Northern Light Laboratory

About Us

About Us

Medicare Lab Screening Benefits

The Medicare Program covers preventive screening tests for cardiovascular disease, diabetes, colorectal cancer, HIV infection, prostate cancer, STD’s & hepatitis C.

Patient Eligibility and Diagnosis Requirements

SCREENING TEST ORDERED	HCPCS/CPT CODES	COVERED ICD-10 CODES	WHO IS ELIGIBLE	FREQUENCY
Cardiovascular Disease	80061-lipid panel Must include cholesterol (82465),lipoprotein (83718)and triglycerides (84478)	Z13.6	*All beneficiaries	1 every 5 years
Colorectal Cancer	G0328 82270 ST IOB 1MS or 70765326	Z12.11 and Z12.12	Ages 50-85 Asymptomatic *At risk for developing colorectal cancer	Annually
Diabetes	82947-Glucose-quant 82950-Glucose-post dose 82951 Glucose-GTT	Z13.1	At risk for diabetes Diagnosed with pre-diabetes	2 times per year for pre-diabetic Annually if not pre-diabetic
Hepatitis C Virus (HCV)	G0472 HCV MS or 70999999	Z72.89 or F19.20 Z11.59 for those in the 1945-1965 age range	High risk for HCV infection Born between 1945-1965	Annually for high risk 1 lifetime for those born between 1945-1965
HIV	G0433 HIV MS or 69991446	No risk factors – Z11.4 Risk factors – add Z72.89,Z72.51,Z72.52 or Z72.53 Pregnancy-Z11.4 plus Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90, O09.91, O09.92, or O09.93	Increased risk for HIV Pregnant women	Annually for those between ages of 15-65 w/out regard to risk Annually for patients younger than 15 or older than 65 with increased risk. *3 times per pregnancy -at diagnosis -third trimester -at labor
Prostate Cancer	G0103 PSA MS or 70999206	Z12.5	Males over 50	Annually
Sexually Transmitted Infections	86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810 – Chlamydia 87590, 87591, 87850 - Neisseria gonorrhea 87800 - Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique 86592 - Syphilis test, nontreponemal antibody; qualitative (e.g., VDRL, RPR, ART) 86593 - Syphilis test, nontreponemal, quantitative 86780 - Treponema pallidum	Z11.3, Z72.89, Z72.51, Z72.52, Z72.53, Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90, O09.91, O09.92, and O09.93	When all is true: sexually active with increased risk referred and provided by Medicare eligible PCP	Annually for chlamydia, gonorrhea, and syphilis in women at increased risk and not pregnant Annually for syphilis in men at increased risk Twice per pregnancy for chlamydia and gonorrhea for women with increased risk and continued risk to 2nd trimester Once per pregnancy for syphilis in pregnant women; up to two additional occurrences in the third trimester and at delivery if at continued increased risk for STIs
Hepatitis B	G0499 HBV MS or 70900031 86704 - Hep B core antibody 86706 - Hep B surface antibody 87340 - Hep B surface antigen 87341 - Hep B surface antigen neutralization no screen CPT needed for these patients	Must have both Z11.59 AND Z72.89 No risk: Z11.59 and Z34.00 or Z34.80 or Z34.90 or O09.90 At risk: Z11.59 and Z72.89 and one of the following: Z34.00-Z34.03 Z34.80-Z34.83 Z34.90-Z34.93 O09.90-O09.93	High risk, asymptomatic non-pregnant adolescents and adults Pregnant beneficiaries	Annually as long as the risk continues.