Orders for Diagnostic Tests

A 'diagnostic test' includes all diagnostic X-ray tests, all diagnostic laboratory tests, and other diagnostic

A 'diagnostic test' includes all diagnostic X-ray tests, all diagnostic laboratory tests, and other diagnostic tests furnished to a beneficiary. Whether the total diagnostic test is billed or separate components (professional (26) or technical (TC), documentation must support the order of the diagnostic test or components. This includes services where there is a distinct CPT or HPCPS code outlining the total, professional or technical components or if components of the diagnostic test are billed represented by the TC or 26 modifiers.

An order is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary. An order may be delivered via the following forms of communication:

  • A written document signed by the treating physician/practitioner, which is hand-delivered, mailed, or faxed to the testing facility; NOTE: No signature is required on orders for clinical diagnostic tests paid on the basis of the clinical laboratory fee schedule, the physician fee schedule, or for physician pathology services
  • A telephone call by the treating physician/practitioner or his/her office to the testing facility and
  • An electronic mail by the treating physician/practitioner or his/her office to the testing facility

If the order is communicated via telephone, both the treating physician/practitioner or his/her office, and the testing facility must document the telephone call in their respective copies of the beneficiary’s medical records. While a physician order is not required to be signed, the physician must clearly document, in the medical record, his or her intent that the test be performed and the medical record must be authenticated by signature of the treating provider. See Medicare Benefit Policy Manual (PDF, 1.33 MB) Pub 100-02, Chapter 15, section 80.6.1 on the CMS website.