Does Medicare pay for Lyme disease testing?

Aelightning asked...

Does Medicare pay for Lymne Disease testing?

Expert Answer

Medicare Part B covers any medically reasonable testing, including laboratory work, to diagnose and treat any disease. Lyme disease is no different from any other disease. The trouble with Lyme disease is that it is often very difficult to diagnose (not to mention hard to treat effectively). So, the question regarding Medicare coverage is not whether there is Medicare Part B coverage for Lyme disease testing but how much testing Medicare will cover, and which specific tests. In other words, for any specific test to determine whether some has Lyme disease, is that test "medically reasonable" for that patient (in Medicare's judgment).

Whether Medicare Part B covers a specific diagnostic test often comes down to the physician who prescribes the test. If the doctor does a good job of explaining to Medicare why the test is medically reasonable, Medicare Part B is more likely to cover that test. This means not only matching the test to the disease the doctor is looking for but also describing the patient's medical history (symptoms, other test results, etc.) well enough for Medicare to agree that the proposed diagnostic test makes good medical sense for that patient, at that time.

If you want to increase the odds that Medicare Part B will cover a specific test for Lyme disease, discuss the Medicare coverage question with your doctor before the doctor orders the test. The doctor can submit a coverage request to Medicare Part B ahead of your taking the test. If Medicare initially denies the request, or asks that the doctor take other steps before approving the test, your doctor can provide Medicare with additional information, or can go through other steps to increase the odds that eventually Medicare will cover the testing.