Does Medicare Cover Lab Work and Blood Tests?
Key Takeaways
- Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. pays for blood work and lab tests.
- A doctor must certify the tests are medically necessary.
- Medicare blood test coverage may vary by geographic location.
- You won’t usually pay a fee for covered tests.
A simple blood test can help to diagnose medical issues from high cholesterol to diabetes to autoimmune disorders. As part of a routine checkup, your doctor will likely to recommend blood tests to see how your body is working. The procedure is usually quick and easy, although it may cause some short-term discomfort; most people don’t have severe reactions to having blood drawn.
Original Medicare, the federally administered health insurance program for people who are over 65 or have certain disabilities, does not pay for routine annual physical exams. However, Medicare Part B, the part of Medicare that provides medical insurance, does cover blood tests, screenings, and other types of lab work when a doctor certifies them as medically necessary. In fact, Medicare pays for tens of millions of blood tests per year — about 38.7 million in 2022, according to data from the U.S. Department of Health and Human Services.
If you have a Medicare Advantage plan, which substitutes for Original Medicare (Medicare Parts A and B), you will be covered for at least the same testing as you would on Original Medicare — and possibly more, depending on the plan you choose. You may need to go to a lab that’s in your plan’s provider network to take full advantage of this coverage.
Keep reading to learn more about how Medicare covers blood work and lab tests.
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Does Medicare Cover LabCorp or Quest?
Medicare covers medically necessary lab tests from huge national and international organizations that provide outpatient laboratory testing like LabCorp and Quest Diagnostics, as well as from smaller labs.
However, there are a few steps involved in using Medicare blood test coverage or coverage for other lab tests. First, a doctor’s office must indicate the test is medically necessary. They assign a diagnosis code to indicate the reason for the laboratory test.
What tests are covered by Medicare and how often you can receive them may vary based on national and local coverage rules. These rules can mean that Medicare may cover a test in Kansas that it would 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 many diseases and conditions. They also help check the function of your organs and show how well treatments are working.
Specifically, blood tests 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
What Screening Laboratory Tests Does Medicare Cover?
Medicare covers laboratory tests that a doctor deems medically necessary, which means a doctor is screening or looking for a particular condition.
Your doctor will let you know how to prepare for blood tests and other lab tests. Many tests don’t require any special preparations, but for some, you may need to fast (not eat any food) for 8 to 12 hours before the test.
What Are Some Common Blood Tests and Laboratory Tests?
Blood tests and lab work are helpful to assess health risks and diagnose illnesses. Here are a few common examples of tests that your doctor may request as part of diagnosis or treatment.
Blood Tests
- The basic metabolic panel (BMP) measures several chemicals in the blood, including your blood sugar, calcium, electrolytes (like sodium and potassium), and certain waste products that should be removed. The tests can give doctors information about how your muscles (including the heart), bones, and organs, such as the kidneys and liver, are functioning.
- Blood enzyme tests measure the enzymes that control chemical reactions in your body. These tests are commonly used to check for the risk of a heart attack.
- A lipoprotein panel is a blood test that can show whether you’re at risk for coronary heart disease (CHD). This test looks at substances in your blood that carry cholesterol.
- A tissue specimen test is a procedure to remove a piece of tissue or a sample of cells from your body so it can be analyzed in a laboratory. If you’re experiencing symptoms or 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.
- You may receive urinalysis, a test of your urine, 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. If you’ve been diagnosed with a medical condition such as kidney disease or a urinary tract disease, you may go through regular urinalysis to monitor your condition and treatment.
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How Often Does Medicare Pay for Blood Work?
Medicare pays for the medically necessary blood work a doctor orders, as well as screenings. Medicare may limit how often you can have these tests and the amount they pay. Examples include:
- Twice a year diabetes screening
- Annual fecal occult blood test
- One-time hepatitis C screening, plus annual screenings for high-risk individuals
- Annual HIV screening
- Annual prostate-specific antigen test (PSA)
- Annual sexually transmitted infection (STI) screening
How Much Does Medicare Pay for Blood Work?
Provided the test is medically necessary, you will pay nothing for Medicare-approved lab test 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 fully covers only 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 considered medically necessary.
Does Medicare Advantage Cover Blood Tests?
Medicare Advantage plans must cover all the tests that Original Medicare does. However, these plans from private insurers can cover additional tests.
Medicare Advantage plans may offer expanded coverage for preventive testing, including routine blood work. If you’re on a Medicare Advantage plan and not sure about your coverage for physical exams and routine lab tests, check with your insurance carrier for details.
Does Medicare Part B Cover Lab Tests?
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 detect abnormal or potentially cancerous cells in the cervix.
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Sources
- Medicare Medical Necessity. Labcorp.com
- Medicare coverage & coding guides. Questdiagnostics.com
- Blood Tests. NIH.gov
- Biopsy: Types of biopsy procedures used to diagnose cancer. Mayoclinic.org
- Urinalysis. Mayoclinic.org
- Diagnostic laboratory tests. Medicare.gov
- Clinical laboratory tests. Medicare.gov
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