Q&A: Hospital outpatient diagnostic services

February 5, 2018
Medicare Web

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.

Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.