Medicare covers a biopsy that's medically necessary

Does Medicare Pay for Biopsies?

A biopsy is a medical test performed by a surgeon, radiologist, or cardiologist. The doctor will take a tissue sample from the patient’s body for close examination to determine whether the disease exists and its degree.

A doc should suggest a biopsy when an initial test indicated an area of tissue that’s abnormal, such as a mass, tumor, or lesion. Many kinds of biopsies exist. If you’re new to Medicare, you’ll want to know what biopsies will be covered. We’re here to explain.  

Does Medicare Cover a Biopsy?

In short, yes, Medicare covers a biopsy as long as it’s “medically necessary” to see if you have cancer or another health condition. However, you’ll still have some financial responsibility. 

After Medicare pays its portion, your costs will depend on many factors:

  • Your location
  • Whether you have a Medigap policy
  • The type of biopsy performed

Common Types of Biopsies

-Needle biopsies: Medicare covers both fine-needle aspiration and core needle biopsies, PLUS anesthesia and CT scans performed before or during the procedure.

-Breast biopsy: Medicare will pay for some breast cancer screenings. If the biopsy takes place at a doctor’s office or an outpatient center, Original Medicare pays a share of the cost.

-Prostate biopsy: If you’re 50 or older, Medicare (Part B) will pay for an annual test to check for prostate cancer. This would likely be performed on an outpatient basis.

-Oral biopsies: Medicare covers them in the same way as other biopsies. Medicare does NOT cover dental care or cancer screenings performed at the dentist’s office, though.

Original Medicare Coverage for a Biopsy

Part A is your hospital insurance. If you’re an inpatient at a hospital, Part A will pay for a biopsy. 

However, most biopsies are outpatient, which means Part B (medical insurance) covers biopsies performed in doctors’ offices or outpatient medical centers.

If your doc accepts Medicare assignment, you won’t pay a higher rate. But before Medicare contributes, you must meet the annual Part B deductible — $203 in 2021.

What About Medicare Advantage Plans?

If you have a Medicare Advantage plan, it will pay for biopsies, just like Original Medicare. Your costs, though, will depend on your particular program because the private companies — who sell the plans — dictate deductibles and copays. To keep your costs down, use doctors in your plan’s “network” of providers.

Related Post: How Do Medicare Advantage Plans Work?

And Medicare Supplement Plans?

Medicare Supplements help reduce your out-of-pocket costs for services and procedures covered by Medicare. All supplemental insurance plans cover biopsies. But you’ll have to pay a copay OR coinsurance with SOME plans. 

Related Post: Which Medicare Supplement Plans Offer the Most Coverage?

What Else Should You Know?

  • Medicare will cover bone marrow biopsies that are medically necessary. These can diagnose blood cancer. 
  • Medicare will cover skin biopsies and skin cancer treatment. 
  • Medicare covers endoscopic biopsies as well. These tests can diagnose colon, lung, and bladder cancer.

Get Medicare Help Today

Medicare can be complicated, even if you’ve done some research on your own. That’s why you should work with a trusted insurance advisor, like the ones at Fussell & Goodyear. We’re here to answer your Medicare questions, provide quotes, and help you choose the best plan for healthcare needs and budget. Contact us online or call 1-877-874-0711!