Preventive Care Screenings: FSA Eligibility

Private Letter Ruling 200140017

What are preventive care screenings?

Preventive care screening is a medical term that refers to preventing disease and helping medical professionals find problems before symptoms emerge. Preventive care screenings normally refer to things like lab tests and physical exams.

These expenses are eligible as long as the tests are used for diagnosis of the presence of a disease or a dysfunction of the body. Under the ACA, preventive care is now paid at 100%, first dollar so this expense does not arise very often.

What are Lab Tests?

Lab tests provide preventive care such as screenings and tests for suspected diseases or medical conditions that are likely for a given demographic, based on age, gender, risk factors, etc. Examples of preventive care for which a lab test might be conducted include diabetes screening, hepatitis B screening, cervical dysplasia screening, lead screening, vision screening, breast cancer mammography screenings, human papilloma virus (HPV) DNA testing, and more. Many of these tests would only be considered preventive if the patient is considered at risk for developing one of these medical conditions based on their age, gender, lifestyle or other risk factors. Otherwise these tests might be considered diagnostic, in which case they would not be considered eligible for reimbursement under the classification of being a lab test.

Medical professionals will order the lab tests that incur lab fees. If a lab fee is part of the expense, it's because a test requires the use of laboratory technicians and equipment. Most tests to screen for medical conditions require the support of a medical testing laboratory. The most common type of medical appointments that entail lab fees include dermatology appointments, gynecology appointments, oncology appointments, neurology appointments, and prenatal appointments.

Because lab fees are part of visiting a medical professional and receiving health care in a hospital or clinic, they do not require a prescription or Letter of Medical Necessity (LMN) in order to be considered eligible for reimbursement with a consumer-directed healthcare account (U.S. Food and Drug Administration).