Recent CMS change doesn't affect how you bill screening tests

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article is for coders, billers, auditors, and compliance-focused clinicians who need to understand how Medicare guidance applies to diagnostic testing and screening services. It discusses a CMS memo, the distinction between test results and the reason a test was ordered, and the continued use of preventive medicine coding for screening-related services. The article also addresses common billing misconceptions, audit risk, and the difference between screening encounters and follow-up office visits.

Why This Topic Matters

Accurate reporting of screening and diagnostic services affects claim submission, coverage, compliance, and audit risk. The article helps readers recognize that recent CMS diagnostic-test guidance does not eliminate existing screening-test coding principles.

What You Will Learn

  • How CMS guidance distinguishes diagnostic testing from screening services
  • Why the reason for ordering a test matters in Medicare reporting
  • How screening encounters differ from follow-up visits for newly identified conditions
  • Why improper diagnosis selection can create compliance concerns

Who Should Read This

  • Medical coders
  • Medical billers
  • Compliance staff
  • Practice auditors
  • Physicians and office staff

Codes Discussed

Code Ranges Discussed


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