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.
Can your primary care physician perform blood work in his office? If not who would I go to in Lake Mary, FL to do the bloodwork?
In preparation for knee surgery my doctor ordered outpatiient lab work which included a prp and a ptp (blood clotting time test) neither was covered by medicare or my insurance. Can you tell me why.
If I am recovering at home with a Home Health Care Agency and my physician orders lab work, is my insurance (Medicare) billed for the laboroatory processing or does the Home Care Agency become responsible for these fees?
Hi, someone knows how much a blood test to calculate inr costs approximately in sydney?
I have several doctors and they ask for separate blood tests for different conditions. Sometimes these tests come within a couple months of each other. Does medicare cover both tests?
I got several blood tests at UMC in Tucson. Sign says all fee paid up front. I paid the fees of about $55. A few weeks late I get a bill for $106 for doctors having to read the results. I have had many many tests there and never goy this charge. My doctor can resd them fine himself. I can read then fine my self as I always get my own copy fro UMC. I never authorized these charges, were never charged these charges, and nowhere even in small print does it say anything about this. I have no insurance so they gave me a fair price on the blood tests. But, I'm enreged over this new bill. DO I HAVE TO PAY THIS?
I have epilepsy and am not sure which of these it falls under
What is Medicare's rule on lab work for an 85 year old widow, not driving, able to live alone but on coumadin---as in how often can blood be drawn to maintain the correct numbers associated with clotting?
I'm 65 and have Medicare and Medicaid in Portland, Oregon.Why I need pay at first time for diabetics blood test-$ 42,50 and for Vitamin D-$ 94,50.? What wrong with my 2 Insurances? I'm a low-income person with high blood pressure and high cholesterol.