Does Medicare Cover Dermatology Appointments?
Understand Medicare's coverage for dermatology services. Learn what's covered, what's not, and how your plan affects costs.
Medicare is a federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. It provides coverage for a wide range of services, supporting beneficiaries with various medical needs.
Medicare’s General Coverage Principles for Medical Services
Medicare’s fundamental principle for covering medical services is rooted in “medical necessity.” This means a service or supply must be proper and needed for diagnosing or treating an illness, injury, or disease. Such services must also align with accepted medical practice standards. Medicare does not cover purely optional or solely preventive services, beyond approved screenings.
The Centers for Medicare & Medicaid Services (CMS) provides guidelines on medical necessity. This principle applies across all medical specialties, including dermatology. If a service does not meet these criteria, Medicare may not provide coverage, even if a healthcare provider recommends it.
Dermatology Services Typically Covered by Medicare
Medicare generally covers dermatology services that are medically necessary for diagnosing, treating, or preventing skin disorders, injuries, or illnesses. This includes services for diagnosing and treating skin cancer, such as biopsies for suspicious lesions and subsequent treatments for conditions like melanoma, basal cell carcinoma, or squamous cell carcinoma.
Treatment for chronic skin conditions, such as severe psoriasis, eczema, or acne requiring medical intervention, is typically covered. Medicare also covers services for infections or other skin ailments that necessitate medical attention. The removal of skin lesions like moles, warts, or skin tags is covered if medically necessary, for instance, if they are painful, bleeding, or suspected to be cancerous.
Dermatology Services Not Covered by Medicare
Medicare generally does not cover dermatology services considered cosmetic and performed solely to improve appearance. This includes procedures like Botox injections for wrinkles, elective laser treatments for age spots, or non-medical skin tag removal. Hair removal for aesthetic reasons is also typically excluded from coverage. Even if a procedure offers a minor medical benefit, if its primary purpose is cosmetic, Medicare is unlikely to cover it.
For example, mole removal is covered only if medically necessary, such as when a mole is cancerous or suspected. If the removal is purely for cosmetic reasons, Medicare will not cover the cost. Similarly, cosmetic surgery is generally not covered unless it is required to improve the function of a body part or repair an injury, such as breast reconstruction following a mastectomy due to breast cancer.
Navigating Your Medicare Plan and Related Costs for Dermatology
For most medically necessary outpatient dermatology services, Original Medicare, specifically Part B, provides coverage. After meeting the annual Part B deductible, which is $257 in 2025, beneficiaries typically pay 20% of the Medicare-approved amount for the service. Providers who accept Medicare assignment agree to accept the Medicare-approved amount as full payment, limiting what they can charge the patient.
Medicare Advantage plans, also known as Part C, are offered by private companies approved by Medicare and must cover at least the same services as Original Medicare. However, these plans may have different cost-sharing rules, which could include varying copayments, deductibles, and out-of-pocket maximums. Medicare Advantage plans may also have specific provider networks or referral requirements for specialist visits, including dermatologists.
It is advisable for beneficiaries to review their specific plan documents or contact their plan provider to understand their coverage details and potential out-of-pocket costs for dermatology services. Finding a dermatologist who accepts your specific Medicare plan is also an important step. Some Medicare Advantage plans may offer additional benefits or require prior authorization for certain procedures.