Does Medicare Pay for Tuberculosis Tests?

Tuberculosis (TB) is an infectious disease primarily affecting the lungs, though it can impact other body parts. Medicare can provide coverage for TB tests under specific circumstances, particularly when there is a medical need for diagnosis or screening based on risk factors.

Medicare Coverage for TB Tests

Medicare Part B covers medically necessary clinical diagnostic laboratory tests. A doctor or other healthcare provider must order these tests to diagnose tuberculosis. Coverage requires medical necessity due to symptoms, potential exposure, or specific risk factors.

Medicare Part B generally covers diagnostic testing for symptoms like a persistent cough, chest pain, or unexplained weight loss. Coverage is also provided for known exposure to TB or if an individual belongs to a high-risk population. However, Medicare may not cover routine screenings without symptoms or identified risk factors.

Part B also covers certain preventive services, including TB screenings for high-risk individuals. This coverage is often provided without cost-sharing by a participating provider. High-risk populations include healthcare workers, individuals with weakened immune systems, or those in communal living environments.

If tuberculosis requires hospitalization, Medicare Part A covers inpatient care costs. Medicare Part D typically covers prescription medications for treatment.

Types of TB Tests and Related Services

Several types of tests detect tuberculosis. Medicare covers them when medically necessary. The Tuberculin Skin Test (TST), also known as the Mantoux or PPD test, involves injecting fluid under the skin. A healthcare professional examines the reaction 48 to 72 hours later, requiring two visits.

Blood tests for TB, known as Interferon-Gamma Release Assays (IGRAs), include QuantiFERON®-TB Gold Plus (QFT-Plus) and T-SPOT®.TB. These tests measure the immune system’s response to TB bacteria. Blood tests may be recommended over skin tests for individuals vaccinated against TB, as the vaccine can cause false-positive skin test results.

If an initial TB test is positive, Medicare may cover further diagnostic services to determine active disease. These follow-up services include chest X-rays to visualize the lungs. Sputum smears and cultures, which analyze mucus for TB bacteria, are typically covered. Physician visits for ongoing diagnosis and treatment planning are part of covered services.

Navigating Medicare Coverage and Costs

To ensure Medicare covers a TB test, a Medicare-enrolled doctor or other healthcare provider must order it. The test must be medically necessary for diagnosis or due to identified risk factors. Aligning the test with Medicare’s coverage criteria helps avoid unexpected costs.

For Original Medicare (Parts A and B), out-of-pocket costs typically involve the Part B deductible and coinsurance. In 2025, the Part B deductible is $257. After this is met, Medicare generally pays 80% of the Medicare-approved amount for covered services, with the beneficiary responsible for the remaining 20% coinsurance. Some diagnostic laboratory tests may be covered in full.

Confirm that the healthcare provider or testing facility accepts Medicare assignment for the lowest out-of-pocket costs. After receiving services, beneficiaries should review their Explanation of Benefits (EOB) statement or Medicare Summary Notice (MSN). An EOB details the services received, the amount billed, and how much the plan covered; it is not a bill.

Medicare Advantage (Part C) plans must cover at least all services covered by Original Medicare, though specific cost-sharing amounts like copayments or coinsurance can vary. Medicare Supplement (Medigap) policies can help cover some out-of-pocket costs, such as deductibles and coinsurance, not covered by Original Medicare.