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Laboratory Benefit Management (LBM) Policies

Laboratory Benefit Management (LBM) Policies

Effective July 1, 2024, Presbyterian implemented a new Laboratory Benefit Management (LBM) program with the goal of providing high-quality healthcare at the most affordable costs. All policies are directed at enforcing correct billing guidelines and are listed below.

Additional Resources

Administrative Claims Edits Guide Summary of UpdatesLaboratory Benefit Management FAQReimbursement (Laboratory Procedures Reimbursement Policy), AHS-R2162

Medical Policy Manual


A

Allergen Testing, AHS-G2031Alpha-1 Antitrypsin Deficiency, Testing for, AHS-M2068Alzheimer Disease and Dementia, Biochemical Markers of, AHS-G2048Autism Spectrum Disorder and Developmental Delay, Testing for, AHS-M2176Autoimmune Rheumatic Disease, Biomarker Testing for, AHS-G2022

B

Beta-Hemolytic Streptococcus Testing, AHS-G2159Bone Turnover Markers Testing, AHS-G2051Brain Injury (Serum Testing for Evidence of Mild Traumatic Brain Injury), AHS-G2151

C

Cardiovascular Disease Risk Assessment, AHS-G2050Celiac Disease Testing, AHS-G2043Cervical Cancer Screening, AHS-G2002Colorectal Cancer Screening, AHS-G2181Coronavirus Testing in the Outpatient Setting, AHS-G2174

D

Diabetes Mellitus Testing, AHS-G2006Dry Eyes, Evaluation of, AHS-G2138

E

Epithelial Cell Cytology in Breast Cancer Risk Assessment, AHS-G2059

F

Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing, AHS-G2060Fecal Calprotectin Testing in Adults, AHS-G2061Flow Cytometry, AHS-F2019Folate Testing, AHS-G2154

G

Gamma-glutamyl Transferase, AHS-G2173

H

Helicobacter pylori Testing, AHS-G2044Hepatitis Testing, AHS-G2036Homocysteine Metabolism-Related Conditions, Testing of, AHS-M2141Human Immunodeficiency Virus (HIV), AHS-M2116

I

Idiopathic Environmental Intolerance, Diagnosis of, AHS-G2056Immune Cell Function Assay, AHS-G2098Immunohistochemistry, AHS-P2018Inflammation Testing, General, AHS-G2155Inflammatory Bowel Disease, Laboratory Testing for the Diagnosis of, AHS-G2121Influenza, Diagnostic Testing of, AHS-G2119Intracellular Micronutrient Analysis, AHS-G2099In Vitro Chemoresistance and Chemosensitivity Assays, AHS-G2100Iron Homeostasis & Metabolism, Diagnostic Testing of, AHS-G2011

L

Liver Disease (Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease), AHS-G2110Lyme Disease Testing, AHS-G2143

M

Multiple Sclerosis and Related Neurologic Diseases, Serum Biomarker Testing for, AHS-G2123Myocardial Infarction and Chronic Heart Failure, Biomarkers for, AHS-G2150

N

Nerve Fiber Density Testing, AHS-M2112Nucleic Acid Probes (Identification of Microorganisms Using Nucleic Acid Probes), AHS-M2097

O

Onychomycosis Testing, AHS-M2172Oral Cancer Screening and Testing, AHS-G2113

P

Pancreatic Enzyme Testing for Acute Pancreatitis, AHS-G2153Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing, AHS-G2164Pathogen Panel Testing, AHS-G2149Pediatric Preventive Screening, AHS-G2042Prenatal Screening (Nongenetic), AHS-G2035Prescription Medication and Illicit Drug Testing in the Outpatient Setting, AHS-T2015Prostate Biopsy Specimen Analysis, AHS-G2007Prostate Specific Antigen (PSA) Testing, AHS-G2008

S

Salivary Hormone Testing, AHS-G2120Sexually Transmitted Infections (Diagnostic Testing of Common Sexually Transmitted Infections), AHS-G2157

T

Testosterone, AHS-G2013Therapeutic Drug Monitoring for 5-Fluorouracil, AHS – M2067Therapeutic Serum Antibodies, Immunopharmacologic Monitoring of, AHS-G2105Thiopurines Testing, Metabolite Markers for, AHS-G2115Thyroid Disease Testing, AHS-G2045Tuberculosis (Testing for Diagnosis of Active or Latent Tuberculosis), AHS-G2063Tumor Markers for Malignancies, Serum, AHS-G2124

U

Urinary Tumor Markers for Bladder Cancer, AHS-G2125Urine Culture Testing for Bacteria, AHS-G2156

V

Vaginitis, Diagnosis of, AHS-M2057Vector-Borne Infections, Testing for, AHS-G2158Venous and Arterial Thrombosis Risk Testing, AHS-M2041Vitamin B12 and Methylmalonic Acid Testing, AHS-G2014Vitamin D Testing, AHS-G2005

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