Medicare Advantage PPO Lab Network

BCBSM has partnered with Quest Diagnostics and Joint Venture Hospital Laboratories to provide a nonpatient clinical pathology lab network for Medicare Plus Blue℠ PPO or Blue Cross® Medicare Private Fee for Service members. By using the network for all lab and pathology services, you can help members avoid out-of-pocket costs.

Reimbursement for lab services

Whenever Medicare Plus Blue PPO or Blue Cross® Medicare PFFS members have lab services performed within the Medicare Advantage PPO lab network, services are paid in full.

Lab services reimbursement breakdown
Medicare Advantage Plan In-network services Services performed at a network hospital that is non-par with JVHL Out-of-network services
Essential $0 $40 50% coinsurance after deductible
Vitality $0 $40 40% coinsurance after deductible
Signature $0 $30 40% coinsurance after deductible
Assure $0 $20 30% coinsurance after deductible
Blue Cross® Medicare PFFS Refer to the group’s summary of benefits for cost sharing information.

Lab specimens can be obtained in-office or at a patient service center

When qualified members of your office staff obtain laboratory specimens in your office, Quest Diagnostics or JVHL can arrange for a courier to pick up the specimen. If you prefer, direct your patients to have their laboratory specimens collected at Quest Diagnostics or JVHL patient service centers.

To find a patient service center:

Medicare Advantage Physician Office Lab List

Certain lab procedures may be performed in your office without referring the patient or the specimen to a Medicare Advantage PPO lab network provider if:

  • The results are needed at the time of service to support making real-time therapeutic decisions
  • The services can be performed economically and accurately
  • The services are medically necessary

The procedures on the Medicare Advantage POLL (PDF) are those that we believe are appropriate to be provided in an office setting. If you provide lab services that are not on this list you will not be paid and you may not bill the member for a lab service not on this list.