Current Procedural Terminology (CPT) Coding

CPT codes listed in this Resource Guide are provided only as guidance to assist you in billing. The CPT codes listed reflect our interpretation of CPT coding requirements only and are subject to change at any time. It is your responsibility to verify the accuracy of the codes listed. FBR assumes no responsibility for billing errors due to reliance on the CPT codes listed in this Resource Guide. If you have any questions, please refer to your CPT manual published by the American Medical Association. To verify reimbursement or if you have questions regarding usage of a CPT code, please contact your local carrier.

Medical Necessity

The web sites below provide relevant information on medical necessity guidelines for specific tests performed at FBR. Each web site lists covered and non-covered ICD-9 codes as defined by National Coverage Determination policies (e.g. Iron studies and Alpha-fetoprotein). Please check with your local carrier for current information. This information is subject to change without notice. ICD-9 code selection should reflect a patient's medical condition as noted in the medical record. Links to these sites are provided as a courtesy only; the FBR can make no recommendations regarding ICD-9 code selection.

Serum Iron Studies (iron, transferrin/TIBC, and ferritin):
http://www.cms.hhs.gov/CoverageGenInfo/downloads/manual200901.pdf

Alpha-fetoprotein Studies:
http://www.cms.hhs.gov/CoverageGenInfo/downloads/manual200901.pdf

Completing the Medicare Advance Beneficiary Notice (ABN)

Medicare patients whose laboratory work includes serum iron studies (iron, transferrin/TIBC and ferritin) or tumor antigen/non-pregnancy alpha-fetoprotein testing and whose diagnosis does not meet the Medicare definition of medical necessity MUST review the ABN form, found on the reverse side of the test requisition.It is also available as a PDF document (70k).

Use the ABN form only if a test ordered on a Medicare patient is not regarded by Medicare as medically necessary, i.e., it should not be signed as a matter of routine.

For your convenience...

• An alphabetized listing of relevant CPT codes can be found on the back of the client copy of all requisitions;
• The web sites below provide relevant information on medical necessity guidelines for specific tests performed at FBR. Each web site lists covered and non-covered ICD-9 codes as defined by National Coverage Determination policies (e.g. Iron studies and Alpha-fetoprotein). Please check with your local carrier for current information. Links to these sites are provided as a courtesy only; the FBR can make no recommendations regarding ICD-9 code selection.
• Disregard ABN materials for non-Medicare patients. If desired, you may remove the ABN before returning the requisition to FBR.