Does Medicare Cover Prostate Biopsy?
Medicare Part B typically covers a diagnostic prostate biopsy if it’s deemed medically necessary by a doctor. Part B also covers certain yearly preventive prostate cancer screenings.
Medicare Advantage (Part C) plans also cover prostate biopsies if they are deemed medically necessary by your doctor in order to diagnose potential prostate cancer.
How much does Medicare pay for prostate cancer screenings?
Medicare Part B generally pays 80 percent of the Medicare-approved amount for covered doctor services, such as a medically necessary prostate biopsy.
You typically pay the remaining 20 percent after you meet your Part B deductible. In 2024, the Part B deductible is $240 per year.
Medicare Part B also covers two other types of prostate cancer screenings:
- Digital rectal exams
- Prostate specific antigen (PSA) blood tests
These preventive screenings are covered by Medicare Part B once every 12 months for men over the age of 50.
You typically pay 20 percent of the cost of your digital rectal exam (plus your doctor’s fees) after you meet your Part B deductible.
Will Medicare pay for a PSA test?
You pay nothing for your yearly PSA blood test if your doctor accepts Medicare assignment. If your doctor accepts assignment, this means he or she agrees to accept the Medicare-approved amount as full payment for covered services.
A PSA test or digital rectal exam are not the same thing as a prostate biopsy. We recommend speaking with your doctor or health care provider about specific costs and to find out if your biopsy will be covered.
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Medicare Advantage plans typically cover medically necessary biopsies
Medicare Advantage plans are sold by private insurance companies as an alternative to your Original Medicare (Medicare Part A and Part B) benefits.
Every Medicare Advantage plan must cover the same hospital and medical costs as Medicare Part A and Part B. If your prostate biopsy is covered by Original Medicare, it is also covered by Medicare Advantage. Medicare Advantage plans can also offer benefits that aren’t offered by Original Medicare.
A licensed insurance agent can help you find Medicare Advantage plans in your area so that you can find a plan that works for you.
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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
