Medical Necessity Guide

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Part of our customer promise is helping you ensure that all testing is ordered and performed in accordance with quality and medical necessity guidelines. By clicking on the top link below, you will be able to access a listing compiled by Sunrise of all ICD-9-CM codes included in the National (CMS) and Local (NGS) Coverage Determinations for limited coverage tests. If you wish to read the complete NCDs and LCDs, including the explanatory text, you can click on the additional links listed below, which will take you to the applicable pages on the CMS and NGS web sites.

Medicare Medical Review Policies (Code Listings)

Complete National and Local Coverage Determinations, including explanatory text:

CMS National Coverage Determinations

NGS Local Coverage Determinations