Medicare *Does* Have a Definition of "Screening Tests"

 Medicare's Internet Only Manual, Series 4 (Claims), Chapter 16 (Labs), does have a definition of "screening tests" in Section 120, which I don't recall noticing before, or had forgotten.

https://www.cms.gov/Regulations-and-guidance/Guidance/Manuals/Downloads/clm104c16.pdf

Section 120 is "Negotiated Rulemaking Implementation."  Negotiated Rulemaking was a law circa 1999 that required CMS to standardize, as much as possible, procedures for common lab tests across MACs.

Here we read:

Clarification of the Use of the Term “Screening” or “Screen" 

The final rule clarifies that effective February 21, 2002, the use of the term “screening” or “screen” in CPT code descriptor does not necessarily describe a test performed in the  absence of signs and symptoms of illness, disease or condition.  

Contractors do not deny a service based solely on the presence of the term “screening” or “screen” in the descriptor. 

Tests that are performed in the absence of signs, symptoms, complaints, personal history of disease, or injury are not covered except when there is a statutory provision that explicitly covers tests for screening as described. 

If a person is tested to rule out or to confirm a suspected diagnosis because the patient has a sign and/or symptoms, this is considered a diagnostic test, not a screening test.  

Contractors have discretionary authority to make reasonable and necessary scope of benefit determinations.