Home Resources Our blog Understanding Medicare Coverage: What’s Included and What’s Not
About Medicare
//
May 29, 2024

Understanding Medicare Coverage: What’s Included and What’s Not

medicare procedure coverage

Medicare provides coverage for a wide range of medical services and procedures. However, understanding what Medicare covers can be complex. This article aims to clarify the basics of how Medicare determines coverage.

What Does Medicare Cover?

Medicare coverage focuses on what is considered “medically necessary.” A medically necessary service or procedure is one that is required to diagnose or treat an illness or injury, or to improve the functioning of a malformed body part.

How Does Medicare Determine Coverage?

Medicare coverage decisions are based on national and local policies. The process includes:

• Medical Necessity: Medicare only covers services and supplies that are considered medically necessary. Doctors and healthcare providers must provide documentation to support the need for the service or procedure.
• Medical Coding: Providers use specific codes to report medical services and procedures to Medicare. These codes must match the services billed to Medicare and be justified as medically necessary.
• Participating Providers: Medicare covers services provided by participating providers who accept Medicare assignment. This means they agree to the Medicare-approved amount for a service as full payment.

Medicare has a tool that you can use to check if your test, item, or service is covered. You can utilize this tool here.

Understanding what Medicare covers and the criteria used for determining coverage will help you make informed decisions. Always check with Medicare or your insurance provider to confirm the coverage of specific services and procedures.

If you have any questions about Medicare coverage or need assistance, we’re here to help! Our agents are collectively licensed in all 50 states to offer free Medicare guidance, so you don’t have to face Medicare alone. At AMAC, we make Medicare make sense. Call 855-611-4856 to speak to an agent today!

Share this article:

Shop and compare Medicare Advantage plans now

Related Blog Articles
medicare card and number
About Medicare
// Jun 13, 2024

Can’t Locate Your Medicare Number? Find it Online!

There may be times when you need your Medicare number right away and can’t seem to ...
Read more
health and obesity
About Medicare
// Jun 10, 2024

Health, Fitness, and Obesity: The Role of Medicare

Health and fitness have long been recognized as crucial components of a healthy lifes...
Read more
summer exercise; man running
Other
// Jun 7, 2024

Exercise Tips to Beat the Heat This Summer

Summer is the perfect season to take your fitness routine outside. Longer days and wa...
Read more
physical therapy coverage and medicare
About Medicare
// Jun 6, 2024

Understanding Medicare Coverage of Physical Therapy

Physical therapy is essential for recovery from injuries, surgeries, and managing chr...
Read more