Medicare

SpectraCell accepts Medicare assignment. Most test components are reimbursable when ordered for diagnostic purposes. There are test components that are not covered by Medicare or are limited by frequency and/or condition. These components are in orange and marked “Patient Bill” on the test requisition form. If these orange tests are ordered, a signed “Advanced Beneficiary Notice” (ABN) must be attached to the requisition form. The patient will be responsible for and will be billed for those “non-covered” components if they are ordered.

 

Under Section 1862(a)(1) of the Social Security Act, Medicare limits coverage for services that it deems to be "reasonable and medically necessary" for the diagnosis or treatment of illness or injury. The diagnosis must be present in order for the procedure to be paid. In addition, the procedure must be medically reasonable and representative of the patient's condition.

Section 1862(a)(1) also excludes routine screening from the Medicare program. Screening, as defined by Medicare, is an examination and/or diagnostic test that is performed in the absence of signs or symptoms.

SpectraCell's Medicare test request form includes an "Advance Beneficiary Notice" (ABN). Healthcare providers' Medicare patients must read and sign this form. Signing the form serves as an acknowledgement by the patient that SpectraCell's tests are likely to be non-reimbursable services by Medicare and that the patient agrees to assume financial responsibility for non-covered tests and tests deemed by Medicare to be for screening purposes only. The patient's signature on this form will enable SpectraCell to bill Medicare patients directly for non-covered micronutrient test components and/or cardiovascular risk assessment tests.