Laboratory tests that are billed to Medicare/Medicaid or other federally-funded
programs may be subject to the following payment restrictions:
Medicare does not pay for screening tests, except for certain specifically approved
procedures, and may not pay for non-FDA-approved tests or those tests considered
Medicare may deny payment for a test that the physician believes is appropriate,
but which does not meet the Medicare coverage criteria. If there is reason to
believe that Medicare will not pay for a test, the patient should be informed. The
patient may then be asked to sign an Advance Beneficiary Notice (ABN) to indicate
that he or she is responsible for the cost of the test if Medicare denies payment.
Payment for organ or disease related panels may be restricted unless all components
of the panel are medically necessary.
The ordering physician must provide an ICD-10 diagnosis code or a narrative description
to document the medical necessity of the ordered tests.
Certain tests may be subject to a copay and or deductible that is the patient's