NCDs, LCDs & LCAs for Covered Signs, Symptoms, Diagnoses & ICD-10 Codes
An Advance Beneficiary Notice of Noncoverage, or ABN, is an acknowledgment by the Medicare beneficiary that they have been notified that the services provided may be deemed as not medically necessary by Medicare and that they are responsible for payment if Medicare denies payment.
Services that Medicare reviews are called National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs). NCDs, LCDs and LCAs provide guidance for administering the ABN form.
To help medical professionals with compliance, Sanford Laboratories provide the following guidelines accessible all in one place:
- Advance Beneficiary Notice of Noncoverage Form (ABN), instructions and training slide show
- Medical Necessity Billing Information
- National Coverage Determinations (NCD) established by the Centers for Medicare and Medicaid Services
- Local Coverage Determinations (LCD) established by Noridian Healthcare Solutions.
- Local Coverage Articles (LCA) contain coding and billing guidelines that complement the LCD.
Advance Beneficiary Notice of Noncoverage Form (ABN)
Whenever a test with limited coverage (NCD, LCD or LCA) is ordered, the laboratory is allowed to submit the test to Medicare for payment. If payment is denied, the laboratory will be able to bill the beneficiary if an Advance Beneficiary Notice of Noncoverage Form was completed. The form regulations apply to participating and nonparticipating provider services that may be determined as not medically necessary.
Under federal law, providers must inform beneficiaries in writing before providing a service which Medicare may consider not medically necessary. Advance Beneficiary Forms also protect the provider's right to collect payment from the beneficiary when claims are denied by Medicare as "not reasonable and necessary."
Medical Necessity Billing Information
If you submit testing to Sanford Laboratories located in Sioux Falls, Rapid City, Fargo or Bismarck and your facility is not located in South Dakota or North Dakota, the NCDs, LCDs and LCAs will still apply to your facility because Sanford Laboratories files Medicare claims with Noridian Healthcare Solutions.
If you submit testing to Sanford Laboratories - Bemidji, and your facility is not located in Minnesota, the NCDs, LCDs and LCAs will still apply to your facility because Sanford Laboratories files Medicare claims with National Government Services.
These files include:
- Information for tests that are sent to Sanford Laboratories and billed to Medicare by Sanford Laboratories
- A guide to determine when an Advance Beneficiary Notice of Noncoverage (ABN) needs to be signed
- Background information
- Limited coverage policies by test
Printable Compliance Forms
Advance Beneficiary Notice of Noncoverage
Sanford Laboratories provide a comprehensive overview of the Advanced Beneficiary Notice of Noncoverage Form, plus related forms and instructions.
- Printable ABN Form (English), updated June 28, 2023. Complete the necessary boxes. Remember to choose only one option.
- Patient Fees to Use with ABNs, updated July 1, 2022
- Detailed Medical Necessity Information, updated July 25, 2022
- Patient/Third-Party Fee Disclosure, updated July 1, 2023.
- ABN Form PowerPoint Presentation, updated September 25, 2023
- Instructions for Completing and ABN, effective June 23, 2020
- Laboratory Tests with Reflex Criteria, updated January 20, 2023
National Coverage Determinations
Sanford Laboratories provide the most current NCDs and LCDs of Covered Signs and Symptoms. You can print as many copies as your facility needs as these documents are not copyrighted.
Local Coverage Determinations
Sanford Laboratories provide the most current LCDs of Covered Signs and Symptoms. You can print as many copies as your facility needs as these documents are not copyrighted.
Sioux Falls, Rapid City, Bismarck and Fargo Labs
- B-Type Natriuretic Peptide (BNP) Testing 10-1-2019
- Lab: Bladder/Urothelial Tumor Markers (UroVysion) 3-4-2021
- Lab: Coenzyme Q10 (CoQ10) 2-25-2021
- Lab: Controlled Substance Monitoring & Drugs of Abuse Testing 04-8-2021
- Lab: Cystatin C Measurement 6-9-2022
- Lab: Flow Cytometry 1-13-2022
- Lab: Special Histochemical Stains & Immunohistochemical Stains 11-2-2023
- Magnesium, Serum 1-29-2020
- MDS FISH 6-30-2022
- Measurement of Salivary Hormones 1-29-2020
- MolDX: Biomarkers in Cardiovascular Risk Assessment 3-21-2024
- MolDX: Blood Product Molecular Antigen Typing 5-23-2024
- MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease 7-16-2023
- MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin and MTHFR) 7-20-2023
- MolDX: HLA-DQB1*06:02 Testing for Narcolepsy 7-8-2021
- MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer 4-18-2024
- MolDX: MGMT Promotor Methylation Analysis 10-14-2021
- MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer 7-27-2023
- MolDX: Molecular Diagnostic Tests (MDT) 5-4-2023
- MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing 12-22-2022
- MolDX: Next-Generation Sequencing for Solid Tumors 8-8-2023
- MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies 3-28-2024
- MolDX: NRAS Genetic Testing 11-4-2021
- MolDX: Pharmacogenomics Testing 8-24-2023
- MolDX: Plasma-Based Genomic Profiling in Solid Tumors 12-26-2022
- MolDX: Repeat Germline Testing 4-25-2024
- Vitamin D Assay Testing 4-1-2022
Bemidji Lab
- Biomarker Testing for Neuroendocrine Tumors - Neoplasms 2-10-2022
- Biomarker Testing for Prostate Cancer Diagnosis 3-1-2023
- B-type Natriuretic Peptide (BNP) Testing 11-7-2019
- Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases 10-3-2019
- Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms 4-1-2022
- Heavy Metal Testing 4-15-21
- Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) 8-1-2022
- Molecular Pathology Procedures 7-1-2020
- Multimarker Serum Test Related to Ovarian Cancer Testing 6-28-2022
- Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) 8-1-2022
- RAST Type Tests (Allergy Testing) 11-7-2019
- Respiratory Pathogen Panel Testing 12-1-2021
- Urine Drug Testing 10-1-19
- Vitamin D Assay Testing 10-1-2021
Local Coverage Articles
Sioux Falls, Rapid City, Bismarck and Fargo
- LCA - B-Type Natriuretic Peptide (BNP) Testing 10-1-2022
- LCA - Influenza Diagnostic Tests 3-23-2022
- LCA - Lab: Bladder/Urothelial Tumor Markers 4-27-2023
- LCA - Lab: Coenzyme Q10 (Q10) 1-1-2020
- LCA - Lab: Controlled Substance Monitoring and Drugs of Abuse Testing 7-1-2023
- LCA - Lab: Cystatin C Measurement 6-9-2022
- LCA - Lab: Flow Cytometry 10-14-2022
- LCA - Lab: Special Histochemical Stains & Immunohistochemical Stains 12-4-2019
- LCA - Magnesium Serum 4-12-2024
- LCA - MDS FISH 10-1-2022
- LCA - Measurement of Salivary Hormones 11-1-2019
- LCA - MoIDX: BCR-ABL 9-19-2024
- LCA – MolDX: Blood Product Molecular Antigen Typing 10-1-2024
- LCA - MolDX: Clarification of Order Requirements for Lab and Molecular Diagnostic Services 5-2-2024
- LCA - MoIDX: FDA-Approved BRAF Tests 8-2-2023
- LCA - MoIDX: FDA-Approved EGFR Tests 5-30-2024
- LCA - MoIDX: FDA-Approved KRAS Tests 3-3-2022
- LCA – MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease 10-1-2024
- LCA - MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) 8-12-2021
- LCA - MolDX: HLA-DQB1*06:02 Testing for Narcolepsy 7-8-2021
- LCA – MolDX: HLA Testing for Transplant Histocompatibility 2-25-2022
- LCA - MolDX: Immunohistochemistry (IHC) Indications for Breast Pathology 11-19-2020
- LCA - MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer 10-1-2024
- LCA - MolDX: MGMT Promotor Methylation Analysis 11-30-2021
- LCA - MolDX: Microsatellite Instability-High (MSI-H) and Mismatch Repair Deficient (dMMR) Biomarker Billing and Coding Guidelines for Patients with Unresectable for Metastatic Solid Tumors 1-23-2024
- LCA – MolDX: Biomarkers in Cardiovascular Risk Assessment 2-23-2023
- LCA – MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer 3-21-2024
- LCA - MolDX: Molecular Diagnostic Tests 7-1-2024
- LCA – MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing 10-1-2024
- LCA - MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies 10-1-2024
- LCA - MolDX: Next-Generation Sequencing for Solid Tumors 1-12-2024
- LCA - MolDX: NRAS Genetic Testing 10-1-2021
- LCA – MolDX: Pharmacogenomics Testing 1-25-2024
- LCA – MolDX: Plasma-Based Genomic Profiling in Solid Tumors 1-19-2024
- LCA - MolDX: Repeat Germline Testing 9-5-2024
- LCA - MoIDX: Targeted and Comprehensive Genomic Profile Testing in Cancer 3-21-2024
- LCA - MoIDX: Testing of Multiple Genes 2-10-2022
- LCA - Vitamin D Assay Testing 11-16-23
Bemidji
- LCA - B-Type Natriuretic Peptide (BNP) Testing 11-7-2019
- LCA - Biomarker Testing for Neuroendocrine Tumors/Neoplasms 10-17-2019
- LCA - Biomarker Testing for Prostate Cancer Diagnosis 11-1-2022
- LCA - CPT Code 87641 (Infectious agent detection by nucleic acid [DNA or RNA]; Staphylococcus aureus, methicillin resistant, amplified probe technique) 4-30-2020
- LCA - Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Disease 1-1-2023
- LCA - Genomic Sequence Analysis in the Treatment of Solid Organ Neoplasms 7-1-2024
- LCA - Heavy Metal Testing 10-1-2021
- LCA - Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) 8-1-2022
- LCA - Molecular Pathology Procedures 10-1-2024
- LCA - Multimarker Serum Tests Related to Ovarian Cancer Testing 7-1-2020
- LCA - Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) 8-1-2022
- LCA - RAST Type Tests (Allergy Testing) 10-1-2021
- LCA - Respiratory Pathogen Panel Testing 4-10-2022
- LCA - Urine Drug Testing 10-1-2022
- LCA - Vitamin D Assay Testing 10-1-2021