Medicare does not pay for routine laboratory testing, and may not pay for tests that are performed too frequently. Medicare and other insurance carriers may not pay for tests that are considered investigational.
Medicare will only pay for services that it determines to be "reasonable and necessary" under section 1862 (a)(1) of the Medicare law. If Medicare determines that a particular service, although it would otherwise be covered, is not "reasonable and necessary" under Medicare program standards, Medicare will deny payment for that service. Specifically, Medicare will deny payment for a Screening Pap Smear if you have had one during the last two years.
In these instances the Medicare patient must be informed Medicare is likely to deny payment. And the Medicare patient must be asked to sign an Advance Beneficiary Notice agreeing to be personally and fully responsible for payment for the indicated laboratory tests.
You may click on the following link to receive the most current information regarding Medicare Medical Necessity Policies.WPS Medicare
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