What It Is
Blood testing by a laboratory
What's Covered
The basic Medicare rule regarding blood tests is that Medicare covers the drawing of blood and laboratory testing, reasonably ordered by a physician or other appropriate practitioner, to diagnose or monitor a particular disease or condition. But Medicare does not cover routine blood tests ordered as part of a general physical examination or screening.
If a medically reasonable diagnostic blood test is performed on an inpatient in a hospital or skilled nursing or rehabilitation facility, Medicare Part A covers it. If the test is performed on an outpatient, in any setting, Medicare Part B covers it.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for blood tests, contact the plan directly.
What Medicare Pays
If Medicare Part A covers a blood test for an inpatient, the cost of the testing becomes part of the overall covered hospital charges. Medicare Part A payment for inpatient hospital charges is subject to a deductible and to daily co-payments for stays of 60 days or more.
If Medicare Part B covers an outpatient blood test, the amount it pays depends on where the patient gets the testing. If a patient has a covered blood test at a Medicare-certified independent laboratory, Medicare Part B pays the full cost. If the testing is performed by a hospital outpatient department, Medicare pays the full cost except for a patient co-payment. The amount of the co-payment depends on the geographic location of the hospital and the type and amount of testing done.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
