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Folic Acid, Serum (L1086) RETIRED
LCD - Local Coverage Determination
Medicare Policies and Guildelines
LCD Determination ID:
Original Determination Effective Date:
Latest Revision Effective Date:
Latest Revision Ending Date:
Indications and Limitations of Coverage and/or Medical Necessity
Folic acid, also known as folate, is a B complex vitamin which serves as a carrier of one-carbon groups in many metabolic reactions. As tetrahydrofolate, it is required in the synthesis and catabolism of several amino acids, the formation of creatine and choline, the methylation of RNAs, the synthesis of purines, and the synthesis of DNA. Folic acid deficiency is usually nutritional in origin, and results in megaloblastic anemia.
Serum folic acid levels are generally indicated in the evaluation of megaloblastic anemias whose cause is unknown, and in the setting of nutritional deficiency states, alcoholism, pregnancy, and malabsorption. Therapy with certain drugs, especially dihydrofolate reductase inhibitors such as methotrexate and trimethoprim, can result in folic acid deficiency and may be an indication to determine serum folic acid levels.
Except in malabsorptive states where periodic serum folic acid determination may help in monitoring disease severity, sequential testing for folic acid is usually unnecessary, as response to treatment can be ascertained through increase in hemoglobin, hematocrit or decrease in macrocytosis/megaloblastosis.
CMS National Coverage Policy:
Title XVIII of the Social Security Act, §1862 (a)(7). This section excludes routine physical examinations.
Title XVIII of the Social Security Act, §1862 (a)(1)(A). allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis of treatment of illness or injury or to improve the functioning of a malformed body member.
Revision #21, 01/23/2011 01/23/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, in compliance with the J11 AB MAC Statement of Work (SOW), C.188.8.131.52 - Consolidation of Local Coverage Determinations, this LCD was not selected for MAC implementation and is being retired. The effective date is January 23, 2011.
Revision #20, 09/23/2010 Under Bill Types verbiage changes were made to 12X, 13X, 14X, 21X, 22X, 71X, 72x and 85X. Under Revenue Codes verbiage changes were made to 0300 and 0301. These changes became effective 08/01/2010.
This revision becomes effective on 09/23/2010.
Revision #19, 05/13/2010 Under ICD-9 Codes that Support Medical Necessity the following ICD-9 codes were added 284.1, 287.5, 288.50 and 289.89. This revision becomes effective 05/13/2010.
Revision #18, 04/23/2010 This LCD has had its annual validation and no changes were made. This revision becomes effective 04/23/2010.
Revision #17, 04/01/2010 Under CMS National Coverage Policy section the following change request was added: CMS Manual System, Pub. 100-20, One-Time Notification, Transmittal 477, dated April 24, 2009, Change request 6338. Under Bill Type Codes 73x has been changed to 77x. This revision becomes effective on 04/01/2010.
Revision #16, 09/03/2009 Under CMS National Coverage Policy section CMS Manual System, Pub 100-08, Medicare Program Integrity, Transmittal 63, Change Request 3010, dated January 23, 2004, was changed to CMS Manual System, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.1-13.13.14. The annual validation is completed. This revision becomes effective 09/03/2009.
Revision #15, 10/01/2008 Under AMA/CPT & ADA/CDT Copyright Statement changed the copyright date from 2007 to 2008. Under ICD-9 Codes That Support Medical Necessity V45.1 was carried out to a fifth digit and V45.11 was added. This policy becomes effective 10/01/2008.
Revision #14, 08/14/2008 This LCD has had its annual review. No changes were made. This revision becomes effective on 08/14/2008.
Revision #13, 06/27/2007 Under CMS National Coverage Policythe verbiage was corrected under SSA 1862 (a)(7). This sectionn was deleted and the word exam was spelled out examinations.. Verbiage was also corrected under SSA 1862 (a)(7)(A). The word off was changed to or.. Under CMS Manual System Put 100-8, it was changed to read 100-08. Under Bill Type Codes 18x was added. Under Revenue Codes section the revenue code was changed from 0300-0309 to 030x. The verbiage under Diagnoses That Do Not Support Medical Necessity section was deleted and replace with N/A. Under Sources of Information and Basis for Decision section the verbiage was deleted and replaced with N/A. Under Advisory Committee Meeting Notes the verbiage Advisory Committee Meeting Date: N/AA was added. These changes become effective on 06/27/2007.
Revision #12, 09/13/2006 Under Bill Types added 71x, 73x. Revised verbiage under Documentation Requirements. This revision becomes effective 09/13/2006.
Revision #11, 11/15/2004 Deleted reference to CDT-4 copyright language as this policy does not contain CDT-4 codes or descriptions. This revision is effective immediately.
Revision #10, 07/16/2004 Reformatted the policy to conform with LCD criteria in CR 3010. This revision is effective 07/16/2004.
Revision #8, 07/30/2003 Added ICD-9 codes V23.7 insufficient prenatal care and V45.1 renal dialysis status to the ICD-9 codes that support medical necessity.
Revision #7, 02/05/2003 TOB 85X added to policy. Effective immediately
Revision #6, 09/22/2000 TOB12X added to policy. Effective June 1, 2000
Revision #5, 01/01/2000 AMA Copyright statement added.
Revision #4, 07/01/1999 Addition of 22X, 23X, bill types.
Revision #3 04/30/1999 Addition of ICD-9 Codes 281.9 and 285.9.
Revision #2, 03/01/1999 Addition of ICD-9 codes 355.9 and 529.6. Clarification of ranges requiring 5 digits.
Revision #1, 11/11/1997 Addition of Bill Type 831
09/30/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, Palmetto GBA Title 18 Part A (00382) was removed from this LCD and transitioned to Palmetto GBA J11 MAC Part A (11501). Effective date of this transition is September 30, 2010.
01/23/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, in compliance with the J11 AB MAC Statement of Work (SOW), C.184.108.40.206. - Consolidation of Local Coverage Determinations, this LCD was not selected for MAC implementation and is being retired. The effective date is January 23, 2011.
Start Date of Comment Period:
End Date of Comment Period:
Start Date of Notice Period:
Last Reviewed On Date:
Advisory Committee Meeting Notes
This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the Intermediary, this policy was developed in cooperation with advisory groups, which include representatives from the affected provider community. Advisory Committee Meeting Date: N/A
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.
Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill
Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12 - Hospital Inpatient (Medicare Part B only) 13 - Hospital Outpatient 14 - Hospital - Laboratory Services Provided to Non-patients 18 - Hospital - Swing Beds 21 - Skilled Nursing - Inpatient (Including Medicare Part A) 22 - Skilled Nursing - Inpatient (Medicare Part B only) 23 - Skilled Nursing - Outpatient 71 - Clinic - Rural Health 77 - Clinic - Federally Qualified Health Center (FQHC) 85 - Critical Access Hospital