Does Medicare Cover B12 Shots?

Medicare is a federal health insurance program for individuals aged 65 or older, younger people with certain disabilities, and people with End-Stage Renal Disease. This article explains when Medicare covers B12 injections, outlining specific requirements and costs.

Medicare Coverage Criteria for B12 Shots

Medicare provides coverage for vitamin B12 injections when a licensed medical professional determines they are medically necessary to diagnose or treat a specific disease, condition, or injury. These injections are covered under Medicare Part B, which addresses medical services and outpatient care. If you receive the shots in a doctor’s office or clinic, Part B covers them. However, if the injections are administered during a hospital stay or in a skilled nursing facility as part of your treatment plan, Medicare Part A, which covers hospital insurance, may provide coverage.

Medical necessity means the treatment is considered appropriate and essential for your health. Conditions that qualify for B12 shot coverage include pernicious anemia, a condition where the body cannot absorb vitamin B12 from food, or certain gastrointestinal disorders that lead to malabsorption. Other qualifying conditions include a history of low blood levels of vitamin B12 or treatments with specific chemotherapy drugs, such as pemetrexed or pralatrexate, where B12 injections help reduce side effects. For example, with pemetrexed, one intramuscular injection of vitamin B12 is covered before the first dose and then every three cycles.

The Centers for Medicare & Medicaid Services (CMS) guidelines specify that vitamin B12 injections are covered when there is a documented history of low serum B12 levels or conditions causing such deficiency. The injections must be administered by a qualified healthcare professional in an approved outpatient facility to be eligible for coverage. Your healthcare provider must certify that the B12 injections are required to treat or prevent a health condition, and both the provider and the facility must accept Medicare assignment.

Understanding Your Costs for Covered B12 Shots

When Medicare Part B covers your B12 shots, you have certain out-of-pocket costs. For 2025, the standard Medicare Part B deductible is $257 per year. After you meet this annual deductible, Medicare pays 80% of the Medicare-approved amount for the service, and you are responsible for the remaining 20% coinsurance. This 20% coinsurance applies to each Medicare-approved service or item, and there is no annual limit on how much you might pay in coinsurance under Original Medicare.

If you have a Medicare Advantage (Part C) plan, your out-of-pocket costs for covered B12 shots may differ. Medicare Advantage plans are offered by private insurance companies approved by Medicare and must provide at least the same level of coverage as Original Medicare. However, these plans often have different cost-sharing structures, such as fixed copayments instead of a 20% coinsurance, and may include additional benefits. Your specific costs will depend on your plan’s design, including its network requirements and whether the B12 injection is included in your plan’s formulary or list of covered services.

Medicare Supplement Insurance (Medigap) policies can help cover some of the out-of-pocket costs associated with Original Medicare, such as deductibles, copayments, and coinsurance. If your B12 shot is covered by Original Medicare, a Medigap policy may help pay your share of the costs, depending on the specific plan you have. These policies are designed to work in conjunction with Original Medicare, reducing your financial responsibility for covered services.

When Medicare Does Not Cover B12 Shots

Medicare does not cover B12 injections if they are not considered medically necessary. This means that if the shots are sought for general wellness, to boost energy levels, for anti-aging purposes, or for weight loss, they will not be covered, as they are not considered medically necessary.

Furthermore, over-the-counter B12 supplements, whether in pill form or as self-administered injections without a prescription and documented medical necessity, are not covered by Medicare. While Medicare Part D plans cover prescription drugs, they do not cover vitamins, minerals, and supplements, even if prescribed by a doctor. This distinction is important because B12 injections, when covered, fall under medical procedures (Part B or A), not prescription drugs.

Medicare also explicitly excludes coverage for B12 injections used to strengthen foot tendons or ligaments, even if a doctor recommends them for peripheral neuropathy, due to insufficient research on effectiveness. If Medicare does not cover your B12 shot, Medigap policies also will not provide payment for it. Beneficiaries should always confirm with their doctor and Medicare plan administrator whether a B12 injection is considered medically necessary for their specific situation to avoid unexpected costs.