Medicare Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive. pays for blood work and lab tests.
A doctor must certify the tests are medically necessary.
Covered tests may vary by geographic location.
You won’t usually pay a fee for covered tests.
Bloodwork and lab work can be an essential part of getting a medical diagnosis. Medicare Part B covers these tests providing a doctor certifies them as medically necessary. If you have Medicare Advantage, you may need to go to an in-network laboratory to pay the least amount. Keep reading to find out how much you’ll pay for these tests under Medicare.
Blood tests are very common. When you have routine checkups, your doctor may recommend blood tests to see how your body is working. Many blood tests don’t require any special preparations. For some, you may need to fast (not eat any food) for 8 to 12 hours before the test. Your doctor will let you know how to prepare for blood tests.
The procedure usually is quick and easy, although it may cause some short-term discomfort. Most people don’t have severe reactions to having blood drawn. Doctors can’t diagnose many diseases and medical problems with blood tests alone. Your doctor may consider other factors to confirm a diagnosis.
Keep reading to learn more about how Medicare covers blood work and lab tests.
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Medicare covers medically necessary lab tests from LabCorp and Quest. These are two large laboratories that provide outpatient laboratory testing.
However, several steps must be completed for Medicare to cover the test. First, a doctor must indicate a laboratory test is medically necessary. They do this by assigning a specific “diagnosis code” to the laboratory test. Covered tests can vary by national and local coverage rules. The rule means that Medicare may cover a test in Kansas that it does not in Indiana. Often, a doctor may check with the laboratory, such as LabCorp, to ensure Medicare covers the ordered test.
Sometimes, a laboratory may ask you to sign an Advance Beneficiary Notice of Noncoverage (ABN). This document states you will be responsible for paying costs if Medicare denies payment for the lab’s services.
Why would my doctor order a blood test?
Blood tests help doctors check for specific diseases and conditions. They also help check the function of your organs and show how well treatments are working.
Specifically, blood tests can help doctors:
- Evaluate how well organs — such as the kidneys, liver, thyroid, and heart — are working
- Diagnose diseases and conditions such as cancer, HIV/AIDS, diabetes, anemia and coronary heart disease
- Find out whether you have risk factors for heart disease
- Check whether medicines you’re taking are working
- Assess how well your blood is clotting
Medicare covers several laboratory tests, providing a doctor deems the test medically necessary. This means a doctor is screening or looking for a particular condition. This distinction is slightly different from if you were to ask a laboratory to test your blood yourself or if a doctor were to offer to run blood tests for you with no particular illness or diagnosis in mind.
What are some common blood tests and laboratory tests?
Blood tests and lab work are helpful to prevent disease, assess risk and diagnose illnesses. Medicare covers several types of tests as long as they are medically necessary. Here are a few common examples that your doctor may request during treatment and/or diagnosis.
- The Basic Metabolic Panel (BMP) measures different chemicals in the blood. These tests usually are done on the fluid (plasma) part of blood. The tests can give doctors information about your muscles (including the heart), bones and organs, such as the kidneys and liver.
- Blood Enzyme tests measure enzymes, which help control chemical reactions in your body. There are many blood enzyme tests. These tests are commonly used to check for the risk of a heart attack.
- A lipoprotein panel is a blood test that can help show whether you’re at risk for coronary heart disease (CHD). This test looks at substances in your blood that carry cholesterol.
Tissue Specimen Tests
- A tissue specimen test is a procedure to remove a piece of tissue or a sample of cells from your body so that it can be analyzed in a laboratory. If you’re experiencing certain signs and symptoms or if your doctor has identified an area of concern, you may undergo a tissue specimen test to determine whether you have cancer or some other condition.
- A urinalysis is a common test that can be used for several reasons. Your doctor may recommend a urinalysis as part of a routine medical exam, pre-surgery preparation or hospital admission. Your doctor may suggest a urinalysis if you’re experiencing abdominal pain or other urinary problems to help diagnose the cause of these symptoms. Suppose you’ve been diagnosed with a medical condition, such as kidney disease or a urinary tract disease. In that case, your doctor may recommend a urinalysis regularly to monitor your condition and treatment.
Medicare Part B may also cover some screening tests. The tests Medicare will cover depend upon your doctor saying the test is medically necessary as well as considerations for what Medicare will cover. Medicare issues National Coverage Determinations (NCDs), which are national guidelines for covered services. There are also guidelines called Local Coverage Determinations, where Medicare Administrative Contractors (MACs) issue additional considerations for coverage.
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Medicare pays for medically necessary blood work a doctor orders, as well as screening laboratory testing. Medicare may limit how often you can have these tests and the amount they pay. Examples include:
- diabetes screening twice a year
- fecal occult blood test once every 12 months
- hepatitis C screening one-time, plus annual screenings for high-risk individuals
- HIV screenings once a year
- prostate-specific antigen test (PSA) once a year
- sexually transmitted disease screenings annually
The frequency at which Medicare covers other tests depends upon your health and the specific test. If you require frequent blood testing, talk to your doctor or contact Medicare to find out more.
Providing the test is medically necessary and covered under Medicare, you will pay nothing for Medicare-approved services once you have met your Part B deductible.
If you have Medicare Advantage, you may need to choose an in-network laboratory to complete your testing. If you choose an out-of-network laboratory, you may be responsible for all or a portion of the costs. You may also be responsible for coinsurance or copayments related to your Medicare Advantage plan.
Does Medicare offer coverage for routine blood work?
Medicare covers “medically necessary” blood work. This means a doctor orders the test because they are trying to make a diagnosis. Routine blood work (such as a cholesterol check at an annual physical) is not covered. However, if a doctor thinks you may have high cholesterol due to lifestyle factors or medical history, the test may be “medically necessary.”
Medicare Advantage plans may offer expanded coverage for preventive testing, such as routine blood work. Your Explanation of Benefits document should explain what your policy covers concerning blood work.
Does Medicare Advantage cover blood tests?
Medicare requires that Medicare Advantage cover all the tests that Original Medicare does. However, Medicare Advantage plans can cover additional tests if they choose to offer those services to their subscribers.
What extra benefits and savings do you qualify for?
Medicare Part B will cover medically necessary laboratory tests, provided your doctor orders the test, and a Medicare-approved lab runs the test. Part B is the Medicare portion that covers medical services, including doctor’s visits.
However, if you have lab tests while you are an inpatient in the hospital, these charges may be covered under Medicare Part A. Medicare Part A is the Medicare portion that pays for inpatient care. Medicare Part A costs include coinsurance while you are in the hospital or an inpatient care facility.
What laboratory tests besides blood work does Medicare cover?
There are other laboratory tests besides blood tests that Medicare covers. Examples include urinalysis, which involves analyzing urine for the presence of substances such as blood, white blood cells or bacteria. Another example is a Pap smear, which may help detect abnormal or potentially cancerous cells in the cervix.