Local medical review policies (LMRPs)

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Local medical review policies (LMRPs)

  • LMRPs (Local Medical Review Policies) are published by Medicare for some laboratory tests.
    • They are usually developed for tests that can be used for screening or diagnosis of disease.
    • LMRPs use CPT codes to identify the tests and ICD-9 codes to determine when coverage is allowed.
    • If an LMRP test is ordered by a physician, an ICD-9 code that is included in the LMRP must be given to the laboratory or the Medicare program will not pay for the test.
    • It is against the law for laboratory to change or add an ICD-9 code submitted by a physician.
    • A laboratory should not submit a claim for an LMRP test that is not accompanied by an acceptable ICD-9 code.
    • The Balanced Budget Act of 1997 made it illegal for physicians to order LMRP tests and not supply an ICD-9CM code with the order.