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Medicare Billing

The following documents are required to bill Medicare.  All required items must be received prior to test initiation.

 Copy of patient's Medicare card, front and back

 Letter of medical necessity from referring physician

 If 18 or older, copy of driver's license or photo ID

 Physician referral or prescription for testing

 Signed Medicare Advanced Beneficiary Notice (Download instructions to this form)

A note about the new CPT codes for 2013:
As many of our tests for rare diseases will be using the unlisted code (81479), we anticipate an increase in denials of coverage.  Verification of coverage of the test codes is required, and patients should be informed of the possibility of Medicare denials.  The common reasons for a Medicare denial are:
     - the test is not medically necessary
     - the test is not considered a covered benefit

Links to Forms

Medicare Advanced Beneficiary Notice (ABN)  /  ABN Instructions 

Sample letter of medical necessity
Checklist for creating a letter of medical necessity