DHT, A1C covered under Medicare? - Advanced Prostate...

Advanced Prostate Cancer
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DHT, A1C covered under Medicare?

homer13
homer13

I switched from private insure to Medicare last month. The Labcorp technician indicated that several of my monthly or quarterly blood draws are not covered under Medicare (eg DHT and A1C) Could someone provide guidance on this issue? Any similar experiences? Thanks

15 Replies
oldestnewest

I've had many routine blood draws including DHT, T, PSA, Estradiol, etc., all covered by medicare. Sometimes the doctors' office has to get creative how they submit the data to medicare.

jal

Do they just have to say it is medically necessary or is there more to it?

Running into same thing with VA. Newer drugs like my Xtandi (enzalutamide) aren't available through them, and the $12,000/month makes it a little high.

Doug

My supplemental carrier, is Humana, I get whatever I need. Paid For.

Nalakrats

homer13
homer13 in reply to Nalakrats

Are you saying they will pay for it even if Medicare does not cover it?

No they pay for it if Medicare does pay for it---I just had these labs done last week--for DHT, you need a Doctor to write a Medical reason for its use.

Nalakrats

Yes. I spoke with Medicare yesterday and they said doctor had to write a letter of Medical Necessity. Go figure.

I've been on medicare 13 yrs & it's been that long since I had radiation for PC. I get a blood test every 3 months & was always told that was what medicare would pay for. By the way, PSA was 105 before radiation, dropped to 3 or less till last yr when it went back to 20. I'm on xtandi now & it's below 1. My doctor got me on a program so I get it free.

homer13
homer13 in reply to Kelly41

Blood test for PSA or DHT?

Do you have a PCa code?

You must have a DX and a code otherwise you wont be covered.

homer13
homer13 in reply to elvismlv123

Yes. The doctor's office had the incorrect one on the lab order. Similar experience last January. I now have the corrected ones.

DHT - Z51.81

AIC - R73.01

I am sure Medicare will reject that part of my lab work and will have figure out how to resubmit to make sure I don't have to pay out of pocket.

I never pay out of pocket for lab work and I have extensive bloodwork and testing.

Sounds like a miracle I know but I have paid for expensive meds rarely.I have AARP supplement plan N but he never charges me even though I offer to pay him by check.

He accepts whatever Medicare gives him. Other docs are out to get every dime they can and they need a good beating!!!!! They should give you a pass the crooks.

He never puts a claim to AARP as well.

he made me pay for procrit and zometa

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