Does Medicare cover biopsies?

Biopsies are medical tests usually performed by surgeons, radiologists, or cardiologists. The standard biopsy involves the removal of cells and tissue samples to determine if a particular organ or portion of the body is diseased, most commonly via cancer. Tissue samples are examined by pathologists. There are multiple types of biopsies. Excisional biopsies are when an entire area of tissue is removed; incisional (or core) biopsies are where a tiny sample is removed.

As you might imagine, biopsies are expensive due to the precision nature of the work and the highly skilled specialists who perform it. Kidney biopsies, for example, can range from $3,000 to $10,000 without health insurance. Liver biopsies typically run between $2000 and $7000. Skin biopsies are generally less expensive, though still nothing to sneeze at with costs between $150 and $1,000.

Medicare may cover your biopsy if your doctor signs off on the fact that it is medically necessary for your continued health and well-being. In some cases, Medicare pays 100% of clinical laboratory services such as biopsies. In other cases, Medicare may decline any and all coverage. It is imperative that you consult with your doctor or healthcare provider before agreeing to a particular service. For example, even though Medicare does cover colonoscopies and various forms of cancer pre-screening tests, if those tests lead to a biopsy or the removal of a polyp, Medicare will classify the test as diagnostic instead of screening.

If the test is deemed diagnostic, you may have to pay 20% of the Medicare-approved amount for your doctor’s services in addition to any applicable co-payment fees. The Medicare-approved amount is the portion of your doctor’s usual fee that Medicare has agreed to pay. If you doctor’s usual fee is higher than the Medicare-approved amount, you will have to pay the difference.

Biopsies and other clinical laboratory services are usually covered under Original Medicare Part B, which assists you with outpatient care and doctor’s office fees. You may need to pay your Part B annual deductible before Medicare will begin covering your biopsy. Consult with your Medicare plan provider for more information. As always, be sure to ask your doctor or healthcare provider if they are certified by Medicare. If they are not, you could be liable for 100% of the biopsy costs and any related fees.

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