If you’re like me and your dermatologist wants to see you every six months to keep an eye on your skin, you might be wondering: will Medicare actually cover that visit – especially when nothing suspicious turns up? The answer is maybe.
Medicare doesn’t “do” routine check-ups
Medicare loves rules. And one of its biggest is this: it doesn’t pay for routine skin screenings just because it’s time for your check-up. There’s no free annual “skin cancer screening” built into Medicare like there is for mammograms or colonoscopies.
But that doesn’t mean you’re out of luck!
The Magic Phrase: Medically Necessary
If you’ve ever had a skin cancer, precancerous lesion, actinic keratosis, or even just a suspicious mole, your dermatologist can bill the visit as a follow-up for a medical condition. That’s what Medicare calls medically necessary care – and it’s covered.
So even if your doctor doesn’t find anything new that day, Medicare will still pay for the visit, because you’re being monitored for a legitimate medical reason.
Why the “code” matters
When your doctor files your claim, they include a diagnosis code. Those little codes tell Medicare what the visit was for.
If the code says “routine screening,” Medicare says nope. If it says “personal history of skin cancer,” or “monitoring precancerous lesions,” Medicare says yep!
A few examples of “yep” codes include:
- Z85.828 – personal history of skin cancer
- L57.0 – actinic keratosis
- D22.5 – dysplastic mole
So if your dermatologist’s office is on the ball, they’ll make sure your visit is coded correctly so it sails right through.
What You’ll Pay
When the visit is covered under Part B, Medicare pays 80% of the bill. Your Medicare Supplement (like Plan G or N) usually picks up the rest.
If your doctor ends up removing or ordering a biopsy on something, that’s also covered under Part B.
Mama’s Tip
When you check in, just say: “Please be sure to bill this as a follow-up for my history of skin issues.”
That one sentence can save you from a denied claim.
Medicare doesn’t cover “just-because” skin screenings, but it does cover follow-ups when you’ve got a medical reason to be checked – even if your doctor doesn’t find anything that day.
So keep those appointments, wear your sunscreen, and remember: taking care of your skin is always worth it, whether Medicare foots the bill or not.
– Medicare Mama
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