Beginning October 12, 2026, patients with Medicare Advantage coverage must have an appropriate medically necessary diagnosis associated with certain laboratory tests for the testing to be covered.
This change affects the following tests:
| Test | Lab Order Code(s) |
|---|---|
| Vitamin D | LAB1231384, LAB1231583 |
| Vitamin B12 | LAB67, LAB1231122 |
| Lipid Panel | LAB18, LAB2111122 |
| Hemoglobin A1c (Hgb A1c) | LAB90 |
| Thyroid Stimulating Hormone (TSH) | LAB129, LAB1231632, LAB1000, LAB3077 |
What Is Changing?
If Z00.00 (general adult medical examination without abnormal findings) is the only diagnosis associated with one of these tests, the order cannot be completed.
Physicians, Advanced Practice Providers and any other staff placing orders will receive a notification in Epic indicating that a medically necessary diagnosis must be associated with the test before the order can be signed. At that point, an appropriate diagnosis must be added or the test must be removed from the order.
Impact to Ordering Offices
To help avoid delays in patient care and testing:
• Ensure appropriate medically necessary diagnoses are included when ordering affected tests for Medicare Advantage patients.
• Orders containing only Z00.00 may require follow-up before testing can proceed.
• Laboratory staff may contact your office to request an updated order when an appropriate diagnosis is not included.
Please note that laboratory and phlebotomy staff cannot accept verbal diagnosis changes. If a diagnosis update is needed, an updated written order must be provided.
Including an appropriate diagnosis at the time of ordering will help prevent delays in testing, reduce follow-up requests, and ensure timely patient care.
Questions?
Please contact your local Laboratory Customer Service Department or Laboratory Account Manager:
- Southeast Michigan: 800.551.0488
- Southwest Michigan: 269.983.8311 ext 1
- West Michigan: 616.774.7721
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