The OIG understands that the physician practice should be able to order tests, including screening tests that they believe are appropriate for treating their patients. With that said, Medicare will only pay for services that meet the Medicare definition of reasonable and necessary.

Question

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Medicare has specific criteria for covering services, including tests, which must be deemed reasonable and necessary for the diagnosis or treatment of illness or injury according to its guidelines. The Office of Inspector General (OIG) acknowledges that while physicians can order any tests they deem appropriate for patient care, Medicare reimbursement is contingent upon these services meeting Medicare's definition of reasonable and necessary.

The OIG Understands That the Physician Practice Should Be Able