Do you know if Labcorp accepts Medicare? this is one of the questions our readers ask a lot. Well, we´ve got you covered.
Labcorp operates one of the largest networks of clinical laboratories in the world, including a U.S. network of 36 primary labs and over 2,100 patient service centers in 48 states and territories.
They are known for providing a wealth of clinical research as well as test and screening results for thousands of patients yearly.
So, does Labcorp accept Medicare? Yes, Labcorp bills Medicare directly for its lab services. For testing done in the hospital, Labcorp bills Medicare Part A. For outpatient testing, Labcorp bills Medicare Part B or Medicare Advantage (Part C). In order to be covered by Medicare, the test must be deemed medically necessary.
This guide will help answer any questions about getting Medicare coverage for tests completed using Labcorp. Using Medicare coverage for your screening and testing will give you peace of mind and avoid unexpected bills.
Does Medicare cover lab tests and screenings?
There are 4 criteria that must be met before Medicare will cover lab tests and screenings:
- Your test must be ordered by a doctor
- The doctor ordering the test must accept Medicare.
- The test must be medically necessary.
- The testing facility must participate in Medicare.
Medicare has what they call “Limited Coverage Policies” (MLCPs) for certain lab tests. MLCPs must meet medical necessity criteria to be covered by Medicare.
Simply put, a doctor must prove there is a medical reason why he or she is ordering the test. Either the patient is showing symptoms of a condition or they have a family history of a condition.
For example, if you have a family history of Type 2 diabetes, and your doctor is concerned about your risk for developing Type 2 diabetes, they can order a lipid test to be processed by Labcorp.
The “medical necessity” is your risk level for diabetes. The doctor will write an order for the test along with the medical reason for Medicare coverage.
If there is no medical necessity for ordering the test, you can still get the test done. Medicare just won’t cover the cost.
Your doctor will have you sign an Advance Beneficiary Notice that states you will be responsible for paying for the test. Then Labcorp will bill you directly.
Read also: Does Quest Diagnostics Accept Medicare? (The Truth!)
How do Labcorp’s testing and billing process work?
It is easy to get testing completed using Labcorp.
- Your doctor will order a test (which must be deemed medically necessary to be covered by Medicare). The doctor will write a diagnosis code to go along with the test order to ensure coverage.
- The specimen or sample is collected, either in the doctor’s office or at a Labcorp Patient Service Center. Use this locator tool to find a Patient Service Center near you.
- A courier picks up the samples and transports them to a Labcorp primary lab. The lab processes your test and sends the results to your doctor for review. Once your doctor has reviewed your test results, you can access them via Labcorp’s patient portal.
- Once the test is fully processed and completed, Labcorp files the claim with either Medicare, private insurance, or bills you directly for the service.
Not every Labcorp patient service center location will offer every type of test. Each state also has different regulations for what tests can be covered by Medicare at testing facilities.
If you are not sure if your test location will be covered by Medicare for your specific test, you can call Labcorp at 1-800-845-6167 or call Medicare at 1-800-MEDICARE.
Read also: Does Costco Accept Medicare for Eyeglasses? (Medicaid – The Truth!)
What types of Medicare coverage does Labcorp accept?
Lab tests and screenings are done in the hospital and sent to Labcorp will be covered by Medicare Part A.
Lab tests and screenings are done in doctor’s offices or at Labcorp patient service centers will be covered by Medicare Part B or Medicare Advantage (Part C).
What is Medicare Part A?
Medicare Part A covers procedures, tests, and services performed in a hospital or skilled nursing facility.
What is Medicare Part B?
Medicare Part B covers medically necessary services and preventative services. For example, Part B will cover supplies and equipment needed to treat a disease, or early detection screenings to prevent a disease from getting worse.
What is Medicare Advantage (Part C)?
Medicare Advantage offers plans through private companies regulated by Medicare. These private health insurance companies must provide at least the same coverage as Medicare Part B.
Some popular companies that offer Medicare Advantage are:
- Anthem (most plans)
- Blue Cross Blue Shield (most plans)
If using one of these companies’ Medicare Advantage plans, your doctor and testing center must be in-network for your test to be covered by Medicare.
If unsure of whether your doctor or testing center are in-network, you can contact either your insurance provider, your doctor, or the testing center to confirm.
What types of tests can I get covered by Labcorp?
Labcorp offers thousands of types of lab tests and screenings. They cover testing for all types of conditions, including heart disease, asthma, allergies, COVID-19, men’s health, women’s health, cancers, digestive issues, and chronic diseases.
A few examples of what Labcorp offers:
- Blood tests and screenings that can help diagnose diabetes, hepatitis, heart disease, and other conditions.
- Urinalysis tests can help detect liver and kidney diseases and conditions.
- Specimen tests such as fecal occult blood screening can detect colon cancer.
How many times a year can I get tested?
Most tests will only be covered by Medicare once per year. This is to prevent abuse of the health care system and over-burdening the system with unnecessary testing.
Some tests are covered multiple times a year, while others are only covered once every 2 years or once every 5 years.
After that number is exceeded, the patient will have to pay for the test out-of-pocket. Here are some examples:
- Bone mass measurements to screen for osteoporosis: covered every 2 years.
- Blood testing for diabetes: covered twice a year.
- Screening for heart disease: covered every 5 years.
- Cervical cancer screening: covered every year.
How do I make sure I won’t pay out-of-pocket for my test?
For the most part, if you have paid off your deductible, Medicare will cover the cost of the test performed at Labcorp and you won’t have to pay anything out of pocket. Here is a final checklist to make sure you don’t get any surprise bills:
- Have a doctor order your test.
- Make sure the doctor provides a medically necessary reason for your test.
- Make sure you haven’t exceeded the number of times you can get the test per year.
- Double-check with your doctor, Medicare, and the Labcorp facility to make sure they participate in Medicare and that the test is covered by Medicare.
- Make sure your Medicare plan’s deductible has been met.
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