Laboratory Charge Capture & Compliance
Direct Line: 585.922.1167
Manager: Shirley Slater - 585.922.1164
Medical Necessity for Ordering Lab Tests
Any test ordered through the Department of Pathology and Laboratory Medicine must be accompanied by signs and symptoms or a diagnosis indicating the reason for ordering each test. Requisitions must be signed by a provider.
Tips for Requisition Completion
- A diagnosis or signs and symptoms must be placed on the requisition relating to each test ordered. Provide all codes or narrative data that are appropriate for the tests ordered. ALL insurances require diagnostic information on claims for laboratory services.
- ICD-10 codes must contain all digits as specified in the current ICD-10 book, and be as specific as possible.
- R/O, screening, up or down arrows, +, -, or possible before a narrative diagnosis are not acceptable.
- Medicare does not pay for laboratory testing for screening purposes except as specifically allowed by regulation. Appropriate screening diagnoses must be provided when allowed screening tests are requested.
Thank you for your cooperation and assistance in helping us provide quality laboratory testing to your patients.
Medical Necessity Policies (National or Local Coverage Decisions)
Medicare has established medical necessity criteria for a variety of tests through local or national coverage decisions. This medical necessity criteria may also be followed by private insurers who offer HMO or managed care coverage to medicare-eligible individuals.
If laboratory tests are requested without covered diagnoses on the requisition, the patient will be asked to sign an Advance Beneficiary Notice (ABN), or your office will be contacted for additional diagnostic information.
Click here for the current information on Medicare coverage decisions.