Question:
When does Medicare pay separately for lab tests?
Answer:
The Centers for Medicare & Medicaid Services (CMS) conditionally packages laboratory tests and only pays separately for them when they are:
• The only services provided to a beneficiary on a claim
• “Unrelated” laboratory tests, meaning they are on the same claim as other hospital outpatient services, but are ordered for a different diagnosis than the other hospital outpatient services and are ordered by a different practitioner than the practitioner who ordered the other hospital outpatient services
• Molecular pathology tests
• Preventive services.