Optima Health has partnered with Avalon Healthcare Solutions for Laboratory Benefits Management (LBM). The laboratory testing policies are accessible through the links below. These policies have been modified for Optima Health’s various products to align with government program policies, rules, and/or state and federal contracts, but note that in case of conflict, the government program policies, rules, and/or state and federal contracts will take precedence.

DISCLAIMER: Application of coverage criteria is dependent upon an individual’s benefit coverage at the time of the request. If there is a conflict between this Policy and any relevant, applicable government policy [e.g. Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs) for Medicare] for a particular member, then the government policy will be used to make the determination. For the most up-to-date Medicare policies and coverage, please visit their search website https://www.cms.gov/medicare-coverage-database/search.aspx or
the manual website.