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.

A doctor and his patient smile while they talk in his office

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 2019, the Part B deductible is $185 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.

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 you’re prostate biopsy is covered by Original Medicare, it is also covered by Medicare Advantage.

In addition to these standard Part A and Part B benefits, many Medicare Advantage plans offer additional benefits that aren’t offered by Original Medicare.

Some of these extra benefits may include one or more of the following:

  • Prescription drug coverage
  • Vision coverage
  • Routine dental coverage
  • Routine hearing care coverage
  • Free gym memberships and other health and wellness program benefits, such as SilverSneakers

Not all plans offer some or any of these benefits. Plan availability can vary by location.

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.

Compare Medicare Advantage plans in your area

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.