NCDs & LCDs 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) and Local Coverage Determinations (LCDs). NCDs and LCDs 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 Medicare Noridian of North Dakota
Advance Beneficiary Notice of Noncoverage Form (ABN)
Whenever a test with limited coverage (NCD or LCD) 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 (in Sioux Falls, Rapid City, Fargo or Bismarck) and your facility is not located in South Dakota or North Dakota, the NCDs and North Dakota LCDs still apply to your facility because Sanford Laboratories (in Sioux Falls, Rapid City, Fargo or Bismarck) files its Medicare claims with Medicare Noridian of North Dakota.
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 February 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) 5-16-2017
- B-Type Natriuretic Peptide (BNP) Testing 10-1-2017
- Coenzyme Q10 (CoQ10) 4-30-2018
- Controlled Substance Monitoring & Drugs of Abuse Testing 12-27-2018
- Flow Cytometry 10-1-2018
- Helicobacter Pylori Infection Testing 5-27-19
- Magnesium, Serum 10-1-2017
- Measurement of Salivary Hormones 10-1-2017
- MolDX: APC and MUTYH Gene Testing 5-15-2017
- MolDX: Biomarkers in Cardiovascular Risk Assessment 1-31-2019
- MolDX: BRCA1/BRCA2 Genetic Testing 1-1-2019
- MolDX: CYP2C19, CYP2D6, CYP2C9, VKORC1 Genetics 1-1-2019
- MoIDX: Cystatin C Measurement 2-11-2019
- MoIDX: Foodborne Gastrointestinal Identified by Multiplex Nucleic Acid 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 (5-13-2019)
- 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 8-1-2018
- Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms 4-1-2019
- Heavy Metal Testing 1-1-2017
- Molecular Pathology Procedures 1-1-2019
- RAST Type Tests (Allergy Testing) 1-1-2018
- Urine Drug Testing 10-1-2018
- Vitamin D Assay Testing 10-01-2018