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Lab Manual for UCSF Clinical Laboratories

Lab Manual for SFGH

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Testing Requiring ICD9 Verification

The following is a list of tests which UCSF is responsible for verifying Medical Necessity. Click on a test name to see a list of ICD9 codes that meet the guidelines for Medical Necessity

To search for a specific ICD9 code, try the following web site: http://www.icd9data.com

CMS Lab NCD information is available for download at the following web site: http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDs.html

National Coverage Determination (NCD)

Acute Hepatitis Panel (only applies if all test below are ordered on the same date of service)

  • Hepatitis A, IgM Antibody
  • Hepatitis B Core Antibody, IgM
  • Hepatitis B Surface Antigen
  • Hepatitis C Antibody

Alpha-fetoprotein, serum

Blood Counts

  • Blood Smear Morphology
  • Complete Blood Count (includes Platelet Count)
  • Complete Blood Count with 5-part Differential
  • Hemoglobin
  • Hematocrit, automated
  • Nucleated red cells
  • Platelet Count

Blood Glucose

  • Glucose Tolerance Test, Pregnancy
  • Glucose, Body fluid
  • Glucose, fasting
  • Glucose, non-fasting

Carcinoembryonic Antigen

Collagen Crosslinks


Fecal Occult Blood Test

Gamma Glutamyl Transferase

Glycated Hemoglobin/Glycated Protein

  • Fructosamine
  • Hemoglobin A1c

HIV Testing (Prognosis)

  • HIV-1 DNA, Qualitative, by PCR
  • HIV-1 RNA, Quantitative, bDNA
  • HIV-1 RNA, Quantitative, by PCR

HIV Testing (Diagnosis)

  • HIV Antibody Screen
  • HIV Antibody Screen Confirmation

Human Chorionic Gonadotropin

  • Human Chorionic Gonadotropin for Pregnancy, serum
  • Human Chorionic Gonadotropin for Tumor, serum

Lipids Testing

  • Cholesterol, HDL
  • Cholesterol, Total
  • Triglycerides, Body fluid
  • Triglycerides, serum
  • VAP TM Cholesterol Test

Prostate Specific Antigen

  • Prostate Specific Antigen, Total

Prothrombin Time (PT)

Partial Thromboplastin Time (PTT)

Serum Iron Studies

  • Iron, liver
  • Iron, serum
  • Iron, Transferrin and % Transferrin Saturation
  • Iron, urine
  • Transferrin, beta-1-

Thyroid Testing

  • Free T3, Adult
  • Free T3, Pediatric
  • Free T4
  • Free T4 (by dialysis)
  • T3, Reverse
  • T3, Total
  • T4, Total
  • Thyroid Stimulating Hormone

Tumor Antigen by Immunoassay CA 19-9

Tumor Antigen by Immunoassay CA 125

Tumor Antigen by Immunoassay CA 15-3/CA 27.29

Urine Culture, Bacterial

Local Coverage Determination (LCD)

Acid Phosphatase

  • Acid Phosphatase, Total
  • Prostatic Acid Phosphatase (note: Prostatic Acid Phosphatase is not covered for any indication)

B-type Natriuretic Peptide

Erythrocyte Sedimentation Rate - Retired, no longer in effect

High Sensitivity C-Reactive Protein

Homocysteine Level, Serum

Serum Magnesium

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