Why the lab should bill Medicare first — and what to say if they won't

Medicare-participating labs are required to bill Medicare first for tests covered by Part B, full stop. If they refuse to bill Medicare and want cash up front, they’re either:

• Not actually a Medicare-participating provider (worth asking),
• Trying to skip the appeal process if the claim gets denied, or
• Confused about how the rules work.

You can verify a lab’s Medicare participation status directly at Medicare.gov Care Compare.

The phone script

“Hi, I’m a Medicare beneficiary. I have an order for [test]. I’d like you to bill Medicare directly for this test. Is that something you can do?”

If they say no, the next call is to a different lab. Use Find a Lab to see what’s nearby and call ahead before you drive.

Sources

1. CMS — Medicare Claims Processing Manual
2. Medicare.gov — Care Compare (verify provider participation)