The Importance of Test Orders

The Importance of Test Orders

All diagnostic X-ray, laboratory, and other diagnostic tests must be ordered by the provider who is treating the patient. The Medicare Benefit Policy Manual defines an order as, “A communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary.” Per 42 CFR 410.32 the treating provider is “the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem.”
Tests not ordered by the treating provider are not reasonable and necessary, and will not be recognized as legitimate or covered by Medicare payers.

John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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