Other Notices of Patient Financial Liability | Download PDF |
| Disclosure of Medicare Regulations | Go to Site |
| Medicare PAP Smear Guidelines | Download PDF |
| Screening Pap Tests and Pelvic Examination Brochure | Go to Site |
| Non-Covered ICD-10-CM Codes for all Lab NCD's | Download PDF |
| Medicare Parts A and B Coverage and Preauthorization | Download PDF |
| Molecular Pathology: Quick Reference Guide | Download PDF |
| Naturopathic Physicians and Doctors of Chiropractic Ordering Diagnostic Laboratory Testing, May 2012 | Download PDF |
Patient Potential Financial Liability Forms |
|
| Medicare: Advanced Beneficiary Notice of Non-Coverage (ABN), Form #DOC0010534 | Download PDF |
| Medicare: Advance Beneficiary Notice of Non-Coverage (ABN) for patients who are dual eligible (Medicare/Medicaid), Form #DOC0010534 | Download PDF |
| VT and NY Medicaid: Notice of Financial Responsibility, Form #037113 | Download PDF |
| Tricare Request for Non-covered Services, Form #037112 | Download PDF |
| Commercial: Advance Notice of Potential Non-Coverage, Form #037111 | Download PDF |
Preventive Services |
|
| Medicare Preventive Screening Educational Tool | Go To Site |
| Cardiovascular Screening | Go to Site |
| Cervical Cancer and HPV Screening | Go to Site |
| Colorectal Cancer | Go to Site |
| Diabetes Screening | Go to Site |
| HCV Screening | Go to Site |
| Hepatitis B Virus Infection Screening | Download PDF |
| HIV Screening | Go to Site |
| Pap Test and Pelvic Exam for Early Detection of Cervical or Vaginal Cancer | Go to Site |
| Prostate Cancer Screening | Go to Site |
| Sexually Transmitted Infections Screening | Go to Site |
Coverage Decisions |
|
| Urine Culture NCD-190.12 | Download PDF |
| HIV (Monitoring) NCD-190.13 | Download PDF |
| HIV (Diagnosis) NCD-190.14 | Download PDF |
| Blood Counts NCD-190.15 | Download PDF |
| Partial Thromboplastin Time (PTT) NCD - 190.16 | Download PDF |
| Prothrombin Time NCD-190.17 | Download PDF |
| Collagen Crosslinks NCD-190.19 | Download PDF |
| Glucose Testing NCD-190.20 | Download PDF |
| Thyroid Testing NCD-190.22 | Download PDF |
| Lipids Testing NCD-190.23 | Download PDF |
| Digoxin NCD-190.24 | Download PDF |
| Alpha Fetoprotein NCD-190.25 | Download PDF |
| Carcinoembryonic Antigen - NCD 190.26 | Download PDF |
| Human Chorionic Gonadotropin - NCD 190.27 | Download PDF |
| Tumor Antigen CA 125 NCD-190.28 | Download PDF |
| Tumor Antigen CA 15-3 and CA 27.29 NCD-190.29 | Download PDF |
| Tumor Antigen by Immunoassay CA 10-9 NCD190.30 | Download PDF |
| Gamma Glutamyl Transferase - NCD 190.32 | Download PDF |
| Hepatitis Panel / Acute Hepatitis Panel NCD-190.33 | Download PDF |
| Fecal Occult Blood NCD - 190.34 | Download PDF |
| B-Type Natriuretic Peptide (BNP) Testing LCD-L33573 | Go to Site |
| B-Type Natriuretic Peptide (BNP) Billing and Coding A56826 | Go to Site |
| Cytogenetic Studies NCD-190.3 | Go to Site |
| Billing and Coding: Cytogenetic Studies | Download PDF |
| Diagnostic Pap Smears NCD 190.2 | Go to Site |
| Billing and Coding: Urine Drug Testing A56761 | Go to Site |
| Drug Screen Urine LCD-L36037 | Go to Site |
| Genomic Sequence Analysis in the Treatment of Hematolymphoid Diseases LCD-L37606 | Go to Site |
| Billing and Coding: Genomic Sequence Analysis in the Treatment of Hematolymphoid Diseases A56793 | Go to Site |
| Genomic Sequence Analysis Solid Tumor Neoplasm LCD-L37810 | Go to Site |
| Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms A56867 | Go to Site |
| Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) | Go to Site |
| Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) | Go to Site |
| Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) | Go to Site |
| Glycated Hemoglobin (A1c) NCD - 190.21 | Download PDF |
| Heavy Metal Testing LCD - L35074 | Go to Site |
| Heavy Metal Screening Billing and Coding A56767 | Go to Site |
| Histocompatibility NCD-190.1 | Go to Site |
| Billing and Coding: Histocompatibility Testing | Download PDF |
| Billing and Coding: CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique) | Go to Site |
| Iron Testing NCD-190.18 | Download PDF |
| Lipid Testing NCD-190.23 | Download PDF |
| Next Gen Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer - CAG-0045N | Go to Site |
| Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) LCD-L39189 | Go to Site |
| Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) A58921 | Go to Site |
|
Molecular Pathology Procedures LCD-35000 |
Go to site |
| Billing and Coding: Molecular Pathology Procedures - A56199 | Go to Site |
| Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis LCD-L37733 | Go to Site |
| Billing and Coding: Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis-A56609 | Go to Site |
| Prostate Specific Antigen - NCD 190.31 | Download PDF |
| RAST Type Tests LCD-L33591 | Go to Site |
| RAST Billing and Coding A56844 | Go to Site |
| Respiratory Pathogen Panel Testing A58741 | Go to Site |
| Respiratory Pathogen Panel Testing L39027 | Go to Site |
| Solid Organ Neoplasm LCD-37810 | Go to Site |
| Sweat Testing NCD-190.5 | Go to Site |
| Billing and Coding: Sweat Testing | Download PDF |
| 10Vitamin D Assay LCD-L37535 | Go to Site |
| Vitamin D Billing and Coding A57736 | Go to Site |
Laboratory Contact Information
If you have any questions about Pathology & Laboratory Medicine, please contact Laboratory Customer Service, at (802) 847-5121 or 1 (800) 991-2799 or Fax 802-847-5905. University of Vermont Medical Center, Pathology & Laboratory Medicine-MP-103, Burlington VT 05401.