Medicare Part B covers dermatologist visits, but only for medical skin conditions — not cosmetic ones

Medicare Part B pays for dermatologist care when you have a skin condition that needs medical treatment: acne, eczema, psoriasis, skin cancer screening, moles that need removal for health reasons, fungal infections, or severe sunburn. The visit itself is covered at 80 percent after you meet your annual deductible. What Medicare will not pay for is anything purely cosmetic — Botox, laser hair removal, chemical peels for wrinkles, or removal of a mole solely because you dislike how it looks.

The key distinction is medical necessity. A dermatologist can treat a mole because it shows signs of melanoma. Medicare covers that. The same dermatologist cannot bill Medicare to remove an identical mole on your shoulder just because you want it gone. You would pay out of pocket for the cosmetic removal, even if the same doctor performs both procedures on the same day.

Key Takeaways

  • Medicare Part B covers dermatologist visits for medical skin conditions like acne, eczema, psoriasis, skin cancer, and fungal infections after you pay your annual deductible.
  • You pay 20 percent of the Medicare-approved amount for the visit; the dermatologist's office bills Medicare for the other 80 percent.
  • Cosmetic dermatology — Botox, laser hair removal, wrinkle treatments, and removal of benign moles for appearance — is never covered by Medicare.
  • If a dermatologist cannot determine whether a procedure is medical or cosmetic, they should document the medical reason in writing before the visit.

How the 80/20 split works for dermatology

When you see a dermatologist covered by Medicare, you are responsible for 20 percent of what Medicare considers the approved amount for that visit. Medicare sets the approved amount based on a fee schedule; it is not what the dermatologist charges. If a dermatologist charges $200 but Medicare's approved amount is $150, you pay 20 percent of $150 ($30), not 20 percent of $200.

Before you pay anything, you must first meet your Part B deductible for the year — $240 in 2024, though this amount changes annually. Once you have paid that deductible, the 80/20 split begins. If you have a Medigap or Medicare Advantage plan, that secondary coverage may pay some or all of your 20 percent coinsurance, depending on your plan.

The dermatologist's office should tell you upfront whether they accept Medicare assignment, meaning they agree to bill Medicare directly and accept the approved amount as payment in full (except for your deductible and coinsurance). Most dermatologists do accept assignment, but it is worth confirming when you call to schedule.

What counts as a medical skin condition versus cosmetic

Medicare distinguishes between skin conditions that affect your health or function and those that are purely about appearance. Medical conditions include skin cancer and precancerous lesions, infections (bacterial, fungal, or viral), inflammatory conditions like psoriasis or severe eczema, acne that causes scarring or significant distress, warts that interfere with function, and moles or growths that change in size, color, or shape.

Cosmetic procedures include Botox and other injectables, laser resurfacing for wrinkles, chemical peels for sun damage or age spots, hair removal by laser or electrolysis, and removal of benign moles, skin tags, or other growths solely for appearance. If you have a mole that is itching, bleeding, or changing — signs of potential melanoma — removal is medical. If the mole is flat, stable, and you straightforward dislike it, removal is cosmetic.

The gray area is smaller than it seems. If your dermatologist is unsure whether Medicare will cover a procedure, they should document the medical reason in the patient record before the visit. This protects you from surprise bills. Ask your dermatologist to put the medical justification in writing if there is any doubt.

How to find a dermatologist who takes Medicare

Use Medicare's official provider search tool at Medicare.gov under "Care Providers." Search for dermatologists in your area and filter by those who accept Medicare. You can also call your state's dermatology society — most have referral lines — and ask which dermatologists in your region accept Medicare assignment.

When you call to schedule, ask three things: whether they accept Medicare, whether they accept assignment, and what your out-of-pocket cost will be for the specific visit you need. If the office cannot estimate your cost without seeing you first, ask them to call Medicare to verify the approved amount for the type of visit you are having.

If you have a Medicare Advantage plan instead of Original Medicare, check your plan's provider directory first. Advantage plans often have smaller networks of dermatologists, and you may need a referral from your primary care doctor before the visit is covered.

When Medicare denies a dermatology claim

Medicare may deny a dermatology claim if the procedure is deemed cosmetic, if the dermatologist is out of network (for Advantage plans), if you have not met your deductible, or if the dermatologist did not accept assignment and charged you more than the approved amount. You will receive a notice called an Explanation of Benefits (EOB) that explains why the claim was denied.

If you disagree with the denial, you have the right to appeal. For Original Medicare, you can request an appeal through Medicare within 120 days of receiving the EOB. For Advantage plans, follow your plan's appeal process, which is usually faster. Keep all documentation: the dermatologist's notes, photos of the skin condition if available, and any correspondence about the medical reason for the procedure.

If the dermatologist charged you more than the approved amount and you were not told in advance, you may be able to recover the overage. Dermatologists who accept assignment cannot balance-bill you for the difference between their charge and Medicare's approved amount.

Preventive skin cancer screening under Medicare

Medicare Part B covers one skin cancer screening per year with a primary care doctor or dermatologist at no cost to you — you pay nothing, even before meeting your deductible. This is considered a preventive service. The screening must be a visual examination; it does not include biopsies or removal of lesions, which would be billed separately as treatment if needed.

If the screening finds a suspicious lesion, the biopsy or removal is a separate service and subject to your deductible and coinsurance. Make sure your dermatologist codes the screening and any treatment as separate visits so you receive the preventive benefit for the screening portion.

Medicare Advantage plans and dermatology coverage

Medicare Advantage plans must cover everything Original Medicare covers, including dermatology for medical conditions. However, Advantage plans often require you to use in-network providers and may require a referral from your primary care doctor before you see a specialist. Some Advantage plans also charge a copay per visit instead of coinsurance, which may be lower or higher than your 20 percent coinsurance under Original Medicare.

Check your Advantage plan's formulary and provider directory before scheduling a dermatology visit. If you see an out-of-network dermatologist without a referral, you may owe the full cost of the visit. If your plan denies coverage for a dermatology service you believe is medically necessary, you can appeal through your plan's process.

Frequently Asked Questions

Does Medicare cover acne treatment by a dermatologist?

Yes, if the acne is severe enough to cause scarring or significant physical or emotional distress. Mild acne that a primary care doctor can treat may not be covered by a dermatologist visit, but severe or treatment-resistant acne is considered medical. Your dermatologist should document the severity in their notes.

Will Medicare pay for a dermatologist to remove a mole I have had for years?

Only if the mole shows signs of change or concern for skin cancer — bleeding, itching, growing, or changing color. If the mole is stable and you want it removed for appearance, Medicare will not cover it. You would pay the full cost out of pocket.

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

Not under Original Medicare. You can see any Medicare-accepting dermatologist directly. If you have a Medicare Advantage plan, check your plan documents — many Advantage plans do require a referral from your primary care doctor before covering a specialist visit.

What if my dermatologist charges more than Medicare approves?

If the dermatologist accepts Medicare assignment, they cannot charge you more than your deductible and 20 percent coinsurance. If they do not accept assignment, they can charge more, but you should be told this in writing before the visit. Always confirm assignment status when you schedule.

Is Botox or laser treatment for wrinkles ever covered by Medicare?

No. Botox, laser resurfacing, chemical peels, and other cosmetic procedures are never covered by Medicare, even if a dermatologist performs them for a medical reason like treating a scar. These are considered cosmetic and you pay the full cost out of pocket.