US · guidance
CMS Pub. 100-04, ch. 16, § 90.4
Evaluating the Medical Necessity for Laboratory Panel CPT
Codes
(Rev. 1, 10-01-03)
PM-B-98-1
The American Medical Association’s (AMA) 1998 edition of the Current Procedural
Terminology (CPT) establishes three new and one revised Organ or Disease Oriented
laboratory panels. Since these panels are composed of clinically relevant groupings of
automated multi-channel tests there is a general presumption of medical necessity. If
A/B MACs (B) suspect abuse of the new panel codes, they should review such claims.
Should an A/B MAC (B) determine the need to develop a LMRP for laboratory panel
codes, the A/B MAC (B) should develop such a policy at the panel code level. As
appropriate, an A/B MAC (B) may review the panel and deny component tests on a case-by-case basis or evaluate the need for the component level test.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a04ea46397c44ea2c8373be1e5482c183c6cfd833ff82d91f7a50d60c27a4aa3
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