Frequently Used Tests & ICD-9 Codes
Medicare limited coverage policies outline indications for which testing is considered reasonable and medically necessary.  Monitoring of treatment or therapy may be reasonable and medically
necessary at frequencies outlined in Medicare's Limited Coverage Policies and indicated below as Q--.  Test(s) ordered in addition to Medicare's recognized frequencies for monitoring and in
response to changes in patient treatment or condition, the diagnosis must support medical nenessity and should be accompanied by a diagnosis code (ICD9) specific to that medical condition. If
testing is requested which is not covered by Medicare the patient or responsible party may sign an Advanced beneficiary Notice (ABN) and be fully responsible for payment.  Please refer to
your Medical Necessity policies and ICD9 Code book for additional information.
Albumin, Prealbumin (NDS) BNP    B-type Natriuretic Peptide (LC)
263.0    Malnutrition of moderate degree 402.91     Unspecified Hypertensive Heart Disease with Heart Failure
263.9    Malnutrition, Protein-Calorie  NOS 428.0       Congestive Heart Failure Unspecified
269.9    Unspecified nutritional deficiency 428.9        Heart Failure Unspecified
280.9    Anemia, iron deficiency unspecified 786.00      Respiratory Abnormality Unspecified
281.0    Anemia, pernicious 786.02      Orthopnea (difficulty breathing except in upright position)
285.0    Sideroblastic anemia 786.05      Shortness of Breath
285.9    Anemia, unspecified 786.06      Tachypnea (hyperventilation)
356.0    Hereditary peripheral neuropathy 786.07      Wheezing
401.9     Hypertension, unspecified CMP     Comprehensive Metabolic Panel (NDS)
586         Renal failure unspecified 042           HIV Disease
707.00    Pressure ulcer unspecified site 250.10-250.43      Diabetes Mellitus
783.21    Abnormal loss of weight 250.80-250.83      Diabetes with other specified manifestations
V58.69    Long-term (current) use of other (high risk) medications 263.0       Malnutrition of moderate degree
BMP   Basic Metabolic Panel (NDS) 263.1       Malnutrition of mild degree
042           HIV Disease 263.9       Malnutrition, Protein-Calorie  NOS
250.20     Diabetes w/hyperosmolarity Type II or unspecified 275.09     Other Disorders of iron metabolism
250.22     Diabetes w/hyperosmolarity Type II or unspecified, controlled 276.50     Volume Depletion, unspecified
263.0       Malnutrition of moderate degree 290.0       Senile Dementia, Uncomplicated
263.1       Malnutrition of mild degree 290.3       Senile Dementia with Delirium
263.9       Malnutrition, Protein-Calorie  NOS 298.9       Unspecified psychosis
290.0       Senile Dementia, Uncomplicated 401.9       Hypertension, unspecified
290.3       Senile Dementia with Delirium 536.2       Persistent Vomiting
401.9       Hypertension, unspecified 593.9       Unspecified Disorder of Kidney and Ureter
416.9       Chronic Pulmonary Heart Disease, Unspecified 780.71     Fatigue syndrome, chronic
536.2        Persistent Vomiting 780.79     Other malaise and fatigue
593.9        Unspecified Disorder of Kidney and Ureter 782.3       Edema
780.39      Convulsions NOS 782.4       Jaundice unspecified
780.71      Fatigue syndrome, chronic 995.20     Unspecified adverse effect of drug, medical and biological susbstance
782.3        Edema V58.69     Long-term (current) use of other (high risk) medications
995.20      Unspecified Adverse Effect of Unspecified Drug, Medicinal & Biological Substance V67.51     Following completed treatment with high risk medicine, NEC
V58.69      Long-term (current) use of other (high risk) medications Digoxin (LC) Q yearly after steady state is achieved
Dilantin (Phenytoin) (NDS) 427.31     Atrial fibrillation
350.1         Trigeminal neuralgia 428.0       Congestive heart failure
427.9         Cardiac arrhythmia unspecified 972.0       Cardiac rhythm regulators
780.39       Convulsions NOS 972.1       Poisioning by cardiotonic glycosides and drugs of similar action
V58.69       Long-term (current) use of other (high risk) medications 995.20     Unspecified adverse effect of drug, medical and biological susbstance
  V58.69     Long-term (current) use of other (high risk) medications
LC=Limited Coverage Test.  These procedures are covered by Medicare for a specific group of dignosis determined & identified in Medicare Limited Coverage Policies.
