Q&A: Coverage of outpatient diagnostic services
Q. How should diagnostic services be covered in hospital outpatient departments?
A. Hospitals frequently furnish diagnostic services to Medicare beneficiaries in provider-based departments, in addition to therapeutic services. For example, hospitals may operate clinical laboratories, radiology departments, and various other diagnostic centers (e.g., stress testing, neurodiagnostics, sleep laboratories) in outpatient departments.
Similar to therapeutic services, Medicare has specific coverage requirements for diagnostic services furnished in hospital outpatient departments. The general coverage rules are similar, but not identical, to the coverage rules discussed above for therapeutic services. The general coverage rule mandates that diagnostic services are furnished:
- Directly or under arrangements by the hospital
- Under the order of a physician or NPP
- Under the appropriate level of supervision
Some diagnostic services are not covered under the general diagnostic coverage requirements and have their own coverage requirements.
For more information, see Provider-Based Entities: A Guide to Regulatory and Billing Compliance, Second Edition.
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