Does Medicare Cover a TB Test?
Understand Medicare's approach to TB testing coverage. Learn about eligibility, covered scenarios, and potential out-of-pocket expenses.
Tuberculosis (TB) is an infectious disease caused by bacteria that primarily affects the lungs but can also impact other parts of the body. A TB test helps detect the presence of Mycobacterium tuberculosis bacteria, which can cause either a latent infection without symptoms or an active disease with symptoms. Understanding Medicare’s coverage for these tests is important for beneficiaries.
Medicare’s General Coverage for TB Tests
Medicare generally covers TB tests, primarily through Medicare Part B (Medical Insurance). Part B covers medically necessary services and preventive services, including various clinical laboratory and diagnostic services. For individuals requiring hospitalization, Medicare Part A (Hospital Insurance) may cover TB tests if performed during an inpatient hospital stay.
TB tests fall into two main categories: screening tests for latent TB infection and diagnostic tests for active TB disease. Screening tests identify infection in individuals without symptoms but at risk of exposure. Diagnostic tests are used when a healthcare provider suspects active TB based on symptoms or known exposure. Most outpatient TB testing is covered under Part B, either as a preventive measure or a diagnostic tool.
Specific Scenarios for TB Test Coverage
Medicare Part B covers TB screening tests for individuals at high risk for TB exposure or infection. High-risk criteria include close contact with someone who has active TB, or immigrating from a country with a high incidence of TB. Individuals working in healthcare settings or those with weakened immune systems due to conditions like HIV/AIDS, kidney disease, diabetes, or specific medications, are also considered high-risk. Common screening tests covered include the Tuberculin Skin Test (TST), also known as the PPD test, and blood tests such as Interferon Gamma Release Assays (IGRAs).
Medicare Part B also covers diagnostic tests when active TB disease is suspected. This suspicion typically arises from symptoms such as a persistent cough lasting more than three weeks, fever, night sweats, or unexplained weight loss. Diagnostic procedures covered may include sputum smears and cultures, chest X-rays, and further blood tests to confirm the disease and guide treatment. All covered tests must be medically necessary and ordered by a healthcare provider.
Medicare also covers tests required to monitor the effectiveness of TB treatment and detect potential side effects. Coverage for these monitoring tests falls under Part B.
Understanding Your Costs and Next Steps
For services covered under Medicare Part B, beneficiaries typically incur certain out-of-pocket costs. In 2025, the annual Part B deductible is $257. After this deductible is met, beneficiaries are generally responsible for a 20% coinsurance of the Medicare-approved amount for most services. However, certain preventive services, including some specific TB screenings, may be covered at 100% with no deductible or coinsurance if specific criteria are met, particularly if performed as part of an annual wellness visit. Diagnostic tests for active disease typically follow the standard Part B deductible and coinsurance structure.
Beneficiaries enrolled in a Medicare Advantage (Part C) plan receive their Medicare benefits through a private insurance company. These plans must cover at least the same services as Original Medicare (Parts A and B), but their cost-sharing amounts, such as copays, coinsurance, and deductibles, can differ. Individuals with a Medicare Advantage plan should contact their specific plan provider to understand their out-of-pocket costs for TB testing. Medicare Supplement Insurance (Medigap) plans can help cover some out-of-pocket costs associated with Original Medicare, such as the Part B deductible and coinsurance.
It is advisable to consult with a doctor to determine if a TB test is medically necessary based on individual health conditions and risk factors. Before receiving services, beneficiaries should confirm coverage with their specific Medicare plan or healthcare provider.