Is Laser Therapy Covered by Medicare?

Laser therapy is a medical treatment that utilizes concentrated light beams to precisely cut, burn, or destroy tissue. This advanced technology allows healthcare providers to target specific areas with accuracy, minimizing damage to surrounding healthy tissue. Lasers find applications across diverse medical fields, including ophthalmology, dermatology, and oncology. While offering numerous medical benefits, Medicare coverage for laser therapy is not uniform and depends on specific criteria and medical necessity.

Medicare’s Coverage Framework

Medicare determines coverage for any medical service, including laser therapy, based on several principles. A treatment must first be considered medically necessary, meaning it is appropriate for diagnosing or treating an illness or injury, or improving a malformed body part’s function.

The Centers for Medicare & Medicaid Services (CMS) specifies that covered services must meet accepted standards of medical practice. This means the treatment should be widely recognized and utilized within the medical community for the condition being addressed. Medical devices and therapies, including those utilizing lasers, require approval from the Food and Drug Administration (FDA) for their specific medical use to be considered for Medicare coverage.

For laser therapy to be covered, it must be prescribed by a qualified healthcare professional, such as a physician. The procedure must also be performed in an approved clinical setting, such as a physician’s office, an outpatient clinic, or a hospital.

Covered Laser Therapy Applications

Medicare covers laser therapy applications when they are medically necessary for treating specific diagnosed conditions. YAG laser capsulotomy, for example, corrects posterior capsule opacification after cataract surgery. This procedure uses a laser to create an opening in the clouded capsule behind the artificial lens, restoring clear vision.

In dermatology, certain laser procedures are covered if they address a specific medical condition rather than purely cosmetic concerns. This includes using lasers to remove or treat precancerous lesions, such as actinic keratoses, or certain types of skin cancers.

Laser therapy is also covered for specific pain management treatments, particularly when conventional therapies have proven ineffective and the laser application is medically necessary for a diagnosed condition. For instance, physical therapy, which can include certain laser applications, is covered by Medicare Part B when medically necessary for pain management. However, some forms, like cold laser therapy for neuropathy, are not covered as they may be considered experimental or lacking sufficient evidence of efficacy by CMS.

Non-Covered Laser Therapy Applications

Medicare does not cover laser therapy applications that are considered purely cosmetic or are not medically necessary for a specific illness or injury. Procedures such as laser hair removal, wrinkle reduction, or tattoo removal are excluded from coverage.

Experimental or investigational laser treatments that have not yet received FDA approval for a particular use or are not widely recognized within standard medical practice are also not covered. This includes therapies that are still undergoing clinical trials or lack sufficient evidence of safety and effectiveness. For example, cold laser therapy for neuropathy is not covered because CMS does not recognize infrared therapy devices as medically necessary for this condition.

Confirming Coverage and Financial Considerations

Before undergoing any laser therapy, beneficiaries should confirm coverage to understand their potential financial responsibilities. Contact the healthcare provider’s billing department to inquire about the specific CPT (Current Procedural Terminology) codes and diagnosis codes for the proposed treatment. This helps verify coverage with Medicare or their Medicare Advantage plan.

Beneficiaries with Original Medicare should be aware of the Medicare Part B deductible, which is $257 in 2025, and must be met annually before Medicare begins to pay its share. After the deductible is satisfied, Original Medicare covers 80% of the Medicare-approved amount for covered outpatient services, leaving the beneficiary responsible for the remaining 20% coinsurance. For example, if a covered laser procedure has a Medicare-approved amount of $1,000, and the deductible has been met, Medicare would pay $800, and the beneficiary would owe $200.

If coverage for a service is uncertain, or if the provider believes Medicare may not cover the treatment, they might ask the beneficiary to sign an Advance Beneficiary Notice of Noncoverage (ABN). An ABN is a written notice from a provider, given before a service is furnished, advising that Medicare may not pay for it. Signing an ABN means the beneficiary agrees to be personally responsible for payment if Medicare denies coverage. Medicare Advantage plans, also known as Medicare Part C, are offered by private companies and must cover at least what Original Medicare covers. However, these plans may have different cost-sharing structures, including varying deductibles, copayments, or coinsurance amounts, so it is important to review the specific plan’s details.