Does Medicare Cover a TB Test? 

Tuberculosis (TB), also known as consumption, is an infection caused by the mycobacterium tuberculosis bacteria. It mainly affects the lungs but it can also harm other organs in the body. People who are infected should receive immediate medical care because TB can be life threatening if it isn’t treated. It is a contagious disease that can be transmitted through airborne droplets. 

Fortunately, if you test positive for TB, your health care provider can prescribe treatment. It’s also a preventable disease when people get vaccinated.  According to the Centers for Disease Control (CDC), in the United States there were 8,300 reported cases of TB in 2022. This was an increase in incidence from 2021, when there were just over 7,800 reported cases. 

If you have contact with a person infected with TB, you may also become infected. A TB infection in the lungs often has three stages with different symptoms:

  • Primary TB infection is the first stage. In some cases, the body’s immune system might fight off the infection. In some cases, there are no symptoms, but some people have flu-like symptoms including low fever, fatigue, and cough.  
  • Latent TB infection occurs after the primary infection. The body’s immune system surrounds TB germs and battles to keep them under control, but the TB bacteria survive. There are usually no symptoms at this stage. 
  • Active TB disease occurs when the immune system can no longer control the infecting bacteria. Some of the most common symptoms are cough, chest pain, painful breathing, fever, chills, coughing up blood or phlegm, night sweating, weight loss, fatigue, and loss of appetite. 

If you’re experiencing any of the above-mentioned symptoms, your physician may order TB testing. You can get either a skin or blood test that shows whether you’ve been exposed to the tuberculosis bacterium, but you’ll need a chest X-ray to determine whether you have a latent or active TB infection.  

Does Medicare cover tuberculosis testing? 

Original Medicare Part B (medical insurance) covers medically necessary clinical diagnostic laboratory exams that your Medicare-affiliated health care provider orders for you. In the case of tuberculosis testing, this coverage includes a TB skin test also known as a Mantoux or tuberculin skin test, or a TB blood test known as an Interferon-Gamma Release Assay (IGRA) test. 

To perform a Mantoux test, your health care provider injects a tuberculin fluid under the skin in your arm to see if you have a reaction to it after 48 to 72 hours. The IGRA blood test checks your body’s immune system response to TB bacteria in your blood.  

Original Medicare Part B pays 100 percent of the costs for clinical diagnostic laboratory tests when you meet eligibility requirements. If your physician orders a chest X-ray to determine whether you have a latent or active case of TB, your coverage depends on where you have the X-rays taken:

Original Medicare Part A (hospital insurance) covers X-rays that you have while you are an inpatient in a hospital that accepts Medicare assignment. As a hospital inpatient, you must pay your Part A deductible for the current benefit period before Medicare pays its share of the costs. 

Original Medicare Part B covers 100 percent of the cost for your X-rays as diagnostic and medically necessary testing ordered by your Medicare-affiliated physician. Part B covers X-rays taken in outpatient settings like physicians’ offices or clinics, outpatient hospital centers, emergency rooms, or urgent care centers. In some instances, you may need to pay a coinsurance fee to the outpatient facility. 

Does a Medicare Advantage plan cover a TB Test?

If you have coverage through a Medicare Advantage (Part C) plan, your provider must offer coverage for the same clinical diagnostic laboratory tests as Original Medicare. Medicare Advantage plans cover X-rays that are medically necessary and ordered by your physician. Depending on the type of plan you have, you may need to use laboratories and health care providers who are approved by your plan. This list of network providers is available with your plan policy, or you can contact your provider for more information. You may also need to pay a copayment or coinsurance fee. 

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