Our Data & Sources
Every number and coverage rule on MedCarePrecheck comes from public federal data or peer-reviewed research. This page shows exactly where each figure comes from.
Important: Original Medicare Only
All coverage rules and rates on this site apply to Original Medicare (also called Traditional Medicare or Medicare Fee-for-Service — Parts A and B), administered directly by the federal government.
If you are enrolled in a Medicare Advantage plan (Part C) — a plan offered by a private insurance company — your coverage rules, reimbursement rates, and prior authorization requirements may be different. Medicare Advantage plans set their own rules, which are not publicly published. Contact your plan directly for coverage and cost information.
Not sure which type of Medicare you have? Check your insurance card: if it says “Medicare Advantage,” “Medicare Part C,” or shows a private insurer’s name (Humana, UnitedHealthcare, Aetna, BCBS, etc.), you have a Medicare Advantage plan.
Where Our Data Comes From
MedCarePrecheck draws on three data sets, all published by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare:
1. Local Coverage Determinations (LCDs)
LCDs are coverage policies set by each regional Medicare contractor. They specify which diagnosis codes (ICD-10) justify a lab test for Medicare reimbursement. When you upload a lab order, MedCarePrecheck checks the CPT codes against the LCD rules that apply in your region.
Source: Centers for Medicare & Medicaid Services, Local Coverage Determinations database
2. National Coverage Determinations (NCDs)
NCDs are nationwide coverage policies issued by CMS directly. They take precedence over LCDs for the tests they cover. Our tool checks both.
Source: Centers for Medicare & Medicaid Services, National Coverage Determinations database
3. Clinical Laboratory Fee Schedule (CLFS)
The CLFS is what Medicare actually pays for each lab test — the official reimbursement rate. CMS sets and publishes this annually. The Medicare rate shown for each test on our site is pulled live from our database so it always reflects the current year.
Source: Centers for Medicare & Medicaid Services, Clinical Laboratory Fee Schedule (CLFS)
Statistics from Our Blog Posts
The statistics cited in our blog posts come from peer-reviewed journals, federal agencies, and non-profit health policy organizations:
- 80%+ of medical bills contain at least one error — Pat Palmer / Medical Billing Advocates of America via Healthline
- 53% of Medicare complainants said the billed amount was inaccurate — CFPB Issue Spotlight, May 2023
- ~75% who contacted a billing office had the error corrected — JAMA Health Forum 2024 via NBC News
- CBC hospital avg $401 vs Medicare $7.77; CMP $957 vs Medicare $14.35 — Cureus/PMC 2024, 42 Florida hospitals
- >80% of appealed Medicare Advantage claims overturned, 2019–2024 — KFF, January 2026 + Counterforce Health
- 76% who negotiated got help or had the bill reduced or canceled — JAMA Health Forum 2024 via NBC News
- Cash prices varied up to 243× between Tennessee hospitals — JALM, February 2025
- ABN rules and provider liability — Centers for Medicare & Medicaid Services; Center for Medicare Advocacy
- Negotiating medical bills — Solace Health
A Note on Data Currency
Medicare rates on this site update automatically whenever CMS changes the Clinical Laboratory Fee Schedule — you’re always seeing the current rate. LCD and NCD coverage rules are updated as CMS issues new determinations.
Last updated: June 2026. Questions about our methodology? Contact us.