NHIC/Medicare reports that recent denials of 80053 and other lab panels are due to their overutilization and potential fraud issues in Southern
California. Some of the laboratory panels are part of the problem. Because they are part of the potential fraudulent billings, they are looking at excessively high frequencies per beneficiary for several tests. The point at which they look at them is at a level that is generally more than twice the normal. Unfortunately, some medically reasonable tests may also get caught up in this process and get denied. Providers will have to appeal these denials with medical records.

To download a copy of the National Coverage Determinations for lab
tests go to: www.cmshhs.gov/ncd/labindexlist.asp