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Reflex Testing Information

Reflex Testing Information

It is the policy of the Bassett Healthcare Clinical Laboratories to perform reflex testing automatically when the two following conditions are met:

  1. Standard industry practice (example: susceptibility testing and confirmations).
  2. Institutional practice based on standard staff practice

These criteria have been predetermined based on specific medical criteria and are consistent with best medical practices.

  • There is currently no CMS reimbursement policy for (or against) reflex testing. Tests that are reflexed should be reasonable and medically necessary.
  • The CMS requires that the physician has the option of selecting a reflex protocol or a single test. The patient will be billed appropriately. Reflexive calculations are not billed.
  • When ordering an Initial Test that is subject to an optional Reflex Test, the ordering physician must consider whether the reflex test is medically necessary for the patient. If the ordering physician considers the reflex test unnecessary then Medicare reimbursement is claimed may be subject to civil penalties.
  • Identification of reflex tests will be noted and updated as needed on this website.
  • Notices of updates to the policy will be sent to Medical Staff via mass email.