CHC LABS INC.

   This policy has been duplicated from the most current Medicare National Coverage Determination or Local Medical Review Policy available at the time this booklet was printed in October 2005. Medicare will consider this test(s) medically reasonable and necessary only if the test(s) was performed for any of the diagnoses/conditions listed on this page. This information is subject to change without notice, and Covenant Health Care Labs (CHC) is not responsible for consequences that may result from using such information. CHC is not indicating one code is more acceptable than another, and that selected codes should reflect the patients actual medical condition as noted in their medical record.