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PLA Codes

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2024
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CMS Transmittals




National Coverage Determinations
The below list contains NCD policies that require specific one-to-one diagnosis code requirements for Medicare medical necessity checking. This list is not exhaustive and does not contain policies that may only include frequency limitations, complex secondary diagnosis code requirements or other requirements not specifically related to CPT to Diagnosis code edits. Please see the National Coverage Determinations (NCDs) by Chapter/Section Index for the complete list of current CMS National Coverage Policies.

Recent Lab NCD Manuals

To use the diagnosis code requirements in these policies for medical necessity checking in your order entry system, please see CodeMap Medical Necessity Data Files

Procedure
Policy Number
Title
8XXXX 90.2 Next Generation Sequencing (NGS)
8XXXX 90.2 Next Generation Sequencing (NGS)
8XXXX 90.2 Next Generation Sequencing (NGS)
8XXXX 90.2 Next Generation Sequencing (NGS)
8XXXX 90.2 Next Generation Sequencing (NGS)
8XXXX 90.2 Next Generation Sequencing (NGS)
8XXXX 90.2 Next Generation Sequencing (NGS)
8XXXX 220.13 Percutaneous Image Guided Breast Biopsy
8XXXX 220.13 Percutaneous Image Guided Breast Biopsy
8XXXX 220.13 Percutaneous Image Guided Breast Biopsy
8XXXX 220.13 Percutaneous Image Guided Breast Biopsy
8XXXX 220.13 Percutaneous Image Guided Breast Biopsy
8XXXX 220.13 Percutaneous Image Guided Breast Biopsy
8XXXX 20.9.1 Ventricular Assist Devices
8XXXX 20.9.1 Ventricular Assist Devices
8XXXX 20.9.1 Ventricular Assist Devices
8XXXX 20.9.1 Ventricular Assist Devices
8XXXX 20.7 Percutaneous Transluminal Angioplasty (PTA)
8XXXX 260.1 Adult Liver Transplantation
8XXXX 260.1 Adult Liver Transplantation
8XXXX 80.11 Vitrectomy
8XXXX 80.11 Vitrectomy
8XXXX 80.11 Vitrectomy
8XXXX 80.11 Vitrectomy
8XXXX 80.11 Vitrectomy
8XXXX 80.11 Vitrectomy
8XXXX 210.14 Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
8XXXX 150.3 Bone Mineral Density
8XXXX 220.4 Mammograms
8XXXX 220.4 Mammograms
8XXXX 220.4 Mammograms
8XXXX 220.4 Mammograms
8XXXX 150.3 Bone Mineral Density
8XXXX 150.3 Bone Mineral Density
8XXXX 150.3 Bone Mineral Density
8XXXX 150.3 Bone Mineral Density
8XXXX 220.6.17 FDG PET for Head and Neck Cancers
8XXXX 220.6.17 FDG PET for Head and Neck Cancers
8XXXX 220.6.17 FDG PET for Head and Neck Cancers
8XXXX 220.6.17 FDG PET for Head and Neck Cancers
8XXXX 220.6.17 FDG PET for Head and Neck Cancers
8XXXX 220.6.17 FDG PET for Head and Neck Cancers
8XXXX 220.6.17 FDG PET for Head and Neck Cancers
8XXXX 190.23 Lipids Testing
8XXXX 190.33 Hepatitis Panel/Acute Hepatitis Panel
8XXXX 190.24 Digoxin Therapeutic Drug Assay
8XXXX 90.2 Next Generation Sequencing (NGS)
8XXXX 210.3 Multitarget Stool DNA (sDNA) Colorectal Cancer Screening Test - Cologuard
8XXXX 190.25 Alpha-fetoprotein
8XXXX 190.34 Fecal Occult Blood Test
8XXXX 190.26 Carcinoembryonic Antigen
8XXXX 190.5 Sweat Test
8XXXX 190.23 Lipids Testing
8XXXX 190.19 Collagen Crosslinks, Any Method
8XXXX 190.18 Serum Iron Studies
8XXXX 190.20 Blood Glucose Testing
8XXXX 190.20 Blood Glucose Testing
8XXXX 190.20 Blood Glucose Testing
8XXXX 190.32 Gamma Glutamyl Transferase
8XXXX 190.21 Glycated Hemoglobin/Glycated Protein
8XXXX 190.21 Glycated Hemoglobin/Glycated Protein
8XXXX 190.18 Serum Iron Studies
8XXXX 190.18 Serum Iron Studies
8XXXX 190.23 Lipids Testing
8XXXX 190.23 Lipids Testing
8XXXX 190.23 Lipids Testing
8XXXX 190.23 Lipids Testing
8XXXX 190.23 Lipids Testing
8XXXX 190.31 Prostate Specific Antigen
8XXXX 190.22 Thyroid Testing
8XXXX 190.22 Thyroid Testing
