Q&A: Hospital outpatient diagnostic services
Q. How does Medicare cover hospital outpatient diagnostic services furnished in a provider-based department?
A. 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. As detailed below, 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, including:
- Cardiovascular and diabetes disease screening tests
- Ultrasound screening for abdominal aortic aneurysm
- Bone mass measurement
- Screening and diagnostic mammography
- Colorectal cancer screening tests
- Prostate cancer screening tests
- Screening pelvic examinations
For more information, see Provider-Based Entities: A Guide to Regulatory and Billing Compliance, Second Edition.