Does Medicare Cover Lab Work?
Medical professionals and health care providers commonly use laboratory tests to diagnose diseases or medical conditions, identify health changes, plan and evaluate treatment options, and monitor disease progression. Without these valuable diagnostic tools, your health could be at serious risk, so it’s fortunate that Medicare covers many of them.
How Medicare Part A covers lab work
Medicare covers many different types of clinical diagnostic laboratory tests if your physician orders them because they are medically necessary to diagnose, rule out, or treat a medical condition.
Original Medicare Part A (hospital insurance) covers medically necessary lab work that a health care provider orders while you’re an inpatient in a hospital, skilled nursing facility, or hospice. As an inpatient, you are responsible for paying the Part A deductible for the current benefit period, but your lab work is included in your Part A coverage.
How Medicare Part B covers lab work
Original Medicare Part B (medical insurance) covers medically necessary clinical diagnostic lab tests you have as an outpatient if your Medicare-affiliated physician orders them. Medicare Part B typically covers 100 percent of the cost for Medicare-approved clinical diagnostic laboratory work including:
- A wide range of blood tests
- Urinalysis for various conditions
- Tests of tissue samples for various conditions
Part B also covers the lab work for screenings of the following health conditions:
- Diabetes
- Heart disease
- HIV
- Hepatitis B and C
- Colorectal cancer
- Prostate cancer
- Sexually transmitted diseases
- Breast cancer (mammograms)
- Cervical cancer
- Osteoporosis
- Abdominal aortic aneurysm
- Lung cancer
In most cases, Medicare covers one annual or biannual screening for each of the health conditions listed above. However, you may be eligible for more per year if your physician believes you are at a higher risk of illness.
Medicare Part B covers your lab work if you get it at any of the following places that accept Medicare assignment:
- A physician’s office
- Hospital labs
- Independent labs
- Skilled nursing facility labs
- Mental health facilities and other types of medical institution labs
If you have coverage through a Medicare Advantage (Part C) plan, your provider must cover the same lab work as Original Medicare Parts A and B do. However, you may be required to use laboratories or other medical facilities and providers that are included in your plan’s network of approved providers. You may also need to pay a coinsurance amount depending on the type of Part C plan you have.
How much does lab work cost without Medicare insurance coverage?
Because there’s such a wide range of lab tests and places to have them done, it’s difficult to determine a cost range for lab work in general. Here’s a look at the national average cost for some of the most common laboratory tests in the United States today:
- A complete blood count (CBC) exam costs between $45 and $125.
- Routine blood work costs between $315 and $650.
- A total lipid panel (cholesterol, LDL, HDL, triglycerides, etc.) costs between $130 and $200.
- An A1C (for diabetes diagnoses) costs between $50 and $150.
- A herpes test costs between $40 and $100.
- An STD panel (sexually transmitted diseases) costs between $520 and $800.
- Basic urinalyses cost between $40 and $120.
If your physician orders clinical diagnostic laboratory tests that aren’t covered by Medicare, you may have to pay for them out-of-pocket. But before you do, ask the ordering physician or the laboratory whether you have other payment options. In some instances, they may offer a discount or even waive the charge.