Imagine your physician orders a vitamin D test because you’re experiencing symptoms that could indicate a deficiency. If the claim is submitted using a diagnosis code that doesn’t support Medicare’s coverage policy for that test, Medicare may deny payment even though your physician believed the test was medically appropriate.
In many cases, the issue is not the laboratory itself or the test that was ordered. It is the diagnosis code attached to the claim. Medicare generally pays for diagnostic laboratory tests that are considered medically necessary, and the diagnosis code helps explain why the test was needed. If that code does not support Medicare’s coverage requirements, the claim may be denied even when the test itself is appropriate. Here is what Medicare recipients need to know about lab coverage and how it could impact what you owe.
