Medicare has limited coverage policies (MLCPs) for certain laboratory tests. "Tests subject to an MLCP must meet medical-necessity criteria in order to be covered by Medicare. MLCP tests ordered without a supportive ICD-10 code will not satisfy medical necessity and therefore will not be covered by Medicare." These orders must be submitted with an Advance Beneficiary Notice signed by your patient, which confirms they are responsible for payment.

Understand a doctor could make a mistake on their coding, When that happens as it did on June 10, 2021, palmettoGBA stated that hepatitis screening is no longer medically necessary if you have rheumatoid arthritis and autoimmune encephalitis and are going on Rituxan. This leads one to believe that hepatitis screening is not medically necessary anymore when your immune system will be suppressed. The problem is that is not true. If you ever in your life had hepatitis, once your immune system is suppressed hepatitis reactivates and you cannot control while suppressed. That's when many people die. So you have to be very careful what PalmettoGBA tells you as well as other private contractors tell you. One day they say not medically necessary and the next day you're dead.