Evaluating the Medical Necessity for Laboratory Panel CPT

90.4 - Evaluating the Medical Necessity for Laboratory Panel CPT Codes (Rev. 1, 10-01-03) PM-B-98-1 The American Medical Association’s (AMA) 1998 edition of the Current Procedural Terminology (CPT) establishes three new and one revised Organ or Disease Oriented laboratory panels. Since these panels are composed of clinically relevant groupings of automated multi-channel tests there is a general presumption of medical necessity. If A/B MACs (B) suspect abuse of the new panel codes, they should review such claims. Should an A/B MAC (B) determine the need to develop a LMRP for laboratory panel codes, the A/B MAC (B) should develop such a policy at the panel code level. As appropriate, an A/B MAC (B) may review the panel and deny component tests on a case- by-case basis or evaluate the need for the component level test.