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statutory exclusion labs


Best answers
So, I have been doing some research on labs and found most labs' status indicator is X (statutory exclusion-these codes represent an item or service that is not in the statutory definition of "physicians services" for the fee schedule payment purposes. No RVU's or payment amounts are shown for these codes and no payment may be made under the physician fee schedule.)

From what I understand an ABN may be voluntarily furnished to the patient, we are not required to bill Medicare for these services, and Medicare should deny and payment will be patient's resposibility.

Do I understand correctly?

By the way we are not a lab.


True Blue
Local Chapter Officer
Swainsboro/Statesboro, GA
Best answers
Clinical Lab Fee Schedule

Could it be that the labs are paid under the Clinical Lab Fee Schedule and not the Physician Fee Schedule??? Do you have some examples of the CPT codes you found as excluded?

In general, an ABN is required when the provider has reason to believe the service about to be rendered may not be payable by Medicare, usually based on the reason for the service. Services that are NOT COVERED by Medicare do not need an ABN. The ABN is for services normally covered but for some reason (diagnosis, time restrictions on certain procedures), the service may not be covered in this situation.