Does Medicare Cover QuantiFERON Gold Test?

Medicare Benefits Solutions
Feb 21, 2021

Tuberculosis, commonly referred to as TB, is a disease transmitted from one person to another by way of germs that are airborne. TB is typically associated with the lungs, but it can also involve the brain, kidneys, spine and other areas of the body. Without treatment, TB can be fatal. QuantiFERON®-TB Gold In-Tube test (QFT-GIT) is a test your doctor may recommend to determine if you have been infected.

What is Tuberculosis (TB)?

If you inhale air contaminated with TB germs, you can get a latent TB infection (LTBI). This means that the germs have permeated your system but the condition is dormant. Because the germs are not active, you may not feel sick. At this stage, you cannot spread the germs to other people, but you can develop TB disease. Once the disease develops, you are likely to have symptoms and be contagious.

If you have spent time with someone who suffers from TB disease, testing is advisable. You can get tested in one of two ways, either a skin test or a blood test. A positive TB skin test reveals a reaction at the test site, the lower part of your arm. A positive TB blood test registers how your immune system responds to the germs that spawn the disease.

TB Diagnosis 

QFT-GIT is one of two whole-blood tests available for sale that received a seal of approval from the United States Food and Drug Administration (FDA). The other FDA-approved whole-blood test is the T-SPOT® TB test (T-Spot). Positive blood test results can reveal that you have LTBI but do not confirm if the infection has morphed into TB disease. If your test results are positive, your doctor will perform a complete medical evaluation to determine if you have TB disease. The evaluation will likely include a chest X-ray, sputum sample and medical history.  

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Medicare Coverage for Blood Tests

QFT-GIT can be performed in a doctor’s office, lab or hospital. Medicare coverage depends on where you have the test done. Medicare Part B covers outpatient blood tests under the category of laboratory services. If the blood is drawn in a Medicare-approved laboratory, you may not have to pay anything for the service. If a health care provider draws blood, you have some responsibility for payment whether you are an inpatient or outpatient. 

Medicare Part A insurance covers inpatient care, which includes your hospital room, meals, nursing care and medication. Part B covers outpatient services that doctors administer. Medicare coverage in that case is usually 80% of the Medicare-approved amount. If you go to your doctor’s office to have the blood drawn, you can expect to pay the Part B deductible plus 20% of the approved Medicare amount to satisfy the coinsurance. 

Medicare Supplement and Medicare Advantage Plans

If you have either a Medicare Supplement plan, otherwise known as Medigap, or a Medicare Advantage (MA) plan, check your plan materials for benefits outside the parameters of Original Medicare insurance. Medigap covers either all or a portion of Part B coinsurance. If you have one of the legacy plans, which includes plan C and plan F, you may be covered for the Part B deductible as well. As an MA plan member, be sure to use a laboratory within the plan’s network to avoid additional charges. 

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