Does Medicare Part B Cover Infusions?
Learn how Medicare Part B covers infusion therapy. Understand coverage criteria, where treatments are covered, and your financial obligations.
Medicare Part B covers various medical services and supplies, including those administered in an outpatient setting. Infusion therapy delivers medication or fluids into a patient’s body, typically through a needle or catheter into a vein. This method is often used when medications cannot be taken orally or require precise, controlled delivery.
When Medicare Part B Covers Infusion Therapy
Medicare Part B covers infusion therapy when it is medically necessary. This means the services or supplies are needed to diagnose or treat a medical condition and meet accepted standards of medical practice. A physician must order the treatment, and a healthcare professional must administer the medication.
Part B generally covers both the infused drug and the professional services for administration. This coverage applies to outpatient prescription drugs and biologicals under specific conditions. The key determinant for Part B coverage of drugs is that they are not usually self-administered.
Types of Infusion Therapies and Settings Covered
Medicare Part B covers a range of common infusion therapies. Examples include certain chemotherapy drugs for cancer treatment, intravenous antibiotics for serious infections, and infusions for pain management. Intravenous immunoglobulin (IVIG) for specific immune conditions and other medically necessary injected medications are also typically covered. These therapies are used for conditions such as autoimmune disorders, dehydration, and gastrointestinal diseases.
Infusion services covered by Part B can be received in several outpatient environments. Hospital outpatient departments are common sites for complex infusions. Infusions may also be administered in a physician’s office or specialized independent freestanding clinics.
For certain situations, home health care is an option, provided by a Medicare-certified home health agency as part of a skilled nursing plan. A specific Home Infusion Therapy (HIT) benefit under Part B covers professional services for infusions administered in the home via a durable medical equipment (DME) pump. This home benefit applies to Part B infusion drugs and does not require the patient to be homebound.
Your Financial Responsibility for Infusion Services
Beneficiaries have financial responsibilities for infusion services under Medicare Part B. An annual deductible must be met before Part B begins to pay for covered services. For 2025, this deductible is $257. After the deductible is satisfied, beneficiaries typically pay a 20% coinsurance of the Medicare-approved amount for most services. Medicare then pays the remaining 80% of the approved cost.
It is important to seek services from providers who “accept assignment.” This means the provider agrees to accept the Medicare-approved amount as full payment for the service. When a provider accepts assignment, your out-of-pocket costs are limited to the deductible and coinsurance. Medicare Supplement (Medigap) policies or Medicare Advantage Plans can help cover these out-of-pocket costs, including deductibles and coinsurance.
Addressing Coverage Details and Confirming Eligibility
Navigating Medicare coverage for infusions requires understanding specific details. Some complex infusion therapies may require prior authorization from Medicare or your specific Medicare plan, such as a Medicare Advantage plan. Checking for this requirement beforehand can help avoid unexpected costs.
Part B typically does not cover self-administered drugs, which are medications you would normally take on your own. These self-administered medications are usually covered under a Medicare Part D prescription drug plan.
It is advisable to confirm coverage details, including specific drugs and the settings where they will be administered, with your prescribing doctor and Medicare directly. This proactive step ensures clarity before beginning treatment. If coverage for a medically necessary infusion is denied, beneficiaries have the right to appeal the decision. The appeals process typically involves multiple levels, allowing for review of the initial decision.