Traditional Medicare insured patients who have a Lipid Panel or Vitamin D 25 ordered more than once per 12 months are not covered due to medical necessity.*
If testing is indicated, you will need to provide an appropriately executed Advance Beneficiary Notice (ABN) for Corewell Health Southeast Laboratories and Advance Beneficiary Notice for Corewell Health Southwest and West Laboratories signed by the patient indicating they would like testing and understand they may be financially responsible for payment (ABN: Option 1). ABN must be submitted with specimen.
For testing ordered inside this frequency range without an ABN, Corewell Health will implement an automatic cancellation.
Effective Date: 09/16/24
Lipid Panel: LAB18
• Medicare only covers once every 60 months (5 years) for screening.
• Annually – When monitoring long-term anti-lipid dietary or pharmacologic therapy and when following patients with borderline high total or LDL cholesterol levels, it may be reasonable to perform the Lipid Panel annually.
• Lipid Component Testing – Measurement of the serum total cholesterol or a measured LDL should suffice for interim visits if the patient does not have hypertriglyceridemia.
• Any one component of the panel or a measured LDL may be reasonable and necessary up to six times the first year for monitoring dietary or pharmacologic therapy.
Effective Date: 09/25/24
Vitamin D, 25 Hydroxy: LAB1231583
• Medicare does not cover as a screening test.
• Annually – Yearly testing of Vitamin D may be appropriate depending upon the indication and other mitigating factors.
• If the follow up test shows they have not yet reached the target level, the Vitamin D can be repeated in another 3 months until the target level is achieved, but an ABN is required for testing to move forward without cancellation.
Be sure to document medical necessity in your progress notes.
Please refer to the CMS Medicare Coverage Database for more information: https://www.cms.gov/medicare-coverage-database/
*Please watch for similar changes to TSH, PSA and A1C testing. Details coming soon.
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