The Office of Inspector General (OIG) requires that physicians using hospital laboratory services receive periodic notification from the hospital of certain items. As a result, UPMC provides the following information:
National Coverage Limitations – policies issued by CMS that specify that services and tests that are reasonable and necessary will be paid for by Medicare. Laboratory National Coverage Determinations (NCDs) can be found on theCMS website.
Local Coverage Determinations (LCDs) – these are issued by the Fiscal Intermediary (FI) or Carrier and make it clear that the physician’s medical records must support the diagnostic information provided to a diagnostic service provider. TheCMS websitecontains a database of all LCDs across the country.
Organ or Disease Related Panels– when these panels are ordered, in order for the laboratory to be able to bill Medicare and receive payment, each test in the panel must be medically necessary.