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Reminder of CMS Lab Ordering Guidelines

February 27, 2023

Thank you for being a valued partner in providing quality patient care to Wellcare Medicare members.

Dear Medicare Provider,

We understand that timely claim payments to our lab and provider partners are important, so we would like to help you avoid unnecessary delays, rejections, or denials when possible. It is important to adhere to all CMS Billing Guidelines (PDF) which outline regulatory guidance, as well as required information and details that must be included when ordering patient labs to aid in timely processing and payment. Specifically, it is imperative that providers turn on the medical necessity flag on the ordering provider’s EMR software. Departure from these guidelines and omission of required information are among the more common reasons that lab claims are delayed, rejected, or denied.

The CMS Lab Billing Guidelines cover the following topics:

  • Insufficient Documentation
  • Documentation Requirements
  • Medicare Signature Requirements
  • Ordering or Referring Services

Thank you for your continued participation in our network and products. If you have any questions, please do not hesitate to contact your Provider Representative.


Wellcare Health Plans, Inc.

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Y0020_WCM_100876E Last Updated On: 2/27/2023