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MUSC Intranet

  Guidelines for Medical Necessity For Limited Coverage Tests





Patient Care Provider Responsibilliites

MUSC Lab Services Responsibilities

What is ABN

Download ABN

Price List


Patient Care Provider Responsibilities

An Advance Beneficiary Notice (ABN) must be obtained when it is determined that the laboratory testing / service(s) is likely to not be covered by Medicare. It is necessary to explain to the patient before the start of care that Medicare is likely to deny payment for the laboratory testing / service(s) and the reasons for non-coverage must be indicated. The ABN is used for notifying the patient of non-coverage.

Under current Medicare law, MUSC Laboratory Services is allowed to bill the patient for claims that are denied by Medicare if the ABN is completed prior to the time of specimen collection. Available on this webpage is the current price list for patient billing, should Medicare deny payment.

Points to Remember

  • The ABN must be submitted with every laboratory requisition, electronic request or Standing Order Form for limited coverage tests when there is not a diagnosis / ICD-9 code appropriate to justify medical necessity for the test.
  • The diagnosis / ICD-9 code must be consistent with the documentation in the patient's chart.
  • The diagnosis / ICD-9 code must be clinically relevant for the tests ordered and coded to the highest degree of specificity.
  • Routine testing or screening (e.g., V70.0 or V72.6) is not a covered service. Please complete an ABN for all routine screening tests ordered.
  • The ABN must be signed before a specimen is drawn.





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