North Carolina Marketplace Laboratory Testing Policies
Medical Policy Statements prepared by CareSource and its affiliates do not ensure an authorization or payment of services. Please refer to the plan contract (often referred to as the Evidence of Coverage) for the service(s) referenced in the Medical Policy Statement. If there is a conflict between the Medical Policy Statement and the plan contract (i.e., Evidence of Coverage), then the plan contract (i.e., Evidence of Coverage) will be the controlling document used to make the determination. According to the rules of Mental Health Parity Addiction Equity Act (MHPAEA), coverage for the diagnosis and treatment of a behavioral health disorder will not be subject to any limitations that are less favorable than the limitations that apply to medical conditions as covered under this policy.
- F2019: Flow Cytometry – Effective Date: 01-01-2023
- F2019: Flow Cytometry – Effective Date: 10-01-2023
- G2002: Cervical Cancer Screening – Effective Date: 01-01-2023
- G2002: Cervical Cancer Screening – Effective Date: 06-01-2023
- G2005: Vitamin D Testing – Effective Date: 01-01-2023
- G2005: Vitamin D Testing – Effective Date: 06-01-2023
- G2006: Hemoglobin A1c – Effective Date: 01-01-2023
- G2006: Diabetes Mellitus Testing – Effective Date: 10-01-23
- G2007: Prostate Biopsies – Effective Date: 01-01-2023
- G2007: Prostate Biopsies – Effective Date: 06-01-2023
- G2008: Prostate Specific Antigen Testing – Effective Date: 01-01-2023
- G2008: Prostate Specific Antigen (PSA) Testing – Effective Date: 10-01-2023
- G2009: Preventive Screening in Adults – Effective Date: 06-01-2023
- G2009: Preventive Screening in Adults – Effective Date: 06-01-2023 to 09-30-2023
- G2011: Diagnostic Testing of Iron Homeostasis & Metabolism – Effective Date: 01-01-2023
- G2011: Diagnostic Testing of Iron Homeostasis & Metabolism – Effective Date: 06-01-2023
- G2013: Testosterone Testing – Effective Date: 01-01-2023
- G2013: Testosterone – Effective Date: 06-01-2023
- G2014: Vitamin B12 And Methylmalonic Acid Testing – Effective Date: 01-01-2023
- G2014: Vitamin B12 and Methylmalonic Acid Testing – Effective Date: 06-01-2023
- G2022: ANA/ENA Testing – Effective Date: 01-01-2023
- G2022: Biomarker Testing for Autoimmune Rheumatic Disease – Effective Date: 10-01-2023
- G2031: Allergen Testing – Effective Date: 01-01-2023
- G2031: Allergen Testing – Effective Date: 10-01-2023
- G2035: Prenatal Screening (Nongenetic) – Effective Date: 01-01-2023
- G2036: Hepatitis C – Effective Date: 01-01-2023
- G2036: Hepatitis Testing – Effective Date: 10-01-2023
- G2042: Pediatric Preventive Screening – Effective Date: 06-01-2023
- G2042: Pediatric Preventive Screening – Effective Date: 10-01-2023
- G2043: Celiac Disease Testing – Effective Date: 01-01-2023
- G2043: Celiac Disease Testing – Effective Date: 06-01-2023
- G2044: Helicobacter pylori Testing – Effective Date: 01-01-2023
- G2044: Helicobacter pylori Testing – Effective Date: 10-01-2023
- G2045: Thyroid Disease Testing – Effective Date: 06-01-2023
- G2045: Thyroid Disease Testing – Effective Date: 10-01-23
- G2048: Biochemical Markers Of Alzheimer Disease and Dementia – Effective Date: 01-01-2023
- G2048: Biochemical Markers of Alzheimer Disease and Dementia – Effective Date: 06-01-2023
- G2050: Cardiovascular Disease Risk Assessment – Effective Date: 01-01-2023
- G2051: Bone Turnover Markers Testing – Effective Date: 01-01-2023
- G2051: Bone Turnover Markers Testing – Effective Date: 06-01-2023
- G2055: Prenatal Screening for Fetal Aneuploidy – Effective Date: 01-01-2023 to 04-30-2023
