HELP!!! re: Reimbursement for Pre-labs for Medicare patients


True Blue
Cumming, GA
Best answers

Can someone please tell me what dx code(s) you use to get Medicare to pay for Pre-op lab work? From what I was told, Medicare does not consider pre-op lab work "medically necessary"...which I do not understand. I would really appreciate some help on this! Thank you! :eek:

1. You are going to have to be be more specific, as "lab work" encompasses many different kinds of tests. What CPT codes are you talking about?

2. Have you looked through Medicare's LCD's and NCD's to see if any of these codes have a published medical policy? If they do, the information you need will be in there.

3. By law, Medicare may only pay for services that are used to therapeutically treat the patient. Screening tests to see if a condition exists are usually not covered. (There are a few published exceptions to this, however). This doesn't mean they aren't medically necessary, it just means they are not a covered benefit.

4. Lastly, even if you supply the CPT codes, asking people who have never seen the patient to provide dx codes seems implausible. How could we know why a physician ordered a certain test?

I don't mean any of this to sound like I'm lecturing. I truly want to help. It's just that there are too many variables to give a definite answer, in my opinion.