Billing

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Billing Information

NCD Policies/Articles

NCD Number

NCD Description

CPT CODE

Sunquest Codes

Frequency Limitations

190.12

Urine Culture, Bacterial

87086

CURINE

None

87088

 

190.13

Human Immunodeficiency Virus (HIV)Testing (Prognosis Including Monitoring)

87536

HIVIUL

None

87539

 

190.14

Human Immunodeficiency Virus (HIV) Testing (Diagnosis)

86689

HTLVA, 

None

86701

HIVRA, HIV4GC

86702

HIV4GC

86703

 

87390

 

87391

 

87534

 

87535

HIP12M, HIS12M

87537

 

87538

HIP12M, HIS12M

190.15

Blood Counts

85004

 

None

85007

 

85008

 

85013

 

85014

HCRT, FLHCT, HGBHT

85018

HGBNM HGBHT

85025

CBCWD

85027

CBCND

85032

 

85048

EOSCNT, WBCCNT, WBCWD

85049

PLTCNT

190.16

Partial Thromboplastin Time (PTT)

85730

PTT, ANTLUP, TRRPA, AATHRM

None

190.17

Prothrombin Time (PT)

85610

PTM, AATHRM, TRRPA

Once (1) per week

190.18

Serum Iron Studies

82728

FERR, NAFL, THEVPM

Once (1) every three (3) months

83540

FE, TIBCLL, FETM

83550

TIBCLL

84466

TRANSF

190.19

Collagen Crosslinks, Any Method

82523

CTXM

Once (1) every three (3) months in first year, annually thereafter

190.2

Blood Glucose Testing

82948

 

Four (4) times a year

82962

BDGLU

82947

GLU, GLUF, NAFL

190.21

Glycated Hemoglobin/Glycated Protein

82985

FA1GPM, FRUCM

Once (1) every three (3) months

83036

GLYLMW

190.22

Thyroid Testing

84436

FRTUPM, T4

Two (2) times a year

84439

FRT4DM, TSH3GR, T4FREE

84443

TSH3G, TSH3GR

84479

FRTUPM, T3UTAA

190.23

Lipids Testing

83721

LDLD

Lipid Panel: 

Once (1) per year

 

Individual components: 

Six (6) times per year

83700

LPAWSM, LMPPM

83701

LPAWSM 

83704

NMRLPM

80061

LIPIDP

82465

CHOL, LMPPM

83718

HDL, LMPPM

84478

LMPPM, TRIG, FTRIG

190.24

Digoxin Therapeutic Drug Assay

80162

DIG

None

190.25

Alpha-fetoprotein

82105

AFPTM, MSINT2, MSNTD, MSQUAD

None

190.26

Carcinoembryonic Antigen

82378

CEA, FCEA

Once (1) per chemotherapy treatment cycle or every two (2) months post-surgical treatment

190.27

Human Chorionic Gonadotropin

84702

HCGT, HCGQNT, MS1TRI, MSINT2, MSQUAD

Once (1) per month for diagnostic purposes

190.28

Tumor Antigen by Immunoassay CA 125

86304

CA125

None

190.29

Tumor Antigen by Immunoassay CA 15-3/CA 27.29

86300

2729M, CA153M

None

190.30

Tumor Antigen by Immunoassay CA 19-9

86301

CA199

None

190.31

Prostate Specific Antigen

84153

PSAT, PSATF

Once (1) year (12 months)

190.32

Gamma Glutamyl Transferase

82977

GGT, FIBMET

Once (1) per week

190.33

Hepatitis Panel/Acute Hepatitis Panel

80074

HBAT

After a hepatitis diagnosis is established, only individual tests are needed.

190.34

Fecal Occult Blood Test

82272

SOCBSC, SOCBD3

None

LCD Policies/Articles
LCD Policy and Number CPT CODE(S) Description or Sunquest Code Frequency Limitations

Allergy Testing (L36402)

 82785, 86003

IgE and specific allergens and panels

Lab: Special Histochemical Stains and Immunohistochemical Stains (L36805)

 

MDS FISH (L37772)

 

MolDX: Biomarkers in Cardiovascular Risk Assessment (L36523)
  • Lipoprotein subclasses;
  • LDL particles;
  • Intermediate density lipoproteins;
  • High density lipoprotein AI9LpAI and AI/AII;
  • Lipoprotein(a);
  • Apolipoprotein B (Apo B), Apo A-I and Apo E;
  • Lipoprotein-associated phospholipase A2 (Lp-PLA2)
  • BNP
  • Cystatin C
  • Thrombogenic/hematologic actors
  • Interleukin-6 (IL-6), tissue necrosis factor- a (TNF- a) , plasminogen activator inhibitor-1 (PAI-1) and IL-6 promoter polymorphism
  • Free fatty acids
  • Visfatin, angiotensin-converting enzyme 1 (ACE2) and serum amyloid A
  • Microalbumin
  • Myeloperoxidase (MPO)
  • Homocysteine and methylenetetrahydrofolate reductase (MTHFR) mutation testing
  • Uric acid
  • Vitamin D
  • White blood cell count
  • Long-chain omega-3 fatty acids in red blood cell membranes
  • Gamma-glutamyltransferase (GGT)
  • Genomic profiling including CardiaRisk angiotensin gene
  • Leptin, ghrelin, adiponectin and adipokines including retinol binding protein 4 (RBP4) and resistin
  • Inflammatory markers including VCAM-1, P-selectin (PSEL) and E-selectin (ESEL) CARDIOVASCULAR risk panels

