Does Medicare Cover a Biopsy?

When your doctor suggests a biopsy, you may be understandably concerned, but knowing what to expect can help. Procedures can be costly, and when you are already a little stressed about your health, you shouldn’t have to worry about how you will pay the medical bills from the procedure. Let’s find out how Medicare insurance will help cover the cost of a biopsy and any associated expenses.

What is a biopsy?

According to the Centers for Disease Control and Prevention (CDC), a biopsy is a minor surgery to remove body fluid or small pieces of tissue. The procedure is usually ordered by a doctor when an abnormality is suspected. Many people associate biopsies with a cancer diagnosis, but many biopsies can diagnose other non-cancerous conditions or be used to rule out cancer.

Types of Biopsies

There are different kinds of biopsies that a physician may order, but most will involve removing a small section of tissue, organ, or skin to be sent to a lab for analysis by a pathologist. Some procedures are more invasive than others, but your doctor can use numbing agents, sedation, or pain relief medicines to relieve your discomfort or pain. Biopsies can include the following types:

  • Needle biopsy (for easily accessible samples)
  • Endoscopic biopsy (to gather samples from the lungs, bladder, or colon)
  • Bone biopsy
  • Bone marrow biopsy
  • Ultrasound-guided biopsy
  • CT-guided biopsy
  • Liver biopsy
  • Cervical biopsy
  • Kidney biopsy
  • Prostate biopsy
  • Skin biopsy
  • Surgical biopsy (open or laparoscopic surgery)

Will Medicare cover a biopsy?

Medicare Part B covers medically necessary services or supplies needed to diagnose and treat a medical condition and that meet accepted standards of medical practice. If you get your benefits through Original Medicare, you will pay your Part A and/or B deductibles, and 20% coinsurance of Part B services. You may be responsible for other copayments or coinsurance, as well. Medicare should cover anesthesia used during the procedure whether you are in a hospital or outpatient setting, but medications prescribed after the procedure may not be covered unless you have a Prescription Drug Plan.

If you are enrolled in a Medicare Advantage plan, you will have at least the same coverage as Original Medicare, but you may have additional benefits. If you need prescription medications after your procedure, you should be enrolled in a Medicare Advantage plan with prescription drug coverage (MA-PD). Check with your Medicare Advantage plan for coverage details.

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