Medicare’s Coverage of Dermatology Services
The question whether or not Medicare covers dermatologic services has been debated for years. Many have argued that it doesn’t; others believe that it does, but only if the service is considered cosmetic surgery (CS). There are many opinions on this issue, so let us take a look at some facts and figures.
What Is Cosmetic Surgery?
Cosmetic surgery refers to any procedure that is done to improve one’s appearance, such as hair transplants, plastic surgeries, fillers and other procedures. These procedures may include laser treatments, Botox injections and other non-invasive methods. Some examples of these types of procedures are liposuction and rhinoplasty. Other common cosmetic surgical procedures include nose jobs and eyelid lifts.
Why Is It Considered Cosmetic Surgery?
Some argue that CS is cosmetic surgery because it is performed on someone who would never need such a procedure. Others claim that CS is cosmetic surgery when the procedure was done to make the person appear younger than they actually were. Still others say that CS is cosmetic surgery when the person undergoing the procedure had a congenital disease which prevented them from having normal sexual function.
The figure below shows examples of non-cosmetic surgical procedures.
What Does Medicare Say?
Medicare states that plastic surgery (which can include cosmetic surgery) is not covered if it is to correct a congenital abnormality. On the other hand, if it is for normal aging or for a condition that can be reversed, it will be covered.
What Is Dermatology?
Dermatology, on the other hand, has nothing to do with plastic surgery. It is a branch of medicine that deals with skin diseases and conditions. Dermatologists are medical professionals that diagnose and treat skin issues such as cellulitis, skin cancer, acne, psoriasis, parasites, and many others. These skin conditions can affect any part of the body from the head to the toe. Many of these conditions can be inherited or triggered by allergic reactions or even the environment. When left untreated, these conditions can lead to serious health issues.
What Are Some Other Dermatology Procedures and Are They Covered by Medicare?
The following are some of the procedures that fall under the dermatology umbrella and whether or not they are covered by Medicare:
Cellulitis – This is a bacterial skin infection caused by an opening in the skin. If it is mild, then it can be treated and covered by Medicare. If it is more advanced, then it can lead to other serious issues (such as blood poisoning) and may require treatment by a physician. Medicare will cover up to 14 days of treatment for this condition.
Skin cancer – Certain types of skin cancer are covered by Medicare. These include basal cell carcinoma and squamous cell carcinoma. Whether or not Medicare will cover other types of skin cancer depends on the specific condition and how advanced it is.
Keratolysis – Sometimes, a person’s skin can develop small cracks that tear and form scabs. This condition is called keratolysis and normally occurs on the feet, hands, and elbows. It is rare and difficult to treat, but it stems from a bacterial or fungal infection. Medicare Part B will cover up to 14 days of treatment for this condition if the patient meets the criteria.
Moles – Some moles are benign, but some can turn into skin cancer. Medicare Part B will cover the removal of a benign mole if it is larger than one centimeter in diameter. If the removed mole is diagnosed as cancerous, then Medicare will also cover the treatment of the condition.
Corrective Eye Surgery – If a person is blind in one eye, Medicare will pay for corrective eye surgery to improve their vision if they meet certain criteria.
What Is the Procedure for Getting Medicare to Cover Procedures?
If a person wants their procedure covered by Medicare, then they need to find out if it is covered before the procedure takes place. The fastest way to do this is to give your doctor a call and ask them. They can let you know whether or not it is covered by Medicare and what codes to use when you go in for the procedure. This will expedite the entire process and can save you time and effort.
If you have any further questions, contact Medicare directly. Their phone number is (800) MEDICARE.
Sources & references used in this article:
Geographic distribution of nonphysician clinicians who independently billed Medicare for common dermatologic services in 2014 by AS Adamson, EA Suarez, P McDaniel… – … dermatology, 2018 – jamanetwork.com
Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States by R Tripathi, KD Knusel, HH Ezaldein, JF Scott… – … dermatology, 2018 – jamanetwork.com
Melanoma outcomes for Medicare patients: association of stage and survival with detection by a dermatologist vs a nondermatologist by ML Pennie, SL Soon, JB Risser, E Veledar… – … of Dermatology, 2007 – jamanetwork.com
Association of dermatologist density with the volume and costs of dermatology procedures among Medicare beneficiaries by SY Tan, D Tsoucas, A Mostaghimi – JAMA dermatology, 2018 – jamanetwork.com
Mohs micrographic surgery volume and payment patterns among dermatologists in the medicare population, 2013 by C Johnstone, KA Joiner, J Pierce… – American Journal of …, 2018 – ingentaconnect.com
Opioid prescribing patterns and complications in the dermatology medicare population by S Cao, R Karmouta, DG Li, RS Din… – … dermatology, 2018 – jamanetwork.com