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, 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 (English), updated June 23, 2020. Complete the necessary boxes. Remember to choose only one option.
- Patient Fees to Use with ABNs, updated July 1, 2020
- Commercial Insurance Waiver Form, updated February 11, 2020
- Detailed Medical Necessity Information, updated September 1, 2020
- Patient/Third-Party Fee Disclosure, updated July 1, 2020
- ABN Form PowerPoint Presentation, updated May 29, 2019
- Instructions for Completing and ABN, effective June 23, 2020
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
- Bladder/Urothelial Tumor Markers (UroVysion) 10-1-2019
- B-Type Natriuretic Peptide (BNP) Testing 10-1-2019
- Coenzyme Q10 (CoQ10) 1-1-2020
- Controlled Substance Monitoring & Drugs of Abuse Testing 10-1-2019
- Flow Cytometry 12-1-2019
- Foodborne Gastrointestinal Identified by Multiplex Nucleic Acid 10-1-2019
- Lab: Special Histochemical Stains & Immunohistochemical Stains 12-24-2020
- Magnesium, Serum 10-1-2019
- Measurement of Salivary Hormones 11-1-2019
- MolDX: APC and MUTYH Gene Testing 11-1-2019
- MolDX: Biomarkers in Cardiovascular Risk Assessment 10-1-2019
- MolDX: BRCA1 and BRCA2 Genetic Testing 12-4-2019
- MoIDX: Cystatin C Measurement12-10-2020
- MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease 11-1-2019
- MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)11-1-2019
- MolDX: Genetic Testing for Lynch Syndrome 1-7-2021
- MolDX: HLA-DQB1*06:02 Testing for Narcolepsy 11-1-2019
- MoIDX: MDS FISH 11-1-2019
- MolDX: MGMT Promotor Methylation Analysis 11-1-2019
- MolDX: Molecular Diagnostic Tests (MDT) 11-1-2019
- MoIDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels 10-1-19
- MolDX: Next-Generation Sequencing for Solid Tumors 5-17-2020
- MolDX: NRAS Genetic Testing 12-1-2019
- MolDX: Pharmacogenomics Testing 8-17-2020
- Vitamin D Assay Testing 12-1-2019
Bemidji Lab
- Biomarker Testing for Neuroendocrine Tumors_Neoplasms 10-17-2019
- Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis 12-1-2019
- 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 10-3-2019
- Heavy Metal Testing 11-7-2019
- Molecular Pathology Procedures 7-1-2020
- Multimarker Serum Test Related to Ovarian Cancer Testing 7-1-2020
- RAST Type Tests (Allergy Testing) 11-7-2019
- Urine Drug Testing 10-1-19
- Vitamin D Assay Testing 11-14-2019
Local Coverage Articles
Sioux Falls, Rapid City, Bismarck and Fargo
- LCA - Bladder/Urothelial Tumor Markers 10-1-2019
- LCA - B-Type Natriuretic Peptide (BNP) Testing 10-1-2019
- LCA - Coenzyme Q10 (Q10) 1-1-2020
- LCA - Controlled Substance Monitoring and Drugs of Abuse Coding and Billing Guidelines 10-1-2020
- LCA - Flow Cytometry 10-1-2020
- LCA - Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs)10-1-2020
- LCA - Lab: Special Histochemical Stains & Immunohistochemical Stains 12-1-2019
- LCA - Magnesium Serum 10-1-2020
- LCA - Measurement of Salivary Hormones 11-1-2019
- LCA - MolDX: APC and MUTYH Gene Testing 11-1-2019
- LCA - MolDX: BRCA1 and BRCA2 Genetic Testing 7-31-2020
- LCA - MoIDX: BCR-ABL 11-1-2019
- LCA – MolDX: Biomarkers in Cardiovascular Risk Assessment 10-1-2019
- LCA - MolDX: Cystatin C Measurement 10-1-2020
- LCA - MoIDX: FDA-Approved BRAF Tests 11-1-2019
- LCA - MoIDX: FDA-Approved EGFR Tests 11-1-2019
- LCA - MoIDX: FDA-Approved KRAS Tests11-1-2019
- LCA - MoIDX: Fragile X 12-1-2019
- LCA - MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease 11-7-2019
- LCA - MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) 11-1-2019
- LCA - MoIDX: Genetics Testing for Lynch Syndrome 12-10-2020
- LCA - MolDX: HLA-DQB1*06:02 Testing for Narcolepsy 11-1-2019
- LCA - MolDX: MDS FISH 11-1-2019
- LCA - MolDX: MGMT Promotor Methylation Analysis 11-1-2019
- LCA - MolDX: Molecular Diagnostic Tests 1-1-2020
- LCA - MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels 10-1-2020
- LCA - MolDX: Next-Generation Sequencing for Solid Tumors 5-17-2020
- LCA - MolDX: NRAS Genetic Testing 12-1-2019
- LCA - MoIDX: Pharmacogenomics Testing 8-17-2020
- LCA - MoIDX: Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer 12-1-2019
- LCA - MoIDX: Testing of Multiple Genes 6-7-2020
- LCA - MoIDX: TP53 Gene Tests 12-1-2019
- LCA - Vitamin D Assay Testing 10-1-2020
Bemidji
- LCA - B-Type Natriuretic Peptide (BNP) Testing 11-7-2019
- LCA - Biomarker Testing for Neuroendocrine Tumors/Neoplasms 10-17-2019
- LCA - Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis 12-1-2019
- LCA - CPT Code 87641 (Infectious agent detection by nucleic acid [DNA or RNA]; Staphylococcus aureus, methicillin resistant, amplified probe technique) 12-1-2019
- LCA - Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Disease 10-3-2019
- LCA - Genomic Sequence Analysis in the Treatment of Solid Organ Neoplasms 10-3-2019
- LCA - Heavy Metal Testing 10-1-2020
- LCA - Molecular Pathology Procedures 1-1-2021
- LCA - Multimarker Serum Tests Related to Ovarian Cancer Testing 7-1-2020
- LCA - RAST Type Tests (Allergy Testing) 10-1-2020
- LCA - Urine Drug Testing 10-1-2020
- LCA - Vitamin D Assay Testing 10-1-2020