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Medicare will only pay for tests that they consider “medically necessary”. Medicare publishes a list of all the tests for which they check for medical necessity. These tests are referred to as Medicare limited coverage policies. Medicare looks at the diagnosis code(s) submitted for the test being performed. Each test has a corresponding list of codes that are considered “covered” or reimbursable. If the diagnosis code is covered, then Medicare will process the test following normal procedures. If the code is non-covered, then Medicare will deny the test for medical necessity. When non-coverage is a possibility, we ask our Medicare patients to sign an Advanced Beneficiary Notice (ABN) to let the Medicare carrier know that the patient has agreed to be financially responsible for the test.
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