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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
The rules say that claims lines for A6209 billed without A1-A9 modifiers will be rejected as missing 
information. You can find this information in Medicare's Local Coverage Article: Surgical Dressings - Policy 
Article (A54563). 
 
The rules say that assays for ferritin are also useful in assessing iron balance. Low concentrations are 
associated with iron deficiency and are highly specific. High concentrations are found in hemosiderosis (iron 
overload without associated tissue injury) and hemochromatosis (iron overload with associated tissue injury). 
In these conditions the iron is elevated, the TIBC and transferrin are within the reference range or low, and the 
percent saturation is elevated. Serum ferritin can be useful for both initiating and monitoring treatment for iron 
overload 
 
1. Ferritin, iron and either iron binding capacity or transferrin are useful in the differential diagnosis of iron 
deficiency, anemia, and for iron overload conditions. 
a. The following presentations are examples that may support the use of these studies for evaluating iron deficiency: certain abnormal blood count values (i.e., decreased mean corpuscular volume (MCV), decreased 
hemoglobin/hematocrit when the MCV is low or normal, or increased red cell distribution width (RDW) and 
low or normal MCV); abnormal appetite (pica); acute or chronic gastrointestinal blood loss; hematuria; 
menorrhagia; malabsorption; status post-gastrectomy; status post-gastrojejunostomy; malnutrition; preoperative 
autologous blood collection(s); malignant, chronic inflammatory and infectious conditions associated with 
anemia which may present in a similar manner to iron deficiency anemia; following a significant surgical 
procedure where blood loss had occurred and had not been repaired with adequate iron replacement. 
b. The following presentations are examples that may support the use of these studies for evaluating iron 
overload: chronic hepatitis; diabetes; 
hyperpigmentation of skin; arthropathy; cirrhosis; hypogonadism; hypopituitarism; impaired porphyrin 
metabolism; heart failure; multiple transfusions; sideroblastic anemia; thalassemia major; cardiomyopathy, 
cardiac dysrhythmias and conduction disturbances. 
2. Follow-up testing may be appropriate to monitor response to therapy, e.g., oral or parenteral iron, ascorbic 
acid, and erythropoietin. 
3. Iron studies may be appropriate in patients after treatment for other nutritional deficiency anemias, such as 
folate and vitamin B12, because iron deficiency may not be revealed until such a nutritional deficiency is 
treated. 
4. Serum ferritin may be appropriate for monitoring iron status in patients with chronic renal disease with or 
without dialysis. 
5. Serum iron may also be indicated for evaluation of toxic effects of iron and other metals (e.g., nickel, 
cadmium, aluminum, lead) whether due to accidental, intentional exposure or metabolic causes. 
 
You can find this information in the National Coverage Determination (NCD): Serum Iron Studies (190.18). 
 
The rules say that the Physician Fee Schedule Status Indicator N means that it is non-covered service. These 
codes are carried on the Healthcare Common Procedure Coding System (HCPCS) tape as noncovered services. 
You can find this information in the Centers for Medicare and Medicaid Services, Internet Only Manual, 
Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Section 30.2.2. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.