Does Medicare cover dermatology?

AARP

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Yes. Medicare covers medically necessary dermatology services, but not elective cosmetic surgery and other procedures performed only for beauty.

Medicare also won’t cover skin cancer screenings if you don’t show signs of skin cancer. It will cover biopsies and other tests if your doctor finds a suspicious growth or suspects skin cancer.

Which dermatology services does Medicare cover?

While Medicare Part B typically covers some dermatology and prevention, it doesn’t cover cosmetic services not medically necessary or the removal of benign lesions, according to Terrence Cronin Jr., M.D., president of the American Academy of Dermatology.

Medicare usually covers dermatology services to prevent, diagnose and treat skin disorders or a specific medical condition or illness. It may also cover some procedures considered “necessary” cosmetic surgery because of an accident, to improve function of a malformed body part, or if needed after other medical care. For example, Medicare covers breast reconstruction if you had a mastectomy because of breast cancer.

In some cases, you need permission from plan officials, called prior authorization, before Medicare will cover a procedure sometimes considered cosmetic. Your provider must send documentation of medical necessity to Medicare before it will cover:

Blepharoplasty, better known as eyelid surgery, to remove droopy, fatty or excess tissue.

Botulinum toxin injections to treat muscle disorders, such as spasms and twitches. More commonly known brand names are Botox, Daxxify, Dysport, Jeuveau and Xeomin.

Panniculectomy surgery to remove excess skin and tissue from your lower abdomen.

Rhinoplasty surgery, a nose job, to change the shape of your nose.

Vein ablation surgery to treat varicose veins.

How do I get prior approval for dermatology procedures?

If Medicare requires prior authorization before covering a procedure, your physician’s office must provide medical records indicating the surgery is necessary.

A Medicare administrative contractor reviews those records and makes a determination case by case. This process can take two or more weeks, according to the Centers for Medicare & Medicaid Services (CMS).

If Medicare approves an outpatient dermatology procedure as medically necessary, it’s covered under Part B and subject to the deductible and 20 percent coinsurance. If you have a supplemental Medigap policy or retiree coverage, that may pay the coinsurance costs.

If the provider’s office doesn’t receive approval before a procedure occurs, Medicare won’t cover the cost.

Does Medicare cover skin cancer screening?

Medicare doesn’t cover skin cancer screening as a free preventive benefit, and it won’t cover the screening if you don’t show signs of skin cancer. However, it will cover services and tests related to diagnosing a potentially cancerous skin growth and treating skin cancer.

Doctors often refer patients to a local dermatologist who accepts Medicare for more extensive testing of a potentially cancerous skin growth, and Medicare Part B may cover the cost of the referral visit, CMS says. The dermatologist’s visit, biopsies and tests are subject to the Part B deductible and 20 percent coinsurance.

How do I find a dermatologist who accepts Medicare?

You can use Medicare’s physician finder to locate a dermatologist in your area who accepts Medicare. Type in your city and state or zip code and then, under keyword tap dermatology. You’ll see a list of local dermatologists and their contact information.

Each dermatologist listing notes if the doctor charges the Medicare-approved amount, which is helpful. Simply click on the dermatologist of your choice to learn about their specialties, education, board certifications and practice.

Keep in mind

If you have a Medicare Advantage plan rather than original Medicare, skin exam coverage may vary among plans. Medicare Advantage members may need a referral from their primary care physician to see a dermatologist.

And remember, with Medicare Advantage, you may have coverage only for a dermatologist in your plan’s network, and if you see an out-of-network provider, you will pay more.

Published July 21, 2023