Lab Test Order Requirements
As the physician, practitioner, or non-physician practitioner who’s treating the patient (and who provides consultation or treats them for a specific medical problem and uses the results to manage their specific medical problem), you must order the lab tests. Tests you haven’t ordered for treating the patient aren’t reasonable and necessary.
Document medical necessity in the patient’s medical record when ordering the service.
The entity submitting the claim must keep documentation from you, which includes:
- Documentation of the order for the service billed (including information that allows us to find and contact the ordering provider)
- Documentation showing correct order processing and claim submission
- Diagnostic or other medical information you provided to the lab (including any ICD-10-CM code or narrative description)
Diagnostic lab test orders require 1 of these:
- A signed order or signed prescription listing the specific test
- An unsigned order or unsigned lab prescription listing specific tests done AND the requirements in criterion 3
- An authenticated medical record that supports your intent to order specific tests
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Medicare Program Integrity Manual, Chapter 6 (PDF), section 6.9.1 has more information on order requirements. |
You can deliver an order through:
- A written and signed document that’s hand-delivered, mailed, or faxed to the testing facility. We don’t need your signature on orders for clinical diagnostic tests paid based on the clinical lab fee schedule, based on the physician fee schedule, or for physician pathology services.
- A call from you or your office to the testing facility.
- An email from you or your office to the testing facility.
Medicare Benefit Policy Manual, Chapter 15 (PDF), section 80.6 has more information.
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| If you communicate the order by phone, you or your office staff and the testing facility must document the call in the respective patient’s medical record. We don’t require a signed order, but you must document in the medical record your intent to do the test. |
Complying with Medical Record Documentation Requirements (PDF) and Complying with Medicare Signature Requirements (PDF) provide more guidance.
Medical record documentation should include enough information to show the ordered or provided tests are reasonable and necessary, per 42 CFR 410.32.
Signature and date stamps aren’t allowed, with a few exceptions (PDF).