SL
Sanford Health
CLM
CLM
Employees
About Us
Certifications
Catalog
What's New
Testing
Services
SL Rapid City
Education Compliance
Compliance

  < Back a level

Staff
Patient Service Center
Resources
Contact Us
Anatomic Pathology
Employment Opportunities
CLM
Test Directory Search
Our Catalog of Services is ONLINE!
Updated Weekly
Click here to search
CLM

CLM
ADDRESS
Sanford Laboratories
PO Box 5056
Sioux Falls, SD 57117-5056

PHONE
605-328-5464
800-522-2561

FAX
605-328-5434

E-MAIL
E-mail Sanford Laboratories
CLM


CLM CLM
Guidebook
Compliance - NCDs & LCDs and Advanced Beneficiary Notice of Noncoverage (ABN)
Advanced Beneficiary Notice of Noncoverage (ABN)

Printable ABN Form Printable ABN Form
Complete necessary boxes. Remember to choose only 1 Option. Updated 6-21-2017
pdf (245k)

Patient Fees to Use with ABNs Patient Fees to Use with ABNs
Updated July 1, 2017
pdf (134k)

Commercial Insurance Waiver Form Commercial Insurance Waiver Form
September 10, 2014
pdf (261k)


NCDs and LCDs for Covered Signs, Symptoms,Diagnoses, & ICD-10 Codes

Based upon National Coverage Determinations (NCD) Established by CMS (Medicare) & Local Coverage Determinations (LCD) Established by Medicare Noridian of North Dakota


NCDs - Effective 10-1-2017 (ICD-10)

For your convenience, the most current version of NCDs of Covered Signs, & Symptoms, are available to you by choosing the link below. (Allow a few minutes for the file to download.)

You can print as many copies as your facility needs as this document is not copyrighted.


NCDs - ICD-10 Effective 10-1-2017 NCDs - 10-1-2017 (ICD-10)
Use bookmarks to navigate through document.
pdf (10244k)


LCDs - Effective 10-1-2017

For your convenience, the most current version of LCDs of Covered Signs & Symptoms are available to you by choosing the links below. You can print as many copies as your facility needs as this document is not copyrighted.

The updated link for LCDs:


Non-Covered Services 1-18-2017 (ICD-10) Non-Covered Services 1-18-2017 (ICD-10)
pdf (143k)

BNP 10-1-2017 (ICD-10) BNP 10-1-2017 (ICD-10)
pdf (101k)

Controlled Sustance Monitoring & Drugs of Abuse Testing 10-1-2017 (ICD-10) Controlled Substance Monitoring & Drugs of Abuse Testing 10-1-2017 (ICD-10)
pdf (131k)

Flow Cytometry 10-1-2017(ICD-10) Flow Cytometry 10-1-2017 (ICD-10)
pdf (168k)

Magnesium, Serum 10-1-2017 (ICD-10) Magnesium, Serum 10-1-2017 (ICD-10)
pdf (130k)

MolDX: ABC and MUTYH Gene Testing 5-15-2017 MolDX: APC and MUTYH Gene Testing 5-15-2017 (ICD-10)
pdf (83k)

MolDX: Biomarkers in Cardiovascular Risk Assessment 1-1-2017 (ICD-10) MolDX: Biomarkers in Cardiovascular Risk Assessment 1-1-2017 (ICD-10)
pdf (128k)

MolDX: BRCA1 and BRCA2 Genetic Testing 4-15-2016 (ICD-10) MolDX: BRCA1 and BRCA2 Genetic Testing 4-15-2016 (ICD-10)
pdf (109k)

MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease 1-1-2017 (ICD-10) MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease 1-1-2017 (ICD-10)
pdf (93k)

MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) 6-16-2016 (ICD-10) MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) 6-16-2016 (ICD-10)
pdf (89k)

MolDX: Genetic Testing for Lynch Syndrome 12-15-2016 (ICD-10) MolDX: Genetic Testing for Lynch Syndrome 12-15-2016 (ICD-10)
pdf (122k)

MolDx: Molecular Diagnostic Tests (MDT) 1-1-2017 (ICD-10) MolDx: Molecular Diagnostic Tests (MDT) 1-1-2017 (ICD-10)
pdf (106k)

MolDx: CYP2C19, CYP2D6, CYP2C9, VKORC1 Genetics 10-1-2017 (ICD-10) MolDx: CYP2C19, CYP2D6, CYP2C9, VKORC1 Genetics 10-1-2017 (ICD-10)
pdf (129k)

Vitamin D  2-3-2017 (ICD-10) Vitamin D 2-3-2017 (ICD-10)
pdf (116k)

ABN Power Point Advanced Beneficiary Notice of Noncoverage Form Power Point
Updated 7-2013
pptx (319k)

Important! Medical Necessity Billing Information
  • Information for tests that are sent to Sanford Laboratories and billed to Medicare by Sanford Laboratories
  • A guide to determine when an Advanced Beneficiary Notice of Noncoverage (ABN) needs to be signed
  • Background information
  • Limited coverage policies by test
Note: If you submit testing to Sanford Laboratories and your facility is not located in South Dakota or North Dakota, these NCDs and LCDs still apply to your facility because Sanford Laboratories files its Medicare claims with Medicare Noridian of North Dakota.


Advanced Beneficiary Notice of Noncoverage Form (ABN)

Whenever a test with limited coverage (NCD or LCD) is ordered, the laboratory is allowed to submit the test to Medicare for payment. If payment is denied, the laboratory will be able to bill the beneficiary if an Advanced Beneficiary Notice of Noncovereage Form was completed. The form regulations apply to participating and nonparticipating provider services that may be determined as not medically necessary. Under federal law, providers must inform beneficiaries in writing before providing a service which Medicare may consider not medically necessary. Advanced Beneficiary Forms also protect the provider's right to collect payment from the beneficiary when claims are denied by Medicare as "not reasonable and necessary."

A complete comprehensive overview of the "Advanced Beneficiary Notice of Non-Coverage Form" and the "Medical Necessity Information" is available by clicking on the links below.

**Please note the addition of Hepatic Function Panel to the Organ and Disease Oriented Panels - as of October 7, 2016.

Also included is the Full Disclosure of "Patient/Third-Party Fees".


Detailed Medical Necessity Information Detailed Medical Necessity Information
Updated 7-10-2017
pdf (163k)

Patient/Third-Party Fee Disclosure Patient/Third-Party Fee Disclosure
Updated July 2017
pdf (36k)



  CLM A Tradition of Excellence in Laboratory Medicine
  CLM
| HOME PAGE | EMPLOYMENT OPPORTUNITIES | EMPLOYEES | ABOUT US | WHAT'S NEW |
| TESTING | SERVICES | EDUCATION COMPLIANCE | STAFF |
| COMPLIANCE | ANATOMIC PATHOLOGY | PATIENT SERVICE CENTER | RESOURCES |
| CATALOG | CONTACT US | DISCLAIMER | SL RAPID CITY |

   
Employees Privacy of Health Information Privacy Statement
© 2017 Sanford Laboratories. -- All Rights Reserved.
Lawrence and Schiller: Putting the Web to Work.