Medicare, Medicaid, or other federally funded programs will pay
only for tests that meet their coverage criteria and are reasonable
and necessary to treat or diagnose a patient. These programs do not
pay for tests for which the patient record does not support that
the tests were reasonable and necessary.
Medicare generally does not cover routine screening tests even if
the physician or individuals authorized by law to order tests
considers the tests appropriate for the patient.
42 U.S.C. Â§ 1395y(a)(1)(A) of the Federal Register
prohibits Medicare and Medicaid from reimbursing for items or
services which are not reasonable or necessary for the diagnosis or
treatment of illness or injury or to improve the functioning of a
malformed body member.
Laboratories are required to provide annual notice of these
restrictions to physicians and other individuals ordering
laboratory services. Below you will find electronic copies of those
AMA Recognized Organ/Disease Panels