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            Florida Medicare Lab Test Coverage

Florida Medicare Laboratory Testing Services

 

Laboratory tests and services are covered when Medicare coverage criteria are met. Laboratory services (inpatient or outpatient) are covered in support of basic health care services to be used in the screening or detection of disease and determined to be reasonable and medically necessary. Medicare coverage for many tests, items and services also depends on where you live. The list below only includes tests, items and services that are covered no matter where you live. If your test, item or service isn’t listed, talk to your doctor or other health care provider about why you need certain tests, items or services. Ask if Medicare will cover them.

  • Abdominal aortic aneurysm screening
  • Acupuncture
  • Advance care planning
  • Air-fluidized beds & other support surfaces
  • Alcohol misuse screening & counseling
  • Ambulance services
  • Ambulatory surgical centers
  • Anesthesia
  • Artificial eyes & limbs
  • Bariatric surgery
  • Blood
  • Blood processing & handling
  • Blood sugar (glucose) monitors
  • Blood sugar (glucose) test strips
  • Bone mass measurement (bone density)
  • Braces (arm, leg, back, and neck)
  • Breast prostheses
  • Canes
  • Cardiac rehabilitation programs
  • Cardiovascular disease (behavioral therapy)
  • Cardiovascular disease screenings
  • Cataract surgery
  • Cervical & vaginal cancer screenings
  • Chemotherapy
  • Chiropractic services
  • Chronic care management services
  • Clinical research studies
  • Colorectal cancer screenings
  • Commode chairs
  • Concierge care
  • Continuous passive motion (CPM) machine
  • Cosmetic surgery
  • Crutches
  • Custodial care
  • Defibrillator (implantable automatic)
  • Dental services
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Diabetes supplies & services
  • Diagnostic tests
  • Dialysis (children)
  • Dialysis (kidney) services & supplies
  • Doctor & other health care provider services
  • Drugs
  • Durable medical equipment (DME) coverage
  • EKG (electrocardiogram) screening
  • Emergency department services
  • Enteral nutrition supplies & equipment (feeding pump)
  • Eye exams
  • Eyeglasses/contact lenses
  • Federally qualified health center services
  • Flu shots Foot care
  • Foot exam
  • Glaucoma tests
  • Glucose control solutions
  • Gym membership & fitness programs
  • Health education & wellness programs
  • Hearing & balance exams & hearing aids
  • Hepatitis B shots
  • Hepatitis C screening test
  • HIV screening
  • Home health services
  • Hospice & respite care
  • Hospital beds
  • Humidifiers
  • Hyperbaric oxygen (HBO) therapy
  • Incontinence supplies & adult diapers
  • Infusion pumps & supplies
  • Inpatient hospital care
  • Insulin
  • Kidney disease education
  • Kidney transplants (adults)
  • Kidney transplants (children)
  • Laboratory services (clinical)
  • Lancet devices & lancets
  • Long-term care
  • Long-term care hospitals
  • Lung cancer screening
  • Macular degeneration
  • Mammograms
  • Manual wheelchairs & power mobility devices
  • Massage therapy
  • Mental health care (inpatient)
  • Mental health care (outpatient)
  • Mental health care (partial hospitalization)
  • Nebulizers & nebulizer medications
  • Nursing home care
  • Nutrition therapy services (medical)
  • Obesity screening & counseling
  • Orthotics, artificial limbs, & eyes
  • Osteoporosis drugs for women
  • Ostomy supplies
  • Outpatient hospital services
  • Oxygen equipment & accessories
  • Pancreas transplants (adults)
  • Patient lifts
  • Physical therapy/occupational therapy/speech-language pathology services
  • Pneumococcal shots
  • Prescription drugs (outpatient)
  • Preventive & screening services
  • Preventive visit & yearly wellness exams
  • Prostate cancer screenings
  • Prosthetic devices
  • Pulmonary rehabilitation
  • Radiation therapy
  • Religious non-medical health care institution (RNHCI) items & services
  • Rural health clinic services
  • Second surgical opinions
  • Sexually transmitted infections (STI) screening & counseling
  • Shingles shot
  • Shots (vaccinations)Skilled nursing facility (SNF) care
  • Sleep apnea & Continuous Positive Airway Pressure (CPAP) devices & accessories
  • Sleep study
  • Smoking & tobacco use cessation (counseling to stop smoking or using tobacco products)
  • Substance-related disorders
  • Suction pumps
  • Supplies (you use at home)
  • Surgery (estimating costs)
  • Surgical dressing services
  • Tdap shot (tetanus, diphtheria, & pertussis shot)
  • Telehealth
  • Therapeutic shoes or inserts
  • Traction equipment
  • Transitional care management services
  • Transplants (adults)
  • Transportation
  • Travel (when you need health care outside the U.S.)
  • Urgently needed care
  • Walkers X-rays
  • Yearly eye exam

The following clinical diagnostic laboratory tests and services are covered when Medicare criteria are met.

  • Urine Culture,
  • Bacterial
  • Blood Count
  • Blood Glucose
  • Human Chorionic Gonadotropin (hCG)
  • HIV testing (Diagnosis)
  • HIV Testing (Prognosis and Monitoring)
  • HIV Testing (Prognosis Including Monitoring)
  • HIV Serology Testing
  • Pharmacogenomic Testing for Warfarin Response
  • Prothrombin Test PTT (Partial Thromboplastin Time)
  • Serum Iron studies
  • Sweat Test for Diagnosis of Cystic Fibrosis
  • Lipid Testing
  • Thyroid Testing
  • Hepatitis Panel
  • Breath Analysis test for lactose breath hydrogen to detect lactose malabsorption
  • Alpha-fetoprotein
  • Carcinoembryonic
  • Antigen
  • Collagen Cross Link
  • Digoxin Therapeutic Drug Assay
  • Gamma Glutamyl Transferase; see the NCD for Gamma Glutamyl Transferase (GGT) (190.32)
  • Glycated Hemoglobin/Glycated Protein
  • Laboratory Tests for CRD Patients
  • Lymphocyte Mitogen Response Assays
  • Histocompatability Testing

Other Laboratory Tests and Services

  • Home Blood Draws (Venipunctures) - Medically necessary home blood draws (venipunctures) by an independent laboratory technician are covered in the following circumstances:
    • Patient is confined to home or other place of residence used as his or his home when the specimen is a type which would require the skills of a laboratory technician (e.g., where a laboratory technician draws a blood specimen). Patient’s place of residence is an institution, only if:
      • The patient was confined to the facility; and
      • The facility did not have on duty personnel qualified to perform the service.
  • Human Tumor Stem Cell Drug Sensitivity Assay - Addresses two distinct types of assays: 1) Human Tumor stem cell drug sensitivity assays, and 2) Fluorescent Cytoprint Assays. Human tumor drug sensitivity assays are considered experimental, and therefore, not covered under Medicare at this time. The clinical application of the assay, based on testing in tumor microorganisms rather than in clones derived from single cells, is considered experimental, and therefore, not covered under Medicare at this time. See the NCD for Human Tumor Stem Cell Drug Sensitivity Assay.
  • Other Chemosensitivity and Chemoresistance Assays (CSRAs). Examples include but are not limited to:
    • Oncotech Extreme Drug Resistance (EDR) assay
    • DiSC (Differential staining cytotoxicity) assay
    • ATP (Adenosine Triphosphate) assay
    • MTT (Methyl Thiazolyl Tetrazolium) assay
    • HYDRA® (AntiCancer inc) assay
    • EVA-PCD (Rational Therapeutics) assay
    • ChemoFx®assay
  • Other laboratory tests and services that are not covered include, but are not limited to:
    • Obsolete and unreliable diagnostic tests
    • Breath tests for the following:
      • Lactulose breath-hydrogen for diagnosing small bowel bacterial overgrowth and measuring small bowel transit time.
      • CO2 for diagnosing bile acid malabsorption.
      • CO2 for diagnosing fat malabsorption.
    • Pre-marital blood testing admissions and athletic requirement for laboratory testing
    • Cytotoxic food tests
    • Heartsbreath test for heart transplant rejection
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