MolDX: Blood Product Molecular Antigen Typing (L38441)

 

MolDX: Breast Cancer Assay: Prosigna® (L36811)

 

MolDX: Breast Cancer Index® (BCI) Gene Expression Test (L37913)

 

MolDX: Decision Dx-UM (Uveal Melanoma) (L37210)

 

MolDX: EndoPredict® Breast Cancer Gene Expression Test (L37663)

 

MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic Test (L37919)

 

MolDX: Gene Expression Profile Tests for Decision-Making in Castration Resistant and Metastatic Prostate Cancers (L39709)

 

MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease (L36815)

 

MolDX: Genetic Testing for Heritable Thoracic Aortic Disease (L39989)

 

MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) (L36400)

 81241, 81240

FVL, G20210

MolDX: HLA-DQB1*06:02 Testing for Narcolepsy (L37003)

 

MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer (L37921)

 

MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer (L39040)

 

MolDX: Melanoma Risk Stratification Molecular Testing (L38018)

 

MolDX: MGMT Promoter Methylation Analysis (L37001)

 

MolDX: Minimal Residual Disease Testing for Cancer (L38835)

 

MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma (L39479)

 

MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma (L39614)

 

MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis (L39481)

 

MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate Pulmonary Nodules Following Bronchoscopy (L39711)

 

MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer (L39042)

 

MolDX: Molecular Diagnostic Tests (MDT) (L36807)

 

MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (L39044)

 0202U, 87507, 87505, 87483, 0528U 

RESP21, STLPCR, SSPNL, SFPCR, PNBLAV, PNSPUT

MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia (L39356)

 

MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis (L39987)

 

MolDX: Molecular Testing for Risk Stratification of Thyroid Nodules (L39720)

 

MolDx: Molecular Testing for Solid Organ Allograft Rejection (L38680)

 

MolDX: Next-Generation Sequencing for Solid Tumors (L38158)

 

MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies (L38176)

 

MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms (L40022)

 

MolDX: NRAS Genetic Testing (L36797)

 

MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) (L37199)

 

MolDX: Pharmacogenomics Testing (L38435)

 

MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells (L38678)

 

MolDX: Pigmented Lesion Assay (L38178)

 

MolDX: Plasma-Based Genomic Profiling in Solid Tumors (L38168)

 

MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer (L38443)

 

MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer (L38684)

 

MolDX: Prometheus® IBD sgi Diagnostic® Policy (L37539)

 

MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease (L38433)

 

MolDX: Repeat Germline Testing (L38429)

 

ProMark® Risk Score (L37011)

 

Urine Drug Testing (L34645)

 80307

LUDS, UDMONE

Vitamin D Assay Testing (L34658)

 82306, 82652

25VITD, VD2OHM

 Once (1) every three (3) months

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Contact the Billing Department

Phone: (515) 241-6929 · Fax: (515) 241-8881

Email: PL_LabBilling@unitypoint.org
Hours: Monday–Friday, 8:00 a.m. – 4:30 p.m. CT, closed Holidays

Billing Information & Resources

 

Medicare Coverage Lookup Tools

Medicare Coverage Database Search

Search NCDs, LCDs, and articles on cms.gov.

 

Medicare Preventative Services

Quick reference chart of covered preventive services.

 

Quantity Billing List (MUE)

Medically Unlikely Edits from the National Correct Coding Initiative.

 

Annual Compliance Notice to Providers and Clients

Annual Compliance Notice 2026

Billing and CPT Coding Policy

Billing and CPT Coding

DEX Z-Code™ Identifiers

The DEX Z-Code™ Identifier is a unique 5-character alphanumeric code associated with a specific molecular diagnostics (MDx) test.

DEX Z-Code Identifiers are assigned within the DEX Diagnostics Exchange based on the uniqueness of each test or manufacturer's product being registered. For example, a test for the same analyte but performed by a different laboratory methodology is considered unique and is assigned a DEX Z-Code Identifier.

DEX Z-Code Identifiers are applied to all advanced diagnostic tests, including molecular diagnostic and genetic tests.

For frequently asked questions pertaining to DEX Z-Codes, visit PalmettoGBA

 

Click on the button to access Z-Codes for Pathology Laboratory by searching under Labs & Manufactures for UnityPoint Health - Des Moines

Advanced Beneficiary Notice of Noncoverage (ABN) Form

ABN Form Instructions (PDF)

ABN Forms English and Spanish (Incl Large Print) (ZIP)

ABN Alternative Format Sample for Labs (PDF)

 

Coverage Policies

 

National Coverage Determination (NCD)

Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). 

Local Coverage Documents (LCDs) & Articles

Local coverage determinations (LCDS) are defined in Section 1869(f)(2)(B) of the Social Security Act (the Act). ‘Local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered.