Deductible and Coinsurance Application for Laboratory Tests (Rev. 2581, 04-01-13)

by  Jared Staheli
July 9th, 2015

Neither the annual cash deductible nor the 20 percent coinsurance apply to:

• Clinical laboratory tests performed by a physician, laboratory, or other entity paid on an assigned basis;

• Specimen collection fees; or

• Travel allowance related to laboratory tests (e.g., collecting specimen).

Codes on the physician fee schedule are generally subject to the Part B deductible and coinsurance, although exceptions may be noted for a given code in the MPFS or through formal Medicare instructions such as temporary instructions and requirements for specific services noted in this manual.

Any laboratory code paid at reasonable charge is subject to the Part B deductible and coinsurance, unless otherwise specified in the description of coverage and payment rules.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 16