Look Up Limited Coverage Policies

1 Do one of the following:

• To display the Limited Coverage Policy Lookup page in your current browser window, in the menu bar, click References > Limited Coverage Policy Lookup.

• To display the Limited Coverage Policy Lookup page in a separate window or tab, in the information bar, click Tools > Limited Coverage Policy Lookup.

2 In the Lab list, click the lab for which you want to look up limited coverage policies.

This list includes only those labs that are assigned to you.

3 In the Client field, begin typing the client name or number, and then click the appropriate client.

4 In the Insurance list, click the desired insurance carrier.

This list includes only Medicare carriers or other carriers that have insurance coverage rules.

Notes:

• For some carriers, only the mnemonic might appear in the list.

• The selected carrier might change automatically, based on the location of the client or facility. If this occurs, a message advises you of the change.

• Commercial insurance carriers that do not have a limited coverage policy on file do not appear in the list.

5 In the Test Code/Description field, type an order code or test name and press Enter.

To see a list of the diagnoses which the carrier does not consider medically necessary for the specified test, select the Show Unsupported ICD Codes check box.

Note: This check box does not appear if you selected a Medicare insurance carrier in step 3.

6 In the Search Results list, click the desired panel or test.

One of the following occurs:

• If you clicked a test containing a single CPT^® code, click the code to view the associated coverage policy.

• If you clicked a panel or reflex test containing multiple CPT codes, the corresponding CPT descriptions appear. Click one of the CPT descriptions to view the associated coverage policy.

The coverage policy associated with that test opens in a separate window.

Applicable FARS/DFARS Restrictions Apply to Government Use.

7 Review the coverage policy, and then click I Acknowledge to acknowledge that you have reviewed and understand the policy.

The limited coverage policies (ICD diagnosis codes) for the selected panel or test appear. The list contains all of the diagnoses that the carrier considers medically appropriate (supported), or not medically appropriate (unsupported), for the selected test. If more than 10 results appear, navigate the results list by clicking either the left or right arrow.

8 To narrow the list of diagnosis codes, type one or more characters in the Search Diagnoses field.

The list is updated dynamically as you type, to display only the diagnoses containing those characters.

Note: To view the insurance coverage rules, click VIEW POLICY RULES. When you have finished viewing this information, click the X in the upper-right corner to close the window.

If the selected test has no limited coverage requirements, if it is not covered under any circumstances, or if it has only frequency limitations, a message appears at the top of the page, and no diagnoses appear in the Limited Coverage Policies list.

If the test has both limited coverage and frequency limitations, a message about the frequency limitation appears. If the specified diagnosis satisfies the limited coverage policy, that diagnosis appears in the Limited Coverage Policies list.

You can still order the test, but the patient might be responsible for its cost.

If you selected the Show Unsupported ICD Codes check box, the Unsupported ICDs list displays all of the diagnoses that might cause the carrier to not cover the cost of the test.