Questions billers ask › What services are excluded from Medicare Part B coverage?

What services are excluded from Medicare Part B coverage?

Answered from the public Medicare sources on 2026-09-15. The quoted text is the source; the note beneath it is what our AI found. You decide what applies to your claim.

The rule, word for word

“The following services are excluded from coverage: (a) Routine physical checkups such as: (1) Examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptoms, complaint, or injury, except for screening mammography, colorectal cancer screening tests, screening pelvic exams, prostate cancer screening tests, glaucoma screening exams, ultrasound screening for abdominal aortic aneurysms (AAA), cardiovascular disease screening tests, diabetes screening tests, a screening electrocardiogram, initial preventive physical examinations that meet the criteria specified in paragraphs (k)(6) through (k)(15) of this section, additional preventive services that meet the criteria in § 410.64 of this chapter, or annual wellness visits providing personalized prevention plan services. (2) Examinations required by insurance companies, business establishments, