Medicare_Carriers_Manual / 15021 / 15021

Why This Topic Matters

Understanding this guidance helps support proper test ordering, documentation, and communication processes for diagnostic services under Medicare policy.

Article Sections

1. Ordering Diagnostic Tests

   Defines the key participants and general requirements related to ordering diagnostic services. It also discusses forms of communication and the relationship between the order and the testing facility.

2. Treating Physician/Practitioner Ordering of Diagnostic Tests

   Describes the general responsibility of the treating clinician for ordering diagnostic tests and the limits on changing or adding tests at the testing facility.

3. Different Diagnostic Test

   Addresses situations in which a different diagnostic service may be considered at the testing facility when the ordered test is thought to be inappropriate or suboptimal.

4. Additional Diagnostic Test Exception

   Covers an exception involving additional testing when the treating clinician cannot be reached and documentation supports the need for further testing.

5. Interpreting Physician Exception

   Discusses circumstances in which the interpreting physician may make limited adjustments to a test without prior notice, including test design and certain order issues.

6. Surgical/Cytopathology Exception

   Explains an exception for pathology services when additional laboratory work may be needed to complete evaluation and reporting.