8XXXX 190.22 Thyroid Testing
8XXXX 190.18 Serum Iron Studies
8XXXX 190.23 Lipids Testing
8XXXX 190.22 Thyroid Testing
8XXXX 190.27 Human Chorionic Gonadotropin
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.15 Complete Blood Count
8XXXX 190.17 Prothrombin Time (PT)
8XXXX 190.16 Partial Thromboplastin Time (PTT)
8XXXX 190.29 Tumor Antigen by Immunoassay CA 15-3/CA 27.29
8XXXX 190.30 Tumor Antigen by Immunoassay CA 19-9
8XXXX 190.28 Tumor Antigen by Immunoassay CA 125
8XXXX 190.8 Lymphocyte Mitogen Response Assays
8XXXX 190.8 Lymphocyte Mitogen Response Assays
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.1 Histocompatibility Testing
8XXXX 190.1 Histocompatibility Testing
8XXXX 190.1 Histocompatibility Testing
8XXXX 190.1 Histocompatibility Testing
8XXXX 190.1 Histocompatibility Testing
8XXXX 190.1 Histocompatibility Testing
8XXXX 190.1 Histocompatibility Testing
8XXXX 190.12 Urine Culture, Bacterial
8XXXX 190.12 Urine Culture, Bacterial
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX 190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.3 Cytogenetic Studies
8XXXX 190.5 Sweat Test
8XXXX 20.30 Microvolt T-Wave Alternans (MTWA)
8XXXX 20.16 Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)
8XXXX 270.6 Infrared Therapy Devices
8XXXX 180.1 MNT Services
8XXXX 180.1 MNT Services
8XXXX 180.1 MNT Services
8XXXX 20.29 Hyperbaric Oxygen Therapy
8XXXX 210.4.1 Counseling to Prevent Tobacco Use
8XXXX 210.4.1 Counseling to Prevent Tobacco Use
G0102 210.1 Prostate Cancer Screening Tests
G0103 210.1 Prostate Cancer Screening Tests
G0108 40.1 Diabetes Outpatient Self-Management Training
G0109 40.1 Diabetes Outpatient Self-Management Training
G0123 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0124 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0130 150.3 Bone Mineral Density
G0141 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0143 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0144 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0145 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0147 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0148 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0202 220.4 Mammograms
G0204 220.4 Mammograms
G0206 220.4 Mammograms
G0248 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management
G0249 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management
G0250 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management
G0270 180.1 MNT Services
G0271 180.1 MNT Services
G0277 20.29 Hyperbaric Oxygen Therapy
G0279 220.4 Mammograms
G0281 270.1 Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds
G0296 210.14 Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
G0329 270.1 Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds
G0432 210.7 HIV Screening
G0433 210.7 HIV Screening
G0435 210.7 HIV Screening
G0460 270.3 Blood Derived Products for Chronic Non-healing Wounds
G0464 210.3 Multitarget Stool DNA (sDNA) Colorectal Cancer Screening Test - Cologuard
G0472 210.13 Screening for Hepatitis C Virus in Adults
G0475 210.7 HIV Screening
G0476 210.2.1 HPV screening
G0499 210.6 Screening for Hepatitis B Virus (HBV) Infection
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
8XXXX 110.18 Aprepitant for Chemotherapy-Induced Emesis
P3000 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
P3001 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
Q0091 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
Q0162 110.18 Aprepitant for Chemotherapy-Induced Emesis
Q0166 110.18 Aprepitant for Chemotherapy-Induced Emesis
Q0180 110.18 Aprepitant for Chemotherapy-Induced Emesis
Q0181 110.18 Aprepitant for Chemotherapy-Induced Emesis

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