(Reproduced by permission from Medicare Focus, June, 1998, pp.
Medicare Part A
Local Medical Review Policy
Policy Number: A96-06 (Revision - Republished for Diagnosis List Verification
Type of Bill: 12X, 13X, 14X, 22X, 23X, 71X, 74X, 75X
Revenue Codes: 300-319
Indications and Limitations of Coverage and/or Medical Necessity
Ferritin levels are used to:
- aid in diagnosis of iron deficiency and iron overload.
- measure iron storage.
- distinguish between iron deficiency (a condition of low iron storage) and chronic
inflammation (a condition of normal storage).
HCPCS Codes: 82728
ICD9 Codes That Support Medical Necessity
A ferritin level will be eligible for coverage when medically necessary and reasonable for
the following diagnosis codes:
||Other Metabolic and Immunity Disorders
|280.0 - 280.1
281.0 - 281.2
285.0 - 285.1
|Diseases of the Blood and Blood-Forming Organs
Note: 280.8-280.9 added per Medicare Focus January, 2002
|Other Diseases of Digestive System
||Nephritis, Nephrotic Syndrome, and Nephrosis
ICD-9 diagnosis codes should be used at their highest level of specific.
HCPCS Section and Benefit Category: Pathology and Laboratory
HCFA National Coverage Policy
Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be reasonable and medically necessary, i.e., reasonable and necessary are those tests used in the diagnosis and management of illness or injury or to improve the function of a malformed body part.
Title XVIII of the Social Security Act, section 1862(a)(7). This section excludes routine physical examinations.
Reason for Denial
Tests performed during annual physical exams or other routine screening situations without signs, symptoms or illness will result in denial as a non-covered benefit.
Non-Covered ICD-9 Diagnosis Codes
All other diagnosis codes not listed as covered in the "Covered ICD-9-CM Code(s)" section of this policy.
Sources of Information
- ICD-9-CM, Volumes I & II
- Laboratory and Diagnostic Tests, Fifth Edition, Lippincott, 1996
- Other Intermediaries' policies
Use CPT code 82728 when billing for a ferritin level unless it is included in a
ICD-9-CM diagnosis codes are required on claim.
Medical records must clearly document the medical necessity for the test and the frequency
of the test.
If documentation is requested for review, submit the following:
- History and Physical
- Physician orders/progress notes
- Diagnosis/reason for test
- Test results
- Itemization of charges
|Start Date of Comment Period:||April 16, 1996|
|Start Date of Notice Period:||October 1996|
|Original Effective Date:||November 1, 1996|
|Revised Effective Date:||June 1, 1998|
This policy does not reflect the sole opinion of the Intermediary/Medical Director. Although the final decision rests with the Intermediary, this policy his policy was developed in cooperation with the Carrier Advisory Committee, which includes representatives from physician specialties, representatives from the Medical Association of the State of Alabama and other Association Representatives.