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Does Medicare Cover Biopsies?

Sometimes, your doctor may order a biopsy to confirm a diagnosis. Although you might know what a biopsy is from doctor shows, did you know there are different types of biopsies? Or, how about that they’re used for more than checking for cancer? Did you know that they may be covered by Medicare? Even key details of biopsy basics are easy to glance over and miss!

What are Biopsies?

A biopsy is removing a piece of tissue from the body in order to examine it. Let’s say you have symptoms of a specific illness, and some basic scans have supported the diagnosis of that illness. A biopsy may be used to look at the tissue from the affected organ and confirm the diagnosis. Using that sample, a doctor may also be able to determine the condition of the tissue, the progression of an illness, or if further testing is needed.

While biopsies are frequently used to confirm cancer diagnoses, they can be used for a long list of conditions and organs. You may have a biopsy to diagnose a bone infection or inflammation in the kidney. A biopsy can confirm if a transplanted organ is being rejected by the body. They may also be requested to look at your muscles in cases of infection or atrophy. Of course, biopsies are used to determine if a tumor is benign or malignant. Whenever your doctor or team of health care professionals need a better look at something in your body, a biopsy may be useful.

What Types of Biopsies are There?

Not all biopsies are the exact same, as the term itself is fairly broad. As we defined, a biopsy is just the removal of tissue for examination. The how and what goes a long way to defining a biopsy; often, they’re deeply intertwined, with certain biopsy methods being better suited for certain organs than others. In some cases, it’s as simple as scraping away some tissue, while others require more invasive methods and special tools. Which type a doctor utilizes can depend on where the tissue is located and what tools are available to assist with the procedure.

Needle Biopsy Perhaps the most common form of biopsy, a needle biopsy is when a doctor inserts a large, specialized needle into the body to collect cells and tissue from the area of concern. Fine needle biopsies use a thin, hollow needle to take cells, while core needle biopsies uses a wider, hollow needle to gather tissue samples.

Endoscopic Biopsy If you’re receiving an endoscopy, your doctor may take a sample of tissue as part of the procedure. They’ll accomplish this by inserting specialized tools through the endoscope to act as a guide before removing the concerning tissue.

Surgical Biopsy Sometimes called an open biopsy, a surgical biopsy is when a cut is made in the skin to access the tissue that will be biopsied. An incisional biopsy removes a part of the tissue, while an excisional biopsy removes the entire piece of concerning tissue or lump.

Image-Guided Biopsy Your doctor may call on imaging equipment to help guide their biopsy, whether it’s the exact position the needle should take or the location of tissue. This imaging equipment can guide the doctor in real time, giving them accurate and up-to-date information throughout the process. They may use an ultrasound, CT scan, or an MRI scan.

Skin Biopsy A skin biopsy differs from many other types of biopsies because it’s generally easier to take a sample. A doctor may take a shave biopsy, when they use a razor or scalpel to scrape a small amount of tissue off the specific area. They may also do a punch biopsy by using a round blade to punch a hole in the skin and remove tissue there. Finally, they may take an excisional biopsy by removing the full lesion or piece of skin that they wish to investigate.

Liquid Biopsy Very similar to a needle biopsy, a liquid biopsy takes a liquid sample to test for signs of a condition. This can be blood, urine, or any other bodily fluid. Liquid biopsies allow for multiple samples to be taken over a span of time to test the progression of symptoms or to check for signs of a condition like cancer.

Does Medicare Cover Biopsies?

Once you know the type of biopsy you’ll be receiving, the question of insurance coverage and payment comes next. Prices for a biopsy can vary wildly, depending on the type and from where the tissue is taken. Generally, the range of costs can be from $150 (for a skin biopsy) up to $10,000 (for a kidney biopsy), with some going as high as nearly $30,000 (for a lung biopsy). Here is where it pays to have medical insurance; if you’re on Medicare, you should be covered. Most of the time, biopsies are considered medically necessary, and therefore, will be covered.

If your biopsy is taken as part of outpatient care, which is fairly common, it’ll be covered under Medicare Part B. Once you’ve met the Part B deductible ($226 in 2023), Medicare will cover 80 percent of the approved costs. This means you’ll owe the remaining 20 percent (cutting the range to $30 to $6,000). If the biopsy is given as part of inpatient care, it would be covered under Medicare Part A. In this case, you would need to meet your Part A deductible for the year ($1,600 in 2023). After that, you’ll owe a daily coinsurance for days 61 to 90 ($400 in 2023), if you require that long of a stay. If you’re enrolled in a Medicare Supplement, your out-of-pocket costs may be even lower.

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As far as diagnostic strategies go, a biopsy is one of the most direct, giving doctors the ability to see and test concerning tissue. There are many types of biopsies and many ways they may be useful. If you’re ever in need of a biopsy, it’s good to know that Medicare should also have you covered.

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