What Medicare Covers When You See a Dermatologist

Medicare Part B covers dermatologist visits for medical skin conditions, but not for cosmetic reasons

Medicare Part B pays for visits to a dermatologist when you have a skin condition that needs medical treatment — such as skin cancer, psoriasis, severe acne, or infected wounds. The visit itself is covered at 80 percent after you meet your annual deductible, and you pay the remaining 20 percent as your coinsurance. Medicare does not cover dermatology visits or procedures done purely for appearance, such as removing age spots that are not cancerous, smoothing wrinkles, or laser hair removal.

Whether your specific visit is covered depends on the reason your doctor refers you and what the dermatologist documents in your medical record. A dermatologist visit for a suspicious mole that might be skin cancer is covered. A visit to remove a mole solely because you don't like how it looks is not. The line between medical and cosmetic can sometimes be unclear, which is why it matters what your dermatologist writes down about why you came in.

Key Takeaways

Medicare Part B covers dermatologist visits for medical skin conditions like skin cancer, infections, and chronic skin diseases, but not for cosmetic procedures.
You pay 20 percent coinsurance after meeting your Part B deductible, unless you have a Medigap or Medicare Advantage plan that covers additional costs.
Your dermatologist must document a medical reason for the visit in your chart for Medicare to pay — cosmetic reasons are never covered.
Biopsies, skin cancer removal, and treatment of skin infections are covered as part of the dermatology visit.
If your dermatologist is out-of-network, you may owe more out of pocket, or Medicare may not cover the visit at all.

What skin conditions Medicare covers

Medicare covers dermatologist visits for conditions that affect your health or quality of life and require medical care. This includes skin cancer screening and treatment, precancerous lesions, bacterial or fungal infections of the skin, severe acne, psoriasis, eczema, rosacea, and wounds that are not healing properly. It also covers dermatitis caused by allergies or irritants, and skin conditions related to other medical problems like diabetes or autoimmune disease.

If you have a family history of skin cancer or have had skin cancer before, a dermatology visit for screening is covered. If your primary care doctor refers you because of a suspicious mole, changing birthmark, or other concerning skin finding, that visit is covered. The key is that there must be a medical reason documented in your medical record — not just a desire to improve your appearance.

What Medicare does not cover

Medicare does not pay for any dermatology visit or procedure done for cosmetic reasons only. This includes removing age spots, sun spots, or other pigmented areas that are not cancerous; smoothing wrinkles or fine lines; laser resurfacing; chemical peels for anti-aging; microdermabrasion; or hair removal. Even if a dermatologist performs the procedure, if the medical record shows it was done for appearance alone, Medicare will not cover it.

Some procedures fall into a gray area. For example, removing a mole on your face might be medically necessary if it is changing or bleeding, but cosmetic if it is stable and you straightforward dislike it. Your dermatologist's documentation of the medical reason is what determines coverage. If you are unsure whether a procedure you want is covered, ask your dermatologist to explain the medical reason before the visit, and contact Medicare directly at 1-800-MEDICARE to confirm.

How much you pay out of pocket

If your dermatologist is in-network with Medicare, you pay 20 percent of the Medicare-approved amount after you meet your Part B deductible for the year. The dermatologist's office bills Medicare first, and Medicare pays its 80 percent share directly to the provider. You receive a bill for your 20 percent coinsurance. The exact dollar amount depends on what the dermatologist charges and what Medicare approves for that service in your area.

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your 20 percent coinsurance, depending on which plan you have. If you have a Medicare Advantage plan, your out-of-pocket costs may be different — some plans charge a copay per visit instead of coinsurance, and some have different deductibles. Check your plan documents or call your plan's customer service to find out what you will owe before your visit.

In-network versus out-of-network dermatologists

Medicare does not have a formal network the way private insurance does, but dermatologists can choose whether to accept Medicare assignment. If your dermatologist accepts assignment, they agree to accept Medicare's approved amount as payment in full for covered services. You pay only your deductible and coinsurance based on that approved amount.

If your dermatologist does not accept assignment, they can charge up to 15 percent more than Medicare's approved amount — this is called "balance billing." You would owe the 20 percent coinsurance plus the extra 15 percent. Before scheduling an appointment, ask the dermatologist's office whether they accept Medicare assignment. You can also search for in-network dermatologists on Medicare.gov or call 1-800-MEDICARE for a list in your area.

Biopsies and skin cancer treatment

If your dermatologist takes a skin biopsy — removing a small sample of skin to test for cancer or other conditions — that procedure is covered by Medicare as part of the dermatology visit. The biopsy itself, the pathology lab work to examine the sample, and any follow-up visit to discuss results are all covered. If the biopsy shows skin cancer, treatment such as surgical removal, cryotherapy (freezing), or topical medications is also covered.

Mohs micrographic surgery, a specialized technique for removing skin cancer with minimal damage to surrounding skin, is covered by Medicare when performed by a may have access to dermatologist. The cost follows the same 80/20 split after your deductible. If your dermatologist refers you to another specialist for treatment, make sure that specialist also accepts Medicare assignment to avoid surprise bills.

How to prepare for your visit

Before scheduling a dermatology appointment, confirm that the dermatologist accepts Medicare and accepts assignment. You can call the office directly or check Medicare.gov. Bring your Medicare card and any other insurance cards you have. If you have a referral from your primary care doctor, bring that as well — while Medicare does not require a referral for dermatology, having one in your chart helps document the medical reason for the visit.

Write down any skin concerns you have noticed, when they started, and whether they have changed. Bring photos if you have them. Wear loose, straightforward-to-remove clothing so the dermatologist can examine your skin thoroughly. If you are concerned about whether a specific procedure or concern will be covered, call Medicare at 1-800-MEDICARE before your appointment and have your dermatologist's name and the procedure code ready.

When to contact Medicare or your dermatologist

Contact Medicare if you receive a bill from your dermatologist that seems higher than your expected coinsurance, or if Medicare denies a claim you believe should be covered. You have the right to appeal a denial. Contact your dermatologist's office if you have questions about what they will charge, whether they accept your insurance, or what the medical reason for a procedure is.

If you are unsure whether a skin concern is medical or cosmetic, schedule a visit with your primary care doctor first. Your doctor can examine the area and refer you to dermatology if there is a medical reason. This creates a clear record that the visit is medically necessary, which helps avoid coverage disputes later.

Frequently Asked Questions

Does Medicare cover a dermatologist visit just to check for skin cancer?

Yes, if you have a family history of skin cancer or your doctor refers you for screening because of a suspicious finding. A routine skin cancer screening visit is covered. However, if you straightforward want a general skin check with no specific medical concern, coverage may vary — contact Medicare to confirm before your visit.

Will Medicare cover removing a mole I've had for years and don't like?

No, not if the mole is stable and the only reason for removal is appearance. If the mole is changing, bleeding, itching, or your dermatologist documents a medical concern, removal is covered. The dermatologist's documentation of the medical reason is what determines coverage.

What if my dermatologist charges more than Medicare approves?

If they accept assignment, they cannot charge more than Medicare approves — you pay only your deductible and coinsurance. If they do not accept assignment, they can charge up to 15 percent above the approved amount. Ask before your visit whether they accept assignment.

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

Medicare does not require a referral, but having one from your primary care doctor helps document that the visit is medically necessary. It also ensures your primary care doctor knows about your skin condition and any treatment you receive.

Are prescription creams or medications from a dermatologist covered?

Prescription medications are covered under Medicare Part D (prescription drug coverage), not Part B. The dermatologist visit is covered under Part B, but the prescription itself is covered separately through your Part D plan, subject to your plan's formulary and cost-sharing.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.