In order to meet Medicare coverage requirements, all vascular laboratory studies must (1) have a valid, recorded medical indication; (2) be ordered by a licensed independent provider; (3) have archived retrievable test data; and (4) include a physician’s professional interpretation. Each of these will be examined in more detail.

What constitutes a valid medical indication can be a frustrating issue for vascular lab managers because the clinical indications as listed on the requisition or physician’s order determine whether or not a service is covered, meaning paid, by the insurance carrier. A clinical indication that the ordering provider believes is totally appropriate, may not be considered valid by the carrier. For instance, a 60-year-old-lifelong smoker and his primary care provider may believe that a first-time carotid duplex exam is entirely appropriate especially if two of the patient’s brothers and three of his sisters have all suffered strokes. However, the patient’s insurance carrier may consider this a noncovered “screening” exam if the patient has no lateralizing neurologic symptoms. The lab manager is then faced with a dilemma. Refusing to do the exam antagonizes the patient and the ordering provider. On the other hand, performing the exam with no expectation of payment can only be done a limited number of times if the lab is to remain fiscally viable.