The Medicare program has certain guidelines for payment of laboratory testing. Medicare will pay for laboratory tests which are medically necessary. Medicare will not pay for laboratory tests which are associated with a routine physical. Also, Medicare will not pay for non-FDA approved tests or those tests ordered by a Chiropractor or Naturopathic Doctor.

Determine if test ordered on a Medicare patient will be paid, evaluate the test/s and diagnosis as indicated below:

LABORATORY ORDERING PROCEDURE FOR MEDICARE PATIENTS

Step 1.

Determine the tests to be ordered and indicate all medically appropriate ICD-10 codes that accurately reflect the patient’s condition or symptoms, and therefore, the diagnostic purpose for ordering the test(s).

Step 2.
Check to see if the test(s) or any test in a panel/profile ordered appears on the list of Limited Coverage Policies.
If No: Proceed with lab specimen submission procedures.
If Yes: Go to Step 3.

Step 3.
Determine if the ICD-10 codes you have specified are included on the Medicare carrier’s list of covered ICD-10 codes for that test.
If Yes: Proceed with lab specimen submission procedures.
If No: Go to Step 4.

Step 4.
Review with your patient the Advance Beneficiary Notice (ABN) form.

• Insert your patient’s name and Medicare number
• Write in or check off the test(s) that Medicare may not cover in the appropriate column.
• Refer to the Interpath Laboratory Patient Price List for the estimated costs of the test(s) that the patient may be responsible for.
• Present the entire ABN form to your patient and be sure that he/she reads it in its entirety and understands it.
• Explain why you think the test(s) is medically appropriate.
• Have your patient personally select Option 1 or Option 2 on the ABN.
• Once the option is selected, the patient must date and sign the form.
• Provide your patient with a copy of the signed ABN.

Step 5.
Submit the completed Advanced Beneficiary Form (ABN) with the completed requisition for those tests that the patient has agreed to receive.