Are In-Office Injections Covered By Medicare?

Most Americans don’t realize all that is covered under Medicare Part B. The Medicare and You handbook says that Part B “helps to cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, and other medical services.” But, those are pretty broad terms to most.

To determine whether Medicare covers something, the key question you must always ask is, “is it medically necessary?”

What Does “Medically Necessary” Mean?

The term “medically necessary,” as defined by Medicare, means “healthcare services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms that meets accepted standards of medicine.”

Related: Medicare Moments at SeniorResource.com

Medicare covers medically necessary doctor services (including outpatient services and some doctor services you get when you are a hospital inpatient) and covered preventative services. Medicare also covers services you get from other healthcare providers like physician assistants, nurse practitioners, social workers, physical therapists, and psychologists.

Are In-Office Injections Covered By Medicare?

The simple answer is that in-office injections (like macular degeneration injections, which are expensive!) may be covered under Part B if they’re considered medically necessary for you.

What’s your out-of-pocket going to be? It will be the current year’s Part B deductible. The 2023 Part B deductible is $226. That is, once you pay $226, Medicare pays 80% of the Medicare-approved amount, while you pay 20% of that amount.

If you’re enrolled in a Medicare Supplement plan, it may help pay for your out-of-pocket cost.

If Part B will not allow your specific injections to be considered medically necessary, check to see if your Part D plan will cover them.

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