Medicare and Medical Necessity
Medicare will only pay for tests that are considered medically necessary. It will not pay for tests that are considered screening tests or research or experimental tests. In addition, a few tests also have a frequency limit that controls the number of tests that can be performed in a designated time period. If this limit is exceeded, the patient may be responsible for the charges.
PPatients with a test ordered in one of the above categories will be asked to sign an Advanced Beneficiary Notice, or ABN. This notice states the patient may be financially responsible for the test charges if Medicare denies them. The notice will show the name and charge for the tests so the patient can make an informed decision about them.
For more information, go to the Medicare Web site.