Coding Information

Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 12 Hospital Inpatient (Medicare Part B only) 13 Hospital Outpatient 14 Hospital - Laboratory Services Provided to Non-patients 22 Skilled Nursing - Inpatient (Medicare Part B only) 23 Skilled Nursing - Outpatient 72 Clinic - Hospital Based or Independent Renal Dialysis Center 83 Ambulatory Surgery Center 85 Critical Access Hospital Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. 0300 Laboratory - General Classification 0301 Laboratory - Chemistry 0302 Laboratory - Immunology 0303 Laboratory - Renal Patient (Home) 0304 Laboratory - Non-Routine Dialysis 0305 Laboratory - Hematology 0306 Laboratory - Bacteriology & Microbiology 0307 Laboratory - Urology 0309 Laboratory - Other Laboratory CPT/HCPCS Codes: Group 1 Paragraph: Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. Group 1 CPT Codes: 86141 C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP) ICD-10 Codes That Are Covered It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. Medicare is establishing the following limited coverage for CPT/HCPCS codes: 86141. Note: Use ICD-10-CM code Z74.09 and Z78.9 for patients at intermediate risk for CAD who do not have elevated lipids (i.e., do not meet criteria to use ICD-10-CM codes E78.00-E78.3 or E78.49). E78.00 Pure hypercholesterolemia, unspecified E78.01 Familial hypercholesterolemia E78.1 Pure hyperglyceridemia E78.2 Mixed hyperlipidemia E78.3 Hyperchylomicronemia E78.49 Other hyperlipidemia I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris Z74.09 Other reduced mobility Z78.9 Other specified health status ICD-10 Codes That Are Not Covered XX000

Revision History Information

Revision History Date Revision History Number Revision History Explanation 04/10/2025 R2 This article is being retired effective for dates of service on and after 04/10/2025 in response to the LCD being retired. 11/07/2019 R1 Article revised and published on 11/07/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.