Does Medicare Cover Skin Tag Removal?
Clarify Medicare's policies on skin tag removal. Learn the factors influencing coverage and your financial responsibility.
Skin tags are common, small, benign growths that can appear on various parts of the body. They are typically harmless and consist of loose collagen fibers and blood vessels within a layer of skin. Medicare is a federal health insurance program for people aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. This article explores how Medicare covers the removal of skin tags, outlining the specific criteria and financial considerations involved.
Understanding Medicare’s Coverage Approach
Medicare’s coverage philosophy centers on services considered medically necessary for diagnosis or treatment. A service is medically necessary if it is appropriate and consistent with accepted medical practice, treating an illness, injury, or improving function. Medicare Part B, which covers outpatient medical services, typically includes doctor visits, outpatient therapy, and various medical procedures performed in an office or outpatient setting.
Conversely, Medicare generally does not cover procedures performed solely for cosmetic reasons. Cosmetic procedures are those primarily intended to improve appearance without addressing a functional impairment or medical condition. Such procedures are solely for appearance, without a medical reason.
When Skin Tag Removal is Covered
This typically occurs if the skin tag is symptomatic, causing irritation, pain, or bleeding. Coverage also extends to cases where the tag is infected, interferes with bodily function, or if there is a suspicion that the growth might be cancerous. For instance, a skin tag that consistently gets caught on clothing, interferes with vision, or shows signs of change in size, shape, or color might qualify for coverage.
Medicare does not cover skin tag removal if the primary reason for removal is cosmetic. If removal is solely for appearance without medical issues, Medicare will not pay. The determination of medical necessity rests with the healthcare provider, who must document the medical reasons for removal. The provider’s medical assessment and documentation are crucial in supporting a claim for coverage.
Financial Considerations for Removal
When Medicare covers skin tag removal, beneficiaries typically have financial responsibilities under Medicare Part B. After meeting the annual Part B deductible, which for 2025 is $240, Medicare generally pays 80% of the Medicare-approved amount for the service. The beneficiary is then responsible for the remaining 20% coinsurance. This coinsurance applies to each medically necessary procedure.
If skin tag removal is considered cosmetic, Medicare will not cover any portion of the cost. In such cases, the beneficiary is responsible for 100% of the charges. Healthcare providers should inform beneficiaries if a service is not expected to be covered by Medicare. This notification often comes in the form of an Advance Beneficiary Notice of Noncoverage (ABN), which alerts the patient that they may be financially responsible for the service if Medicare denies the claim.