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11/18/2021 2020 Part B Utilization Data Loaded
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Friday Compliance Briefing: Patient Ordered/Performed Testing

Editor's Welcome:

As more and more tests become available either as over-the-counter tests or as CLIA-waived tests, the question of coverage by Medicare and other payers frequently arises. This week we will discuss the coverage issues for both self-prescribed tests as well as patient performed tests. As always, feel free to forward any questions, concerns, or suggestions for future topics.

Sincerely,

Charles B. Root, Ph.D.

Self Prescribed Tests:

Self-prescribed tests are tests ordered or purchased over-the-counter by the patient. Nearly all payers, including Medicare, do not pay for self-prescribed tests. This includes both over-the-counter tests and tests performed by laboratories at a patient's request, so called direct access testing. Direct access testing is presently allowed in only 26 states and restricted to a limited list of tests in many cases.

Patient Performed Tests:

Patient performed ....

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