What Medicare covers for dermatology

Medicare Part B covers dermatology procedures when a doctor documents that they treat a medical condition, not a cosmetic concern. The distinction matters: a mole removed because it shows signs of skin cancer is covered. The same mole removed because you don't like how it looks is not. Medicare pays 80 percent of the approved amount after you meet your Part B deductible; you pay the remaining 20 percent.

The procedures themselves are not what determines coverage — the reason for the procedure does. A dermatologist must document in your medical record that the procedure addresses a diagnosed skin disease, infection, injury, or symptom causing functional impairment or health risk. Medicare's local contractors in each state interpret these rules slightly differently, so what one contractor approves another might deny for the same procedure code.

Coverage also depends on whether your dermatologist is in-network with Medicare (accepts Medicare assignment). Out-of-network providers can charge more, and you may owe the difference between what they charge and what Medicare allows.

Key Takeaways

  • Medicare covers skin biopsies, removal of precancerous lesions, treatment of fungal infections, and removal of benign growths when medically necessary, but not when done for appearance alone.
  • Your dermatologist must document the medical reason in your chart before the procedure; "cosmetic" procedures are never covered, even if performed by a dermatologist.
  • You pay 20 percent of Medicare's approved amount after meeting your Part B deductible; costs vary by procedure and your location.
  • Ask your dermatologist's office whether they accept Medicare assignment and whether they expect the procedure to be covered before you schedule.

Procedures Medicare typically covers

Skin biopsies are covered when a dermatologist suspects skin cancer or another condition requiring tissue analysis. The biopsy itself — the removal and lab analysis — is a covered service. If the biopsy shows cancer, removal of the lesion in a follow-up visit is also covered.

Removal of precancerous lesions such as actinic keratosis (rough, scaly patches from sun damage) is covered when documented as a health risk. Cryotherapy (freezing) and chemical peels for actinic keratosis are covered procedures. Removal of seborrheic keratosis (common brown growths) is covered only if it is causing irritation, bleeding, or infection — not if removed for appearance.

Treatment of fungal and bacterial skin infections is covered, including prescription-strength treatments for conditions like severe athlete's foot, ringworm, or infected wounds. Office visits and prescribed medications are both covered services.

Removal of benign skin growths such as warts, skin tags, and lipomas (fatty lumps under the skin) may be covered if they are causing pain, bleeding, or functional problems. Removal for appearance alone is not covered. Plantar warts on the foot are more likely to be covered than warts elsewhere because they affect walking.

Treatment of eczema, psoriasis, and other chronic skin conditions is covered, including office visits, prescribed medications, and phototherapy (light treatment) when medically necessary.

Procedures Medicare does not cover

Cosmetic procedures are never covered, regardless of who performs them. This includes Botox, dermal fillers, laser skin resurfacing for wrinkles, chemical peels for anti-aging, and removal of age spots or freckles done for appearance. Even if a dermatologist performs the procedure, Medicare will not pay.

Removal of benign moles and skin tags done for cosmetic reasons is not covered. If a mole is not changing, not bleeding, and not causing physical discomfort, removal is considered cosmetic.

Hair removal procedures such as laser hair removal are not covered, even when performed by a dermatologist. The exception is hair removal needed to treat a diagnosed medical condition — for example, removing hair from a surgical site before a procedure — but routine hair removal is cosmetic.

Acne treatment is covered when you see a dermatologist and are prescribed medication, but cosmetic acne procedures such as chemical peels done purely for appearance are not covered. Acne treatment that addresses a medical skin condition is different from acne treatment done for cosmetic improvement.

How to know what your procedure will cost

Before your appointment, call your dermatologist's office and ask three things: Does the office accept Medicare assignment? Is the procedure expected to be covered by Medicare? If so, what is your estimated 20 percent cost after the deductible?

If your dermatologist does not accept assignment, they can charge up to 15 percent more than Medicare's approved amount, and you will owe that difference on top of your 20 percent coinsurance. Ask the office to provide the charge in writing before the procedure.