- G2056: Diagnosis of Idiopathic Environmental Intolerance – Effective Date: 01-01-2023
- G2056: Diagnosis of Idiopathic Environmental Intolerance – Effective Date: 06-01-2023
- G2059: Epithelial Cell Cytology In Breast Cancer Risk Assessment – Effective Date: 01-01-2023
- G2059: Epithelial Cell Cytology in Breast Cancer Risk Assessment – Effective Date: 06-01-2023
- G2060: Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing – Effective Date: 01-01-2023
- G2060: Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing- Effective Date: 06-01-2023
- G2061: Fecal Calprotectin Testing – Effective Date: 01-01-2023
- G2061: Fecal Calprotectin Testing in Adults – Effective Date: 06-01-2023
- G2063: Testing for Diagnosis of Active or Latent Tuberculosis – Effective Date: 01-01-2023
- G2063: Testing for Diagnosis of Active or Latent Tuberculosis – Effective Date: 06-01-2023
- G2098: Immune Cell Function Assay – Effective Date: 01-01-2023
- G2098: Immune Cell Function Assay – Effective Date: 06-01-2023
- G2099: Intracellular Micronutrient Analysis – Effective Date: 01-01-2023
- G2099: Intracellular Micronutrient Analysis – Effective Date: 10-01-2023
- G2100: In Vitro Chemoresistance and Chemosensitivity Assays – Effective Date: 06-01-2023
- G2100: In Vitro Chemoresistance And Chemosensitivity Assays – Effective Date: 10-01-2023
- G2105: Immunopharmacologic Monitoring of Therapeutic Serum Antibodies – Effective Date: 01-01-2023
- G2105: Immunopharmacologic Monitoring of Therapeutic Serum Antibodies – Effective Date: 06-01-2023
- G2107: Measurement Of Thromboxane Metabolites For ASA Resistance – Effective Date: 01-01-2023
- G2107: Measurement of Thromboxane Metabolites for ASA Resistance – Effective Date: 06-01-2023
- G2110: Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease – Effective Date: 01-01-2023
- G2110: Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease – Effective Date: 06-01-2023
- G2113: Oral Screening Lesion Identification Systems and Genetic Screening – Effective Date: 01-01-2023
- G2115: Metabolite Markers For Thiopurines Testing – Effective Date: 01-01-2023
- G2115: Monitoring Metabolite Markers of Thiopurines – Effective Date: 06-01-2023
- G2119: Diagnostic Testing of Influenza – Effective Date: 01-01-2023
- G2119: Diagnostic Testing of Influenza – Effective Date: 06-01-2023
- G2120: kv1 Salivary Hormone Testing – Effective Date: 01-01-2023
- G2120: Salivary Hormone Testing – Effective Date: 10-01-2023
- G2121: Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease – Effective Date: 01-01-2023
- G2121: Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease – Effective Date: 06-01-2023
- G2123: Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases – Effective Date: 01-01-2023
- G2123: Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases – Effective Date: 06-01-2023
- G2124: Serum Tumor Markers for Malignancies – Effective Date: 01-01-2023
- G2125: Urinary Tumor Markers for Bladder Cancer – Effective Date: 01-01-2023
- G2125: Urinary Tumor Markers For Bladder Cancer – Effective Date: 10-01-2023
- G2127: Vectra DA Blood Test for Rheumatoid Arthritis – Effective Date: 01-01-2023
- G2127: Vectra DA Blood Test for Rheumatoid Arthritis – Effective Date: 01-01-2023 to 09-30-2023
- G2130: ST2 Assay for Chronic Heart Failure – Effective Date: 01-01-2023
- G2133: ZIKA Virus Risk Assessment – Effective Date: 01-01-2023
- G2138: Evaluation of Dry Eyes – Effective Date: 01-01-2023
- G2138: Evaluation of Dry Eyes – Effective Date: 10-01-2023
- G2143: Lyme Disease – Effective Date: 01-01-2023
- G2143: Lyme Disease Testing – Effective Date: 10-01-2023
