Direct Pay
Patient pays New Century Labs directly for lab testing.
PatientNew Century Labs
When Can Medicare Patients Use Cash-Pay Labs?
New Century Labs supports non-covered or patient-requested testing where Medicare is not billed. Covered, medically necessary Medicare services require a different billing analysis.
New Century Labs supports all three billing workflows: Direct PayService FeeSelf-Managed Pricing
Educational overview, not legal advice · Last reviewed July 2026 · Choose a starting point here, then confirm it with counsel.
Plain-English answer
Medicare patients may use cash-pay lab workflows for certain non-covered or patient-requested tests. New Century Labs’ Medicare-sensitive workflow is designed for cases where no Medicare claim is submitted and the patient clearly agrees to pay out of pocket.
New Century Labs does not support using cash pay to bypass Medicare billing rules for covered, medically necessary lab testing.
Three billing workflows
Direct Pay, Service Fee, and Self-Managed Pricing
Service Fee
Clinic may charge a transparent fee for professional/admin services.
PatientNew Century Labs + Clinic fee
Self-Managed Pricing
Clinic controls patient pricing where state law and payer context allow.
PatientClinicNew Century Labs
A patient having Medicare does not automatically prohibit cash-pay lab workflows, but it makes billing structure more sensitive: referral-linked compensation, claim submission, patient disclosures, and coverage status all matter. In practice, the cleaner start is:
- New Century Labs bills the patient directly for the lab testing.
- The clinic charges only for its own professional or administrative services, if permitted.
- Any patient-facing charges are disclosed before the order is placed.
- The clinic confirms coverage, non-coverage, and billing rules with counsel or a billing specialist.
What New Century Labs’ cash-pay Medicare workflow supports
| Scenario | What it means |
|---|---|
| Non-covered testing | The test or panel is not covered by Medicare for the patient’s situation. |
| Patient-requested testing | The patient wants testing outside a Medicare-covered diagnostic workflow. |
| Wellness / optimization panels | Testing requested for general wellness, longevity, hormone optimization, performance, or similar non-covered purposes. |
| No Medicare claim submitted | The patient understands New Century Labs is not billing Medicare for the order. |
| Clear patient payment agreement | The patient accepts out-of-pocket responsibility before the order is placed. |
If a test is covered, medically necessary, and should be billed to Medicare, the cash-pay workflow is not the right path.
What New Century Labs does not support
- Avoiding Medicare billing for a covered service.
- Collecting cash from a Medicare patient for a test that should be submitted to Medicare.
- Hiding a lab markup or referral payment inside the patient price.
- Treating Medicare-sensitive orders like ordinary retail checkout.
- Replacing an ABN, coverage determination, or counsel-reviewed Medicare billing process where one is required.
Why the caution
Clinical laboratory services sit on Medicare’s designated-health-services list, so Stark and the Anti-Kickback Statute can reach financial relationships around lab referrals even when no claim is submitted. That is why referral-linked compensation is the main thing to avoid.
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This calculator is for non-covered or patient-requested testing where Medicare is not billed. Do not use it to price covered, medically necessary Medicare services. Takes about a minute; your details go to our verification service only.
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Medicare-sensitive workflow
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Common lab test mix
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How you can bill for lab work is regulated and varies by state. You're responsible for choosing a model that complies with your state's rules. This is an illustration, not legal advice; we'll help you find the right fit on the call.
FAQ
Can Medicare patients pay cash for labs?
Sometimes. Cash-pay can fit non-covered or patient-requested testing where no Medicare claim is submitted and the patient clearly agrees to pay out of pocket. Covered, medically necessary testing is a different analysis.
Does New Century Labs bill Medicare?
No. New Century Labs runs cash-pay workflows and does not bill insurance, including Medicare. That is why its Medicare-sensitive workflow is intended for testing where Medicare is not billed.
Can clinics use cash pay for covered Medicare lab tests?
That is not what this workflow is for. New Century Labs does not support using cash pay to bypass Medicare billing rules for covered, medically necessary services; those orders need a counsel-reviewed Medicare billing path.
What should the patient understand before paying?
That Medicare is not being billed, why the test is non-covered or patient-requested, what it costs, and that they accept out-of-pocket responsibility before the order is placed.
Can a clinic add a service fee for Medicare patients?
Only with extra caution: flat, documented, separate from the lab charge, tied to services actually performed — and reviewed with counsel.
Sources
- HHS OIG, Fraud & Abuse Laws: https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/
- CMS, Physician Self-Referral Law: https://www.cms.gov/medicare/regulations-guidance/physician-self-referral/current-law-and-regulations
Written by New Century Labs and reviewed for operational accuracy by the New Century Labs team — not reviewed as legal advice. Last reviewed July 2026; laws and payer rules may change. Confirm the right workflow for your practice with your healthcare counsel.
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Talk through the right cash-pay lab workflow for your practice.
New Century Labs supports multiple billing workflows so clinics and their counsel can choose the structure that fits their state, payer mix, and practice model. Choose your starting point, then confirm it with counsel — we’ll help you compare Direct Pay, Service Fee, and Self-Managed pricing.