Medicare covers cortisone shots in most cases, but the amount you pay depends on where you get the injection and which Medicare plan you have

If you have Original Medicare (Part A and Part B), cortisone injections are covered when a doctor orders them to treat a medical condition — arthritis, bursitis, tendinitis, or joint pain. Medicare pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent, plus any difference between what the doctor charges and what Medicare allows.

If you have a Medicare Advantage plan (Part C), coverage varies by plan. Some plans cover cortisone shots with a copay (usually $15 to $50 per injection), while others require you to meet a deductible first. Check your plan documents or call the plan directly to find out your exact cost.

The location of the injection matters. Shots given in a doctor's office are covered under Part B. Injections given in a hospital outpatient department may be covered under Part A, with different cost-sharing rules. Injections at an ambulatory surgery center fall under Part B.

Key Takeaways

  • Original Medicare covers cortisone injections at 80 percent after you pay your Part B deductible; you pay the remaining 20 percent plus any balance billing.
  • Medicare Advantage plans cover cortisone shots, but your copay or coinsurance depends on your specific plan and whether you have met your deductible.
  • The setting where you receive the injection — doctor's office, hospital outpatient, or surgery center — affects which Medicare part covers it and what you owe.
  • Your doctor must order the injection to treat a diagnosed condition; preventive or cosmetic injections are not covered by Medicare.

How Original Medicare Covers Cortisone Injections

Under Original Medicare Part B, cortisone shots are covered as an outpatient service when medically necessary. This means your doctor must document that the injection treats a specific condition — not that it might prevent one later. Once you have met your annual Part B deductible (which changes each year), Medicare pays 80 percent of the approved amount for the injection itself, the office visit, and any imaging or lab work done on the same day.

You are responsible for the 20 percent coinsurance. If your doctor charges more than Medicare's approved amount, you also pay that difference — called balance billing. Some doctors accept Medicare's approved amount as full payment and do not balance bill; others do not. Before your injection, ask the office whether they accept Medicare's approved amount or if you will owe extra.

If you have not yet met your Part B deductible for the year, you pay the full cost of the injection until you reach that amount. After that, you pay 20 percent coinsurance for the rest of the calendar year.

Medicare Advantage Plans and Cortisone Shot Costs

Medicare Advantage plans must cover cortisone injections at least as well as Original Medicare does, but they can structure the cost differently. Most plans charge a copay per office visit (often $15 to $50) rather than coinsurance, which can be easier to predict. Some plans waive the copay if the injection is done during a preventive care visit, though this is less common.

Many Medicare Advantage plans also have a deductible you must meet before coverage begins. If your plan has a deductible, you pay the full cost of the injection until you reach it. After that, you pay the copay listed in your plan. Some plans separate medical deductibles from drug deductibles, so check which applies to your situation.

The best way to know your exact cost is to call your plan's member services number — found on your insurance card — and tell them you are planning to have a cortisone injection. They can tell you whether you have met your deductible, what your copay will be, and whether the doctor's office is in-network.

Where You Get the Injection Affects Your Coverage

A cortisone shot given in your doctor's office is covered under Part B. You pay your coinsurance (20 percent under Original Medicare) after meeting your deductible. The office visit itself is also covered, so you do not pay separately for the doctor's time.

If the injection is done at a hospital outpatient department, it may be covered under Part A instead, with different rules. Hospital outpatient services often have a copay rather than coinsurance, and the amount varies. An ambulatory surgery center (a facility that is not part of a hospital) is covered under Part B, with the same 20 percent coinsurance as a doctor's office.

Before scheduling, ask your doctor's office which setting they use and confirm with your Medicare plan how much you will owe in that location. The same injection can cost you different amounts depending on where it is given.

What Conditions Medicare Covers With Cortisone Shots

Medicare covers cortisone injections for joint and soft-tissue conditions that a doctor has diagnosed. The most common are osteoarthritis, rheumatoid arthritis, bursitis, tendinitis, and other inflammatory conditions of the joints, shoulders, elbows, knees, hips, wrists, and ankles. Your doctor must document the condition and explain why the injection is medically necessary.

Medicare does not cover cortisone shots for cosmetic reasons, prevention of future problems, or general wellness. If your doctor wants to give you a shot to prevent arthritis from developing, Medicare will not cover it. The injection must treat a condition you already have.

Some injections combine cortisone with other medications, such as a local anesthetic or hyaluronic acid. Medicare covers the cortisone portion. If the doctor adds other substances, ask whether those are covered separately or if they increase your cost.

How to Reduce Your Out-of-Pocket Costs

If you have Original Medicare and are concerned about the 20 percent coinsurance, consider a Medigap policy (supplemental insurance). Some Medigap plans cover the 20 percent coinsurance you would otherwise owe, bringing your cost to zero after you meet your Part B deductible. Medigap plans have their own monthly premiums, so compare the cost of the premium against what you expect to pay for cortisone shots and other services.

If you have a Medicare Advantage plan with high copays, you can switch to Original Medicare plus Medigap during the annual open enrollment period (October 15 to December 7 each year) or if you may have access to for a special enrollment period. However, Medigap insurers can charge more if you have pre-existing conditions, so get quotes before switching.

Ask your doctor whether the injection is truly necessary right now or whether it could wait until next year. If you have not yet met your deductible and the injection is not urgent, waiting until later in the year might reduce your total out-of-pocket costs if you expect other medical expenses.

What to Ask Your Doctor and Insurance Plan Before Your Injection

Before scheduling a cortisone shot, contact your Medicare plan and ask: Have I met my deductible? What is my copay or coinsurance for this service? Is the doctor's office in-network? Will I owe balance billing? Write down the answers and the name of the person who gave them to you.

Ask your doctor's office: Do you accept Medicare? Will you bill Medicare directly? Do you balance bill patients? How much do you typically charge for a cortisone injection? If the office cannot answer these questions, ask to speak with the billing department.

If you receive a bill after your injection that seems wrong, contact your Medicare plan or your doctor's office to ask for an explanation. You have the right to understand what you are being charged and why.

Frequently Asked Questions

Does Medicare cover multiple cortisone shots in the same year?

Yes, Medicare covers repeated cortisone injections if your doctor orders them for medical reasons. However, there are limits. Medicare typically covers no more than three to four injections per joint per year, depending on the joint and the condition. Your doctor will know these limits and will not order injections beyond what Medicare allows.

Will I owe anything if I have met my deductible and have Medigap?

If you have Original Medicare plus a Medigap plan that covers coinsurance, you should owe nothing for the cortisone shot itself after you meet your Part B deductible. However, you are still responsible for any balance billing if your doctor does not accept Medicare's approved amount. Confirm with your Medigap plan and your doctor's office before your appointment.

What if my doctor recommends a cortisone shot but Medicare denies it?

If Medicare denies coverage, your doctor's office will send you a notice explaining why. You can ask your doctor to appeal the denial or to provide additional documentation about why the injection is medically necessary. You also have the right to request a review of the denial. Contact your Medicare plan for instructions on how to appeal.

Are cortisone shots covered if I get them at an urgent care center?

Cortisone shots at urgent care are covered by Medicare if the urgent care facility is enrolled as a Medicare provider. However, urgent care centers often bill as hospital outpatient departments, which may have different cost-sharing than a doctor's office. Call your Medicare plan before going to urgent care to confirm your cost and whether that facility is in-network.

Do I need a referral from my primary care doctor to get a cortisone shot?

Original Medicare does not require a referral. You can see a specialist or go to a doctor's office directly. Medicare Advantage plans vary — some require a referral from your primary care doctor, while others do not. Check your plan documents or call member services to find out your plan's rules.