Medicare/Medicaid Coverage - Billing lab charges to CMS

  • Only tests that are medically necessary for the diagnosis or treatment of the patient should be ordered, along with the diagnosis that supports testing. 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 experimental.

  • Please inform the patient if there is a reason to believe that Medicare will not pay for a test. The patient should sign an ABN (Advanced Beneficiary Form), at this time to indicate that they will be responsible for the cost of the test if Medicare denies payment.

  • The ordering physician must provide an ICD-9 diagnosis code or narrative description. If the physician does not, the laboratory will contact the physician for the ICD-9 information.

  • Organ or disease-oriented panels should be billed to Medicare only when every component is medically necessary.

Local Coverage Decisions

 National Coverage Decision Codes

Advance Beneficiary Information