Does Medicare Cover Skin Tag Removal?
Medicare will cover skin tag removal if a physician determines the procedure as medically necessary in treating, preventing, or managing a problematic condition. These criteria typically only apply to growths that frequently bleed or cause pain. Medicare will never cover cosmetic procedures or elective dermatological services, such as skin tag removal without a clear medical purpose.
Once Medicare approves a skin tag removal, Part B will cover 80% of all eligible costs after patients meet their annual deductible.
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How Medicare Covers Dermatology
Medicare will only cover dermatological procedures deemed medically necessary in treating, diagnosing, or preventing an underlying skin condition. Examples of covered services include:
- Removal of painful or bleeding skin tags, warts, or epidermal tumors
- Rosacea or psoriasis treatment
- Allergy testing to treat a specific allergen
- Removal of cancerous or visually concerning moles
However, Medicare will not cover elective or cosmetic surgeries, such as:
- Laser hair removal
- Botulinum injections (e.g. Botox)
- Varicose vein removal
- Rhinoplasty surgery
Even if you have a visually concerning or painful skin tag, you must secure documentation of medical necessity from a Medicare-compliant doctor to guarantee removal coverage.
Understanding Medicare Coverage for Skin Tag Removal
Skin tags are harmless growths that can turn up anywhere on a person’s body, usually resulting from prolonged friction with neighboring skin, jewelry, or clothing. While most of these growths do not require serious attention, Medicare occasionally covers skin tag removals deemed medically necessary by a compliant doctor.
For a Medicare-approved doctor to prescribe a skin tag removal as medically necessary, it must meet one of the following criteria:
- The skin tag frequently bleeds or becomes irritable.
- The skin tag has developed on your eyelids, inhibiting your vision.
- The skin tag causes pain.
To guarantee Medicare benefits, a doctor must then submit a request for the procedure stating your diagnosis, prognosis, and medical reasoning for removal.
Medicare Part A Coverage
Medicare Part A (Hospital Insurance) pays for inpatient care received in a hospital, skilled nursing facility, or nursing home, as well as supplies and equipment like beds and bandages. Part A charges an annual $1600 deductible and allows patients to receive 60 days of consecutive care before imposing a daily copayment for continued services.
Virtually all medically necessary skin tag removals occur in an outpatient environment, meaning Medicare Part A rarely applies to these or other minor dermatological procedures.
Medicare Part B Coverage
Medicare Part B (Medical Insurance) covers preventative care, medically necessary doctor’s services, and certain supplies prescribed to diagnose, treat, or prevent health conditions from worsening. For example, Part B will cover:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health services
- Diagnostic testing
- Outpatient surgeries and procedures
If your doctor prescribes skin tag removal as a medical necessity, Medicare Part B will cover 80% of the Medicare-approved costs after meeting your $226 annual deductible.
Private companies sell Medigap – or Medicare Supplement Insurance – policies to help people fill out-of-pocket gaps in their Original Medicare coverage. To access a Medigap plan, you must have both Medicare Part A and Part B and pay an additional monthly premium. These premiums will vary based on your policy details and the company you insure with.
Depending on your plan, Medigap coverage may absorb some or all of the deductible and coinsurance fees remaining after a Medicare-covered skin tag removal.
How Does Medicare Advantage Cover Skin Tag Removal?
Medicare Advantage, or Medicare Part C, must legally cover all the same services as Original Medicare and occasionally even includes additional benefits such as vision, hearing, or dental care. However, because private companies fund and moderate these policies, they can set varying restrictions and cost-sharing protocols.
For example, though all Medicare Advantage Plans will cover a skin tag removal deemed medically necessary by a doctor, some may also require you to secure a referral to a Medicare-approved dermatologist. Others may set higher or lower deductibles, coinsurance, and premium rates.
How Much Does Skin Tag Removal Cost With Medicare?
On average, removing a skin tag without insurance costs around $160. However, prices vary widely depending on your location and the type of removal procedure authorized, such as cauterization, cryosurgery, or an incision. Some of these services may require follow-up visits to monitor your condition, each of which would trigger additional fees.
If you have Original Medicare, Part B would cover 80% of these costs, leaving you with a 20% coinsurance. For example, if you had already met your $226 annual deductible and needed a $160 removal, you would only pay $32 for the service. Part B also covers 80% of your visit charge if you require a follow-up.
Medicare Advantage Costs
Though all Medicare Advantage policies must cover medically necessary skin tag removal, every plan sets independent restrictions and cost-sharing protocols. For example, various Medicare Advantage Plans may charge higher or lower premiums, deductibles, and copayments for covered services. Others include complimentary prescription drug coverage, giving patients access to discounted pain-relieving or infection-reducing pharmaceuticals following their operation.
How to Get a Skin Tag Removed
Follow these steps to get a skin tag removed under Medicare:
- Consult with a healthcare provider. A doctor must visually assess your skin tag to determine the medical necessity of a removal.
- Document medical necessity. To secure coverage, the presiding physician must write a statement to Medicare illustrating the reasons for removal.
- Verify Medicare coverage. This will help prevent surprise out-of-pocket expenses.
- Get prior authorization, if needed. This typically only applies to specific Medicare Advantage beneficiaries.
- Undergo the procedure. Dermatologists can remove skin tags in as little as 15 minutes.
- Submit your Medicare claim. Your doctor should handle this on your behalf. If not, call 1-800-MEDICARE.
- Appeal, if necessary. If Medicare denies coverage, submit a Medicare Redetermination Request form.
All in All
Though skin tags usually prove relatively harmless, many people find them irritating or unsightly. If you have Medicare, Part B will cover most of the cost of any dermatological procedure prescribed as medically necessary by a doctor and performed by a Medicare-approved specialist.
Specifically, skin tags must bleed frequently, cause pain, obstruct vision, or suggest underlying issues like cancer to justify a medically necessary removal.
If you want to remove a growth for purely aesthetic purposes, you must pay 100% of the costs. Consult with your healthcare provider and call 1-800-MEDICARE to ensure your medical eligibility and verify your coverage details. If you have Medicare Advantage, contact your policy directly.