Medicare Blog

how to find out if medicare covers a diagnostic test

by Antwan Rosenbaum Published 2 years ago Updated 1 year ago
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What is Medicare Part B?

Diagnostic non-laboratory tests. Medicare Part B (Medical Insurance) Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. covers these tests (like CT scans, MRIs, EKGs, X-rays, and PET scans) when your doctor or other health care provider orders them as part of treating a medical problem.

How much does Medicare pay for diagnostic tests?

You pay 20% of the Medicare-approved amount of covered diagnostic non-laboratory tests done in your doctor’s office or in an independent testing facility, and the Part B Deductible applies. You pay a Copayment for diagnostic non-laboratory tests done in a hospital outpatient setting.

What is copayment in healthcare?

A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription drug.

Can A Beneficiary Get Extra Coverage?

There are additional ways that a beneficiary can cut their out-of-pocket costs for Medicare-covered services like diagnostic tests. The two most common options are Medicare Supplement plans or Medicare Part C (Medicare Advantage) plans.

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What does Medicare Part B cover?

Part B also covers durable medical equipment, home health care, and some preventive services.

Does Medicare cover tests?

Medicare coverage for many tests, items, and services depends on where you live . This list includes tests, items, and services (covered and non-covered) if coverage is the same no matter where you live.

Does Medicare Cover LabCorp or Quest?

Medicare covers medically necessary lab tests from LabCorp and Quest. These are two large laboratories that provide outpatient laboratory testing.

What Screening Laboratory Tests Does Medicare Cover?

Medicare covers several laboratory tests, providing a doctor deems the test medically necessary. This means a doctor is screening or looking for a particular condition.

How Often Does Medicare Pay for Blood Work?

Medicare pays for medically necessary blood work a doctor orders, as well as screening laboratory testing. Medicare may limit how often you can have these tests and the amount they pay. Examples include:

How Much Does Medicare Pay for Blood Work?

Providing the test is medically necessary and covered under Medicare, you will pay nothing for Medicare-approved services once you have met your Part B deductible. For 2022, the Part B deductible is $233.

Does Medicare Part B Cover Lab Tests?

Medicare Part B will cover medically necessary laboratory tests, provided your doctor orders the test, and a Medicare-approved lab runs the test. Part B is the Medicare portion that covers medical services, including doctor’s visits.

I. Which Tests Does Medicare Cover?

Medicare has two parts: Part A and Part B. In general, Part A covers inpatient hospital care, skilled nursing facility care, nursing home care that is not custodial or long-term, hospice care, and home health care. Part B covers medically necessary services to diagnose or treat medical conditions; and preventive services.

II. How Medicare Covers Testing

Medicare covers many tests and services based on where you live, and the tests we list in this guide are covered no matter where you live. There are some limitations to tests, such as “once in a lifetime” for an abdominal aortic aneurysm screening or every 12 months for mammogram screenings.

III. Featured Expert

This expert contributed information and recommendations for this guide.

Ask a Laboratory Scientist

This form enables patients to ask specific questions about lab tests. Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, American Society for Clinical Laboratory Science.

What is the purpose of blood test?

Blood tests are an important diagnostic tool doctors use to screen for risk factors and monitor health conditions. A blood test is generally a simple procedure to measure how your body is functioning and find any early warning signs. Medicare covers many types of blood tests. Trusted Source.

What is Medicare Part A?

Medicare Part A offers coverage for medically necessary blood tests. Tests can be ordered by a physician for inpatient hospital, skilled nursing, hospice, home health, and other related covered services. Medicare Part B covers outpatient blood tests ordered by a physician with a medically necessary diagnosis based on Medicare coverage guidelines.

How much is Medicare Part B 2021?

You have to meet your annual deductible for this coverage as well. In 2021, the deductible is $203 for most people. Remember, you also have to pay your monthly Part B premium, which is $148.50 in 2021 for most beneficiaries.

How often does Medicare cover mammograms?

once a year if you meet criteria. *Medicare covers diagnostic mammograms more often if your doctor orders them. You are responsible for the 20 percent coinsurance cost. Other nonlaboratory diagnostic screenings Medicare covers include X-rays, PET scans, MRI, EKG, and CT scans.

Does Medicare cover blood tests?

Medicare covers many types of common blood tests needed to diagnose and manage health conditions as long as they are medically necessary. Here are a few final tips to consider:

Does Medicare cover 20 percent coinsurance?

You have to pay your 20 percent coinsurance as well as your deductible and any copays. Remember to go to providers that accept assignment to avoid charges Medicare won’t cover. Helpful links and tools. Medicare offers a tool you can use to check which tests are covered.

Does Medicare cover ABN?

Medicare offers a tool you can use to check which tests are covered. You can also go here to look through the list of covered tests from Medicare. You can look through lists of codes and items Medicare does not cover. Before signing an ABN, ask about the cost of the test and shop around.

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