- G2149: Pathogen Panel Testing – Effective Date: 01-01-2023
- G2150: Cardiac Biomarkers for Myocardial Infarction – Effective Date: 01-01-2023
- G2153: Pancreatic Enzyme Testing for Acute Pancreatitis – Effective Date: 01-01-2023
- G2154: Folate Testing – Effective Date: 01-01-2023
- G2155: General Inflammation Testing – Effective Date: 01-01-2023
- G2155: General Inflammation Testing – Effective Date: 06-01-2023
- G2156: Urine Culture Testing for Bacteria – Effective Date: 01-01-2023
- G2157: Diagnostic Testing Of Common Sexually Transmitted Infections – Effective Date: 06-01-2023
- G2157: Diagnostic Testing Of Common Sexually Transmitted Infections edf; 10-01-23
- G2158: Testing for Mosquito- or Tick-Related Infections – Effective Date: 01-01-2023
- G2158: Testing for Mosquito- or Tick-Related Infections – Effective Date: 06-01-2023
- G2159: B-Hemolytic Streptococcus Testing – Effective Date: 01-01-2023
- G2159: B-Hemolytic Streptococcus Testing – Effective Date: 06-01-2023
- G2164: Parathyroid Hormone Phosphorus Calcium and Magnesium Testing – Effective Date: 01-01-2023
- G2164: Parathyroid Hormone Phosphorus Calcium and Magnesium Testing – Effective Date: 10-01-2023
- G2173: Gamma-glutamyl Transferase – Effective Date: 01-01-2023
- G2174: Coronavirus Testing in the Outpatient Setting – Effective Date: 01-01-2023
- G2174: Coronavirus Testing in the Outpatient Setting – Effective Date: 06-01-2023
- G2181: Colorectal Cancer Testing – Effective Date: 10-01-23
- M2041: Venous and Arterial Thrombosis Risk Testing – Effective Date: 01-01-2023
- M2041: Venous and Arterial Thrombosis Risk Testing – Effective Date: 10-01-2023
- M2057: Diagnosis of Vaginitis including Multi-target PCR Testing – Effective Date: 01-01-2023
- M2057: Diagnosis of Vaginitis including Multi-target PCR Testing – Effective Date: 10-01-2023
- M2058: Genetic Testing for Adolescent Idiopathic Scoliosis – Effective Date: 01-01-2023
- M2068: Testing for Alpha-1 Antitrypsin Deficiency – Effective Date: 01-01-2023
- M2093: HIV Genotyping and Phenotyping – Effective Date: 01-01-2023
- M2093: HIV Genotyping and Phenotyping – Effective Date: 01-01-2023 to 09-30-2023
- M2097: Identification of Microorganisms Using Nucleic Acid Probes – Effective Date: 01-01-2023
- M2097: Identification of Microorganisms Using Nucleic Acid Probes – Effective Date: 06-01-2023
- M2112: Nerve Fiber Density Testing – Effective Date: 01-01-2023
- M2112: Nerve Fiber Density Testing – Effective Date: 06-01-2023
- M2116: Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection – Effective Date: 01-01-2023
- M2116: Human Immunodefiency Virus – Effective Date: 10-01-2023
- M2141: Testing of Homocysteine Metabolism-Related Conditions – Effective Date: 01-01-2023
- M2141: Testing of Homocysteine Metabolism-Related Conditions – Effective Date: 06-01-2023
- M2172: Onychomycosis Testing – Effective Date: 01-01-2023
- M2172: Onychomycosis Testing – Effective Date: 10-01-2023
- M2176: Testing for Autism Spectrum Disorder and Developmental Delay – Effective Date: 01-01-2023
- M2176: Testing for Autism Spectrum Disorders and Developmental Delay – Effective Date: 06-01-2023
- P2018: Immunohistochemistry – Effective Date: 01-01-2023
- P2018: Immunohistochemistry – Effective Date: 06-01-2023
- R2162: Avalon Laboratory Procedures Reimbursement Policy – Effective Date: 01-01-2023
- T2015: Prescription Medication and Illicit Drug Testing in the Outpatient Setting – Effective Date: 01-01-2023
- T2015: Prescription Medication and Illicit Drug Testing in the Outpatient Setting – Effective Date: 10-01-2023