Medicare's coverage of skin cancer treatment depends on the type of radiation therapy and whether your doctor orders it as medically necessary

Medicare Part B covers external beam radiation therapy (EBRT) for skin cancer when your doctor documents that it is medically necessary. This is the most common form of radiation used for skin cancers like basal cell carcinoma and squamous cell carcinoma. You pay 20% of the approved amount after you meet your Part B deductible, and the provider bills Medicare for the remaining 80%.

Superficial radiation therapy (SRT) — sometimes called orthovoltage therapy — is a specific type of external beam radiation that targets only the skin's surface layers. Medicare covers SRT for skin cancer under the same rules as standard EBRT: your doctor must order it, document medical necessity, and the treatment must be performed at a Medicare-approved facility. The cost structure is identical to other radiation therapies covered by Part B.

The key factor is not the name of the radiation type but whether your oncologist or dermatologist has determined that radiation is the right treatment for your specific cancer. Surgery (such as Mohs micrographic surgery) is often the first choice for skin cancer, so radiation is typically ordered when surgery is not an option, the cancer has returned, or the location makes surgery risky.

Key Takeaways

  • Medicare Part B covers external beam radiation therapy and superficial radiation therapy for skin cancer when your doctor orders it as medically necessary.
  • You pay 20% of the Medicare-approved amount after meeting your Part B deductible; the provider bills Medicare for the rest.
  • The treatment must take place at a Medicare-approved radiation oncology facility for coverage to explore.
  • Your doctor must document in your medical record why radiation is the appropriate treatment rather than surgery or other options.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20% coinsurance.

How Medicare determines medical necessity for radiation therapy

Medicare does not cover a treatment straightforward because it exists or because a patient wants it. Your oncologist or dermatologist must submit documentation showing that radiation therapy is medically necessary for your particular case. This usually means one of the following: the cancer is in a location where surgery would cause significant disfigurement or functional loss (such as near the eye or ear), the patient is not a surgical candidate due to age or other health conditions, the cancer has recurred after previous treatment, or the cancer is advanced or aggressive.

The radiation oncology facility will verify coverage before your first appointment. They submit your diagnosis code, the proposed treatment plan, and your doctor's clinical notes to Medicare for review. In most cases, Medicare approves the request within a few days. If Medicare denies the request, your doctor can appeal with additional documentation, or you can request an independent review.

What you pay out of pocket

Your costs depend on whether you have Original Medicare alone, a Medigap policy, or a Medicare Advantage plan. With Original Medicare Part B, you pay 20% coinsurance after you meet your annual deductible (which is $240 in 2024, though this amount changes yearly). A typical course of SRT for skin cancer runs 10 to 20 treatment sessions, so your total out-of-pocket cost usually falls between $200 and $800, depending on the facility's approved charges and how many sessions you need.

If you have a Medigap plan (also called Medigap), it may cover some or all of your 20% coinsurance, depending on which plan you hold. Plans G, F, and N typically cover a larger share of radiation costs than plans A or B. If you have Medicare Advantage, your out-of-pocket costs are capped at an annual maximum, and you may have a different copay structure — check your plan documents or call your plan's customer service line to learn your exact costs before treatment begins.

Where treatment must happen for Medicare to pay

Medicare only covers radiation therapy performed at a facility that is enrolled in Medicare and meets federal standards for radiation oncology. This includes hospital radiation departments, freestanding radiation oncology centers, and some dermatology practices that have their own radiation equipment and Medicare certification. Your doctor's office cannot bill Medicare for radiation therapy performed in-house unless it holds the proper Medicare provider number and certification.

Before scheduling treatment, ask your doctor's office whether the facility where they plan to treat you is Medicare-approved. The facility's billing staff can also confirm this and check your coverage. If your doctor wants to refer you to a non-Medicare facility, you would be responsible for the full cost unless you have other insurance that covers it.

Radiation therapy versus surgery for skin cancer

Surgery — particularly Mohs micrographic surgery — is the standard first-line treatment for most skin cancers because it removes the cancer completely and allows the surgeon to check margins under a microscope. Medicare covers Mohs surgery at a dermatologist's office or surgical center. Radiation therapy is typically reserved for cases where surgery is not feasible, has failed, or the patient cannot tolerate surgery.

If your dermatologist recommends radiation instead of surgery, ask them to explain why in your medical record. This documentation is what Medicare uses to determine medical necessity. Common reasons include cancers on the eyelid or lip (where surgery risks damaging function), cancers in patients over 80 or with serious heart or lung disease, or cancers that have recurred after previous surgery. Understanding the clinical reasoning helps you make an informed decision and ensures Medicare has the information it needs to cover the treatment.

What happens if Medicare denies coverage

If Medicare denies your radiation therapy claim, you have the right to appeal. Your radiation oncology center's billing department can file an appeal on your behalf, usually at no cost to you. The appeal process typically takes 30 to 60 days. Your doctor can submit additional clinical notes, imaging, or pathology reports explaining why radiation is medically necessary in your case.

If the appeal is denied again, you can request an independent review by a third party not employed by Medicare. You can also contact your state's Patient Advocate Foundation or your local Area Agency on Aging for help navigating the appeal. Do not ignore a denial notice — the important date to appeal is usually 120 days from the date on the notice.

Frequently Asked Questions

Does Medicare cover skin cancer screening or biopsy?

Yes. Medicare Part B covers skin cancer screening as part of a preventive visit with your primary care doctor or dermatologist. If a biopsy is needed to diagnose skin cancer, Medicare covers that as well. You typically pay nothing for the screening visit if your doctor does not perform other services, and you pay 20% coinsurance for a biopsy after your deductible.

Will Medicare cover radiation if I choose it over surgery?

Medicare covers radiation only if your doctor documents that it is medically necessary — not straightforward because you prefer it to surgery. If surgery is a safe and effective option for your cancer, Medicare may not cover radiation as an alternative. Your doctor must explain in writing why radiation is the appropriate choice for your specific situation.

What if I have Medicare Advantage instead of Original Medicare?

Medicare Advantage plans must cover all services that Original Medicare covers, including radiation therapy for skin cancer. However, your copay, coinsurance, and deductible may differ. Contact your plan before treatment to learn your exact out-of-pocket costs and whether you need a referral to the radiation oncology facility.

How long does radiation therapy for skin cancer usually take?

Most skin cancer radiation courses last two to four weeks, with treatment sessions three to five days per week. Each session takes 15 to 30 minutes. Your oncologist will tell you the exact schedule based on your cancer's size and location. Medicare covers all medically necessary sessions ordered by your doctor.

Can I get a second opinion before starting radiation?

Yes, and Medicare covers a second opinion from another oncologist or dermatologist. Ask your primary doctor for a referral, or contact your local cancer center. A second opinion does not delay coverage — Medicare will still cover radiation therapy once you and your doctor decide to proceed.