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 Lovcal 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, the NCDs and Minnesota LCDs apply to your facility because Sanford Laboratories - Bemidji files its Medicare claims with National Government Services Inc. of Minnesota.
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, updated June 21, 2017. Complete the necessary boxes. Remember to choose only one option.
- Patient Fees to Use with ABNs, updated May 2019
- Commercial Insurance Waiver Form, updated Sept. 10, 2014
- Detailed Medical Necessity Information, updated May, 29 2019
- Patient/Third-Party Fee Disclosure, updated August 2019
- ABN Form PowerPoint Presentation, updated May 2019
- Instructions for Completing and ABN, effective June 13, 2019
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
- Non-Covered Services 1-01-2019
- Bladder/Urothelial Tumor Markers (UroVysion) 10-1-2019
- B-Type Natriuretic Peptipe (BNP) Testing 10-1-2019
- Coenzyme Q10 (CoQ10) 10-1-2019
- Controlled Substance Monitoring & Drugs of Abuse Testing 10-1-2019
- Flow Cytometry 10-1-2018
- Foodborne Gastrointestinal Identified by Multiplex Nucleic Acid 10-1-2019
- Helicobacter Pylori Infection Testing 10-1-2019
- Magnesium, Serum 10-1-2019
- Measurement of Salivary Hormones 10-1-2017
- MolDX: APC and MUTYH Gene Testing 5-15-2017
- MolDX: Biomarkers in Cardiovascular Risk Assessment 10-1-2019
- MolDX: BRCA1/BRCA2 Genetic Testing 1-1-2019
- MolDX: CYP2C19, CYP2D6, CYP2C9, VKORC1 Genetics 1-1-2019
- MoIDX: Cystatin C Measurement 2-11-2019
- MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease 10-1-2017
- MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) 6-16-2016
- MolDX: Genetic Testing for Lynch Syndrome 4-16-2019
- MolDX: HLA-B*15:02 Genetic Testing 2-26-18
- MolDX: HLA-DQB1*06:02 Testing for Narcolepsy 10-1-2016
- MoIDX: MDS FISH 6-3-2019
- MolDX: MGMT Promotor Methylation Analysis 1-1-2018
- MolDX: Molecular Diagnostic Tests (MDT) 1-1-2019
- MoIDX: Molecular RBC Phenotyping 2-1-2017
- MoIDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels 10-1-19
- MolDX: NRAS Genetic Testing 1-19-2017
- MolDX: Prometheus IBD sgi Diagnostic Policy 1-30-2018
- Vitamin D Assay Testing 10-1-2018
- Non-Covered Services 5-1-2019
- Biomarker Testing for Neuroendocrine Tumors_Neoplasms 4-1-2019
- Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis 12-1-2018
- B-type Natriuretic Peptide (BNP) Testing 1-01-2018
- Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases 8-15-2019
- Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms 4-1-2019
- Heavy Metal Testing 10-1-2019
- Molecular Pathology Procedures 1-1-2019
- RAST Type Tests (Allergy Testing) 1-1-2018
- Urine Drug Testing 10-1-19
- Vitamin D Assay Testing 10-1-2019
Local Coverage Articles
LCAs for Sioux Falls, Rapid City, Bismarck and Fargo
- LCA- Biomarkers in Cardiovascular Risk Assessment 10-1-19
- LCA- B-Type Natriuretic Peptide (BNP) Testing 10-10-19
- LCA- Coenzyme Q10 (Q10) 10-2-17
- LCA- Controlled Substance Monitoring and Drugs of Abuse Coding and Billing Guidelines 1-1-17
- LCA- Flow Cytometry Coverage Clarification 10-1-15
- LCA- Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) 7-1-19
- LCA- Helicobacter Pylori Infection Testing 10-1-19
- LCA- Magnesium Serum 10-1-19
- LCA- MoIDX BCR-ABL Coding and Billing Guidelines 12-1-17
- LCA- MoIDX Billing and Coding for Lynch Syndrome Testing Services 6-1-16
- LCA- MoIDX Bladder Tumor Marker FISH Billing and Coding Guidelines 10-1-17
- LCA- MoIDX CYP2C9 and/or VKORC1 Gene Testing for Warfarin Response Billing and Coding Guidelines 10-24-16
- LCA- MoIDX FDA-Approved BRAF Tests Billing and Coding Guidelines 10-1-18
- LCA- MoIDX FDA-Approved KRAS Tests 12-14-17
- LCA-MoIDX SLCO1B1 Genotype Billing and Coding Guidelines
- LCA- Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Disease 8-15-19
- LCA- Genomic Sequence Analysis in the Treatment of Solid Organ Neoplasms 8-15-19
- LCA- Urine Drug Testing 10-1-19