Clinical Laboratory Reimbursement (Medicare, Medicaid, and Managed Care)

Summary

This practice note covers clinical laboratory reimbursement under Medicare fee-for-service (Part B), Medicaid fee-for-service, and managed care arrangements, including Medicare Advantage, Medicaid managed care, and commercial plans. It addresses how these payers approach coverage, medical necessity, and documentation; where laboratories commonly encounter reimbursement and compliance risk; and what laboratories should do when a billing question or audit request arises.