Your Part B deductible for 2024 is $240 (this amount changes yearly). Once you meet it, you pay 20 percent of the approved amount for each procedure. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower because those plans cover some or all of your coinsurance.

If the dermatologist's office is unsure whether Medicare will cover the procedure, ask them to submit a pre-authorization request to Medicare before your appointment. This takes a few days but gives you a clear answer in writing before you pay anything.

The difference between medical and cosmetic

Medicare's rule is straightforward in theory but sometimes unclear in practice: a procedure is covered if it treats a disease, injury, or symptom; it is not covered if it improves appearance alone. The problem is that some procedures blur this line.

A dermatologist removing a mole because it shows signs of melanoma (color change, irregular border, growth) is performing a medical procedure. The same dermatologist removing an unchanged mole because the patient dislikes it is performing a cosmetic procedure. The procedure code is identical; the coverage depends entirely on the documented reason.

Your dermatologist decides how to document the reason. If they document "patient requests removal for cosmetic reasons," Medicare will deny it. If they document "lesion shows irregular borders and color variation concerning for dysplasia," Medicare will likely cover it. This is why it matters to discuss the medical reason with your dermatologist before the visit — they need to know whether you are seeking treatment for a health concern or an appearance concern.

What to do if Medicare denies your claim

If your dermatologist's office submitted a claim and Medicare denied it, you have the right to appeal. The office should send you a notice called an Explanation of Benefits (EOB) explaining why the claim was denied.

Read the denial reason carefully. Common reasons include: the procedure was deemed cosmetic, the medical documentation was insufficient, or the procedure was not medically necessary. If you believe the denial is wrong — for example, if the mole was actually precancerous — ask your dermatologist's office to submit an appeal with additional medical documentation.

You can also file your own appeal directly with Medicare by calling 1-800-MEDICARE. Have your claim number and EOB in front of you. Medicare's appeals process has multiple levels, and many denials are overturned on appeal when the medical reason is clearly documented.

Medicare Advantage and Medigap coverage

If you have a Medicare Advantage plan (Part C), your dermatology coverage works differently. Each plan sets its own rules about which procedures are covered and what you pay. Some plans cover more cosmetic procedures than Original Medicare does; most do not. Check your plan's coverage documents or call the plan directly before scheduling.

If you have a Medigap (supplemental insurance) plan, it covers some or all of your 20 percent coinsurance for procedures that Original Medicare covers. Medigap does not expand what Medicare covers — it only reduces what you pay for covered services. If Medicare denies a procedure, Medigap will not pay for it either.

Frequently Asked Questions

Will Medicare cover removal of an age spot?

Not if it is removed for appearance alone. Age spots are benign and do not become cancer. If an age spot is bleeding, irritated, or changing in appearance, your dermatologist may document it as a health concern, and removal could be covered. Otherwise, removal is cosmetic and not covered.

Is Botox or filler covered by Medicare?

No. Botox, dermal fillers, and all cosmetic injectables are never covered by Medicare, even when a dermatologist or plastic surgeon performs them. These are always considered cosmetic procedures.

What if my dermatologist says a procedure is medically necessary but Medicare denies it?

Ask your dermatologist's office to file an appeal with Medicare and include detailed medical documentation of why the procedure was necessary. Many denials are overturned on appeal. You can also file your own appeal by calling 1-800-MEDICARE within 120 days of the denial notice.

Do I need a referral from my primary care doctor to see a dermatologist?

No. Medicare Part B covers dermatology visits without a referral. If you have a Medicare Advantage plan, check your plan's rules — some require referrals and some do not.

What happens if my dermatologist is out of network?

Out-of-network dermatologists can charge up to 15 percent more than Medicare's approved amount. You will owe 20 percent coinsurance plus that 15 percent difference. Ask the office for their charge in writing before your appointment so you know your total cost.