Medical Billing
Medical Billing

What is Covered by Part B of Medicare? A Guide for Medical Billers.


When working with your patients in a medical practice, it is important to understand what their insurance coverage is and how it works. This is especially true for Medicare patients.

Currently, 44 million Americans are enrolled in the Medicare program and enrollment is expected to rise to 79 million within 15 years. While only about 10% of beneficiaries rely solely on the Medicare program for health care coverage, it is important to understand what benefits are available for your patients, should they require coverage.

For patients using Medicare, there is a great deal of confusion between Part A, Part B, Part C and Part D of Medicare Coverage. This article will cover what is covered by Part B of Medicare.

What is covered by Part B of Medicare?

Medicare Part B is essentially your patient’s health insurance coverage. Many patients using Medicare never need to go into the hospital, but almost all of them will see the doctor or will need diagnostic screenings and lab tests sooner or later.

It covers two types of services, including medically necessary services such as doctor’s office visits, lab work, x-rays, and outpatient surgeries, and preventive services to keep you healthy, like cancer screenings and flu shots.

The wide range of services Part B of Medicare covers include:

– Approved medical and surgical services from any doctor anywhere in the nation who accepts Medicare patients, whether those services are provided in a doctor’s office, hospital, long-term care facility, or at home

– Diagnostic and lab tests done outside hospitals and nursing facilities

– Preventive services such as flu shots, mammograms, screenings for depression and diabetes, and so on, many of which are free

– Some medical equipment and supplies (for example, wheelchairs, walkers, oxygen, diabetic supplies, and units of blood)

– Some outpatient hospital treatment received in an emergency

Costs for Part B services vary, and sometimes a patient will pay a deductible and then 20% of the Medicare-approved amount, as long as they use providers who accept Medicare assignment.

Most patients pay a premium for Part B. Even if your patients are enrolled in a Medicare Advantage plan that provides Part A and Part B benefits, they still may have to pay a Part B premium.

Knowing and explaining these issues to patients is a huge help for them. Remember that the majority  of patients do not deal with medical health payments as often as you do, so they will greatly appreciate your support.


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