This section provides information about covered and non-covered services under Medicare Part B, which typically covers outpatient health care expenses including doctor fees.

Coverage Services and Items

Subject to certain restrictions, Medicare Part B covers the following services and items when medically reasonable and necessary:

• Physician services, including
  • Surgery
  • Consultation
  • Office and institutional visits
  • Services and supplies furnished “incident to” physician professional services
• Ambulance service
• Approved ambulatory surgical center (ASC) services
• Artificial legs, arms and eyes
• Certified physician assistant services
• Clinical psychologist and licensed clinical social worker services
• Diagnostic x-ray tests, laboratory tests, and other diagnostic tests
• Leg, arm, back and neck braces
• Nurse practitioner, nurse midwife, certified registered nurse anesthetists, and clinical nurse specialist services
• Physical, occupational and speech therapy services
• Prescription Drugs (Beginning Jan 1, 2006, new Medicare prescription drug plans will be available.)
• Prosthetic devices to replace all or part of a body organ
• Rental or purchase of durable medical equipment
• Surgical dressings, splints, casts, and other devices used for reduction of fractures and dislocations
• X-ray, radium, and isotope therapy

Payment may not be made under Part B for services rendered to a patient who is entitled to have payment made for those services under Medicare Part A.

Non-covered (Excluded) Services and Items

Medicare provides basic health care coverage, but it does not pay all medical expenses. Noncovered Medicare services include:

• Any chiropractic service, except for treatment of subluxation of the spine
• Cosmetic surgery
• Custodial care
• Dental care and dentures
• Extra charges for a private room
• Full-time nursing care in the home
• Most eyeglasses and eye exams
• Most immunization shots (except the pneumonia vaccine, flu vaccine and Hepatitis B vaccine)
• Nursing home care
• Over-the-counter drugs
• Personal comfort items
• Private duty nurse
• Routine foot care
• Tests for fitting hearing aids or the hearing aids

In most cases, a physician or supplier may collect charges from you for services that are completely denied as not covered by Medicare, even though assignment was accepted.