What is Billable Through Medicare Part B?

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Medicare Part B covers two types of services:

Medically necessary services: Services that are needed to diagnose or treat your medical condition and meet accepted medical practice standards.

Preventive services: Health care to prevent illness or detect diseases early, when treatment is most likely to work best.

Eligibility for Medicare Part B

Any American eligible for premium-free Medicare Part A is automatically eligible for Medicare Part B by enrolling and paying a monthly premium. If you worry that you are not eligible for premium-free Medicare Part A, it’s essential to know that you can qualify for Medicare Part B by meeting the following requirements:

  1. You must be 65 years or older.
  2. You must be a U.S. citizen or a permanent resident lawfully residing in the U.S for at least five continuous years.

If you are receiving retirement benefits before age 65 or qualify for Medicare through disability, you’re generally enrolled in Medicare Part A and Part B as soon as you become eligible.

What is billable through Medicare Part B? The essential medically-necessary services covered include:

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  • Abdominal Aortic Aneurysm Screening
  • Ambulance Services
  • Blood
  • Bone Mass Measurement (Bone Density)
  • Cardiac Rehabilitation
  • Cardiovascular Screenings
  • Chiropractic Services (limited)
  • Clinical Laboratory Services
  • Clinical Research Studies
  • Colorectal Cancer Screenings
  • Defibrillator (Implantable Automatic)
  • Diabetes Screenings
  • Diabetes Self-Management Training
  • Diabetes Supplies
  • Doctor Services
  • Durable Medical Equipment (like walkers)
  • EKG Screening
  • Emergency Department Services
  • Eyeglasses (limited)
  • Federally-Qualified Health Center Services
  • Flu shots
  • Foot Exams and Treatment (Diabetes-related)
  • Glaucoma Tests
  • Hepatitis B Shots
  • HIV Screening
  • Home Health Services
  • Kidney Dialysis Services and Supplies
  • Kidney Disease Education Services
  • Medical Nutrition Therapy Services
  • Non-doctor Services
  • Outpatient Medical and Surgical Services and Supplies
  • Physical Exams
  • Pneumococcal Shot
  • Prescription Drugs (limited)
  • Prostate Cancer Screenings
  • Pulmonary Rehabilitation
  • Rural Health Clinic Services
  • Second Surgical Opinions
  • Smoking Cessation (counseling to stop smoking)
  • Speech-Language Pathology Services
  • Surgical Dressing Services
  • Telehealth
  • Tests (other than lab tests)

Preventative services that are covered under Medicare Part B:

  • Preventive shots, including the flu shot during flu season, and three Hepatitis B shots, if you’re considered at risk
  • Hearing exams
  • Mammograms
  • Dialysis
  • Pap tests and pelvic exams
  • Mental health care
  • Occupational therapy
  • Physical therapy
  • Prosthetic devices
  • Transplant services

CNBC News states that “estimates for the 2021 Part B premium, which adjusts each year, have been tricky due to the coronavirus pandemic and its effect on health care services. A provision to limit a possible premium increase to 25% of what it would be otherwise is included in a short-term budget bill that funds the government through Dec. 11.”

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See also: A Question Many Seniors are Asking Themselves: Do Dentists Accept Medicare Part B?

You can check out the full details here: Congress caps Medicare Part B premium spike for 2021

The standard monthly Part B premium:  $144.60 in 2020; Medicare Part B premiums may change from year to year, and the amount can vary depending on your situation. If your income exceeds a certain amount, your premium could be higher than the standard premium, as there are different premiums for different income levels.

Part B deductible & coinsurance

In the latest Medicare 2020 regulations, you pay $198 for your Part B deductible. After you meet your deductible for the year, you typically pay 20% of the Medicare-approved amount for these:

  • Most doctor services
  • Outpatient therapy
  • Durable medical equipment (DME)

Some people automatically get Medicare Part B, while some people need to sign up for Part B.  If you fail to sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty

Now that you know what is billable through Medicare Part B, feel free to give us a call to see what the next steps to a thriving practice are. To get some actionable insights that will benefit your practice right-away you can also download our FREE 43-page Report to show you

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