NDS=Non Diagnosis Specific.  There are no specific diagnostic restrictions, however Medicare will pay for these procedures as determined to be reasonable and medically necessary.
CBCD, CBC, H&H (LC) Glucose (LC) Frequent strip tests  Q 3
008.45      Infectious, Clostridium difficile 038.12     Methicillin resistant Staphylococcus aureus septicemia
009.3        Diarrhea of presumed infectious origin 250.00     Diabetes mellitus without mention of complication (non insulin type II)
041.11      Infectious, staphyloccus aureus 250.02     Diabetes mellitus without mention of complication (non insulin type II uncontrolled)
042           HIV Disease 250.90     Diabetes mellitus with unspecified complications (type II or unspecified type)
250.00-250.93      Diabetes Mellitus 250.92     Diabetes mellitus with unspecified complications (non insulin type II) uncontrolled
263.0        Malnutrition of moderate degree 263.0       Malnutrition of moderate degree
263.1        Malnutrition of mild degree 263.1       Malnutrition of mild degree
263.9       Malnutrition, Protein-Calorie  NOS 263.9       Malnutrition, Protein-Calorie  NOS
278.00     Obesity, unspecified 298.9       Unspecified psychosis
280.0      Anemia, secondary to blood loss 482.9       Bacterial pneumonia, unspecified
280.1      Anemia, secondary to inadequat dietary intake 599.0       Urinary Tract infection, site not specified
281.0      Anemia, pernicious 707.00     Pressure ulcer unspecified site
281.2      Anemia, folate deficiency 780.4       Dizziness and giddiness
286.59      Coagulation defects, other Hemorragic disorder due to intrinsic circulating anticoagulants, antibodies or inhibitors 780.71     Fatigue syndrome, chronic
401.9      Hypertension, unspecified 781.0       Abnormal involuntary movements
428.0      Congestive Heart Failure Unspecified 783.1       Abnormal weight gain
465.9      Infection, acute upper respiratory of unspecified site 783.21     Abnormal loss of weight
536.2      Persistent Vomiting 785.4       Gangrene
586         Renal failure unspecified 786.50     Chest pain, unspecified
780.60    Fever NOS V58.69     Long-term (current) use of other (high risk) medications
780.79    Malaise and Fatigue V67.51     Following completed treatment with high risk medicine, NEC
782.3       Edema  
783.1       Abnormal weight gain Hgb A1C (LC) Q 3
783.21     Abnormal loss of weight 250.00     Diabetes mellitus without mention of complication (non insulin type II)
785.4       Gangrene 250.02     Diabetes mellitus without mention of complication (non insulin type II uncontrolled)
786.05     Shortness of Breath 250.90     Diabetes mellitus with unspecified complications (type II or unspecified type)
786.07     Wheezing 250.92     Diabetes mellitus with unspecified complications (non insulin type II) uncontrolled
786.50     Chest pain, unspecified 251.2       Hypoglycemia, Unspecified
789.00     Abdominal pain unspecified site 271.4       Renal glycosuria
V58.69     Long-term (current) use of other (high risk) medications 275.09     Other Disorders of Iron Metabolism 
V67.51     Following completed treatment with high risk medicine, NEC 577.1       Chronic pancreatitis
Lipid Panel Q yearly, LDL & Total Cholesterol Q 2 months first year 790.29     Hyperglycemia NOS
Q 4 months after treatment goals achieved, HDL, Triglycerides, VLDL (LC) V58.67     Long-term (current) use of Insulin
250.00-250.93      See Diabetes Mellitus V58.69     Long-term (current) use of other (high risk) medications
263.0      Malnutrition of moderate degree  
263.1      Malnutrition of mild degree Liver Panel and Components (NDS)
263.9      Malnutrition, Protein-Calorie  NOS 042          HIV Disease
272.0      Pure Hypercholesterolema 275.09     Other Disorders of iron metabolism
272.4      Hyperlipidema NOS 571.5       Cirrhosis
278.00   Obesity, unspecified 573.9       Unspecified liver disorder
401.9     Hypertension, unspecified 782.4       Jaundice, unspecified
402.11   Hypertensive heart disease benign with heart failure 789.1       Hepatomegaly
428.0     Congestive Heart Failure Unspecified 794.8       Abnormal liver scans
