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What Cannot be billed to Medicare Part B?

Medicare Part B helps pay for medically necessary doctor’s services, outpatient care, durable medical equipment, home health services, and other medical services. However, there are some limitations on what can be billed to Medicare Part B.

Doctor’s Services

Medicare Part B covers medically necessary doctor’s services, including:

  • Office visits
  • Surgery
  • Physical exams
  • Mental health services
  • X-rays
  • Lab tests

However, Medicare Part B does not cover:

  • Routine physical exams (except the one-time “Welcome to Medicare” physical exam)
  • Most dental care
  • Routine vision exams, eyeglasses, contact lenses
  • Hearing exams, hearing aids
  • Cosmetic surgery unless medically necessary

Outpatient Care

Medicare Part B covers medically necessary services you get as a hospital outpatient, including:

  • Emergency department services
  • Outpatient clinic services
  • Lab tests billed by the hospital
  • Mental health care in a partial hospitalization program
  • X-rays and other radiology services billed by the hospital
  • Medical supplies such as splints and casts
  • Certain preventive screenings and services

However, Medicare Part B does not cover:

  • Take-home drugs
  • Self-administered drugs you wouldn’t need medical personnel to give you, like insulin
  • Outpatient hospital stays that are not medically necessary

Durable Medical Equipment (DME)

Medicare Part B covers durable medical equipment that your doctor prescribes for use in your home, including:

  • Wheelchairs
  • Walkers
  • Hospital beds
  • Oxygen equipment
  • Blood sugar monitors
  • Nebulizers

However, Medicare Part B does not cover:

  • Most dental care equipment
  • Eyeglasses or contact lenses
  • Hearing aids and batteries
  • Non-medical items like air conditioners or chair lifts
  • TENS units (devices that use electrical nerve stimulation for pain relief)

Home Health Services

Medicare Part B covers medically necessary part-time or intermittent skilled nursing care and home health aide services, including:

  • Wound care
  • Patient education
  • Intravenous (IV) therapy
  • Injections
  • Colostomy care
  • Physical therapy
  • Speech therapy
  • Occupational therapy

However, Medicare Part B does not cover:

  • 24-hour home care
  • Meals delivered to your home
  • Homemaker services like shopping, cleaning, laundry
  • Personal care like bathing, dressing, using the bathroom
  • Home health care provided in assisted living facilities if that’s your main residence

Other Services

Medicare Part B also helps pay for:

  • Ambulance services
  • Dialysis
  • Mental health services
  • Chemotherapy
  • Radiation therapy
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs, like some cancer drugs you wouldn’t give yourself
  • Blood transfusions
  • Transplants and immunosuppressant drugs

However, Medicare Part B does not cover:

  • Most prescription drugs
  • Long-term care (also called custodial care)
  • Most dental care
  • Routine foot care
  • Cosmetic surgery unless medically necessary
  • Acupuncture
  • Hearing aids and exams
  • Routine eye care and most eyewear

Preventive Services

Medicare Part B covers many preventive services, including:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screening and counseling
  • Bone mass measurements
  • Cardiovascular disease screenings
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • HIV screenings
  • Obesity screenings and counseling
  • Prostate cancer screenings (PSA tests)
  • Sexually transmitted infections screenings and counseling
  • Tobacco use cessation counseling
  • Vaccines including flu, hepatitis B, pneumococcal
  • Welcome to Medicare preventive visit (one time)
  • Yearly wellness visit

However, Medicare Part B does not cover:

  • Physical exams for clearing someone for work or insurance purposes
  • Most chiropractic services
  • Routine hearing or vision exams
  • Vitamin B-12 or other injections that aren’t medically necessary
  • Personalized prevention plan services performed by providers who are not primary care providers


In summary, Medicare Part B covers a wide range of medically necessary services and preventive care. However, it does not cover long-term custodial care, most dental services, routine eye care, cosmetic procedures, or other services that are not considered medically necessary. Knowing what is excluded from Medicare Part B coverage can help you plan accordingly for those health care costs.