Laboratory Question for the Week of August 15, 2016

Laboratory Compliance Question of the Week


When does Medicare pay separately for lab tests?


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.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.