Guidelines For Ordering Laboratory Tests
Medical Necessity
Limited Coverage Tests
Advance Beneficiary Notice
Standing Order Policy
Compliance Medical Necessity/Screening

Laboratory testing is deemed Medically Necessary by Medicare if the test is "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."

Any other use of laboratory testing is considered screening. Screening does not always denote that the ordered test is unnecessary or poor medical practice. Screening tests can not be directly linked to an established diagnosis, sign or symptom.

In order to establish Medical Necessity, the test order must be accompanied by the appropriate diagnostic information that justifies the test order. This information should be submitted in the form of an ICD-9 code. Laboratory requisitions have incorporated the commonly used ICD-9 codes for each practice area. Feel free to include additional Diagnoses/ICD-9 if those listed do not reflect the patient's signs/symptoms/diagnosis accurately.

The following tests are covered screening tests for Medicare Beneficiaries:

  • MEDICARE COVERED SCREENING TESTS (Be sure to order correct screening Test)
  • PSA (1/year)
  • FOB (1/year)
  • PAP SMEAR (1/ every 2 years)

Note: If a test has been ordered as a Screening Test, it is considered screening regardless of the test result.

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