786.50   Chest pain, unspecified V58.64     Long-term (current) use of non-steroid anti-inflammatories (NSAID)
V58.64   Long-term (current) use of non-steroid anti-inflammatories (NSAID) V58.69     Long-term (current) use of other (high risk) medications
V58.69   Long-term (current) use of other (high risk) medications V67.51     Following completed treatment with high risk medicine, NEC
Iron, IBC, Ferritin, Transferrin (LC) PTT (LC)
042          HIV Disease 038.9       Unspecified septicemia
250.00     Diabetes/Mellitus Type II 042           HIV disease
263.0       Malnutrition of moderate degree 427.31     Atrial Fibrilation
263.1       Malnutrition of mild degree 428.0       Congestive Heart Failure
263.9       Malnutrition, Protein-Calorie  NOS 586           Renal failure unspecified
275.09    Other Disorders of iron metabolism 729.5        Pain in limb
280.9      Anemia, iron deficiency unspecified 786.05      Shortness of breath
281.0      Anemia, pernicious V58.61      Long term (current) use of anticoagulants
281.2      Anemia, folate deficiency RPR (NDS)
282.60   Sickle-cell disease, unspecified 042            HIV disease
285.9     Anemia, unspecified 331.0        Alzheimer's disease
286.9     Coagulation defects, other and unspecified 331.2        Senile degeneration of brain
428.0     Congestive Heart Failure Unspecified 780.97      Altered Mental Status
428.9     Heart Failure Unspecified TSH, T3 Uptake, T4 Total (LC) Q 6 months in clinically stable patients
586        Renal failure unspecified 244.9        Hypothyroidism
719.40   Pain in unspecified joint 250.00-250.93    Diabetes Mellitus
719.49   Pain in multiple joints 272.2        Mixed hyperlipidemia
790.6     Other abnormal blood chemistry 296.99      Mood Swings
V12.1     Personal history of  nutritional deficiency 783.1        Abnormal Weight Gain
Phenobarbital (NDS) 783.21      Abnormal Loss of Weight
301.9       Personality disorder, unspecified V58.69      Long-term (current) use of other (high risk) medications
780.39     Convulsions NOS V67.51      Following completed treatment with high risk medicine, NEC
V58.69     Long-term (current) use of other (high risk) medications Urinalysis (complete) (NDS)
Platelet Counts (LC) 038.12      Methicillin resistant Staphylococcus aureus septicemia
285.9       Anemia, unspecified 428.0        Congestive Heart Failure Unspecified
V58.61    Long term (current) use of anticoagulants 599.0        Urinary Tract infection, site not specified
V58.69    Long-term (current) use of other (high risk) medications 599.70      Hematuria Unspecified
Potassium and Electrolytes (NDS) 788.1        Dysuria
250.00-250.93     Diabetes Mellitus 788.41     Urine frequency
276.50     Volume Depletion, unspecified V58.64     Long-term (current) use of non-steroid anti-inflammatories (NSAID)
401.9       Hypertension, unspecified V58.69     Long-term (current) use of other (high risk) medications
V58.69    Long-term (current) use of other (high risk) medications V67.51     Following completed treatment with high risk medicine, NEC
V67.51    Following completed treatment with high risk medicine, NEC Urine Culture (LC)
PT    Protime with INR (LC) Q2 to 3 weeks after patient stable 038.12     Methicillin resistant Staphylococcus aureus septicemia
042           HIV disease 288.00     Neutropenia unspecified
286.0 - 286.9      Coagulation defects 585.6       End stage renal disease
428.0 - 428.9      Heart Failure 599.0       Urinary Tract infection, site not specified
586          Renal failure unspecified 599.70     Hematuria, Unspecified
729.5       Pain in limb 601.9       Prostatitis unspecified
964.2       Poisoning by anticoagulants 616.10     Vaginitis and vulvovaginitis unspecified
995.20     Unspecified adverse effect of drug 780.60      Fever NOS
V58.61     Long term (current) use of anticoagulants V58.69     Long-term (current) use of other (high risk) medications
Valproic Acid (NDS) Vancomycin (NDS)
780.39     Convulsions NOS V58.62     Long-term (current) use of antibiotics
V58.62     Long-term (current) use of antibiotics V58.69     Long-term (current) use of other (high risk) medications
V58.69     Long-term (current) use of other (high risk) medications  
Uploaded 04-22-2014