Does Medicare Cover Cortisone Injections?

Medicare provides health insurance coverage for millions of Americans, helping to manage healthcare costs for a wide range of services. Understanding what Medicare covers, especially for specific treatments like cortisone injections, can help beneficiaries navigate their healthcare journey. This overview clarifies how Medicare approaches coverage for these common medical procedures.

Medicare Part B Coverage for Injections

Medicare Part B generally covers cortisone injections when medically necessary and administered in an outpatient setting by a qualified healthcare professional. Medical necessity means the injection is essential for diagnosing or treating an illness, injury, or condition, aligning with accepted medical standards. These injections frequently alleviate pain and inflammation associated with conditions such as arthritis, back pain, bursitis, carpal tunnel syndrome, and various joint issues affecting the ankle, elbow, hip, knee, shoulder, and wrist.

For coverage, the injection must be given by a doctor or other licensed practitioner who accepts Medicare assignment, agreeing to the Medicare-approved amount as full payment. If the cortisone injection occurs during an inpatient hospital stay, it typically falls under Medicare Part A coverage as part of the overall hospital treatment. Medicare Part B specifically covers most injectable and infused drugs given by a licensed medical provider in an outpatient setting, provided they are not self-administered.

Understanding Your Out-of-Pocket Costs

For cortisone injections covered under Medicare Part B, beneficiaries are responsible for some out-of-pocket expenses. After meeting the annual Part B deductible ($257 in 2025), individuals generally pay 20% of the Medicare-approved amount for the service. This 20% is known as coinsurance. The exact cost can vary based on the dosage and the facility where treatment occurs.

An injection in an ambulatory surgical center might have a different cost share than one received in a hospital outpatient department, where additional facility fees may apply. Medicare Supplement (Medigap) plans can help manage these costs by covering the Part B deductible and coinsurance. These supplemental plans work alongside Original Medicare to reduce a beneficiary’s financial responsibility.

Verifying Coverage and Navigating the Process

To ensure coverage for a cortisone injection, confirm medical necessity with the treating physician. The doctor’s office documents why the injection is needed for diagnosis or treatment. Before receiving the injection, verify that your physician and the facility accept Medicare assignment. Providers who accept Medicare assignment agree to the Medicare-approved charge, which helps limit out-of-pocket costs.

Discuss with the doctor’s office whether any prior authorization is required by Medicare or your specific Medicare plan. After the service, the provider’s office typically handles billing Medicare directly. Review your Explanation of Benefits (EOB) statement from Medicare, which details what was covered and any remaining financial responsibility.

Other Medicare Plans and Specific Scenarios

Medicare Advantage plans (Part C) must provide at least the same level of coverage as Original Medicare (Parts A and B). However, these private plans may have different cost-sharing rules, network restrictions, or prior authorization requirements for services like cortisone injections. If a cortisone injection is received during an inpatient hospital stay, it is typically covered under Medicare Part A, which provides hospital insurance.

Cortisone injections are generally covered under Part B, not Medicare Part D. Part D primarily covers prescription drugs that beneficiaries typically administer themselves. Coverage may be denied if the injection is not medically necessary, such as for cosmetic purposes, or if it involves experimental treatments. Beneficiaries have the right to appeal a denied decision.