Looking Up Limited Coverage Policies
For patients who use certain insurance carriers, the cost of a test might be covered if the diagnosis included is considered medically necessary (supported) by the payer. Before placing an order, you can determine whether or not an order code has limited coverage, and whether or not a particular diagnosis is either supported or not supported by the carrier’s limited coverage policy.
For tests that are not covered, this utility does not provide pricing information. The estimated cost appears only on the Advance Beneficiary Notice (ABN) or Advance Written Notification (AWN), if supported, after the order has been filed.
You can display the Limited Coverage Policy Lookup page in either your current browser window or a separate window or tab. (Whether the page appears in a window or tab depends on your browser and its configuration.) Displaying the page in a separate window or tab enables you to look up policy information without interrupting work on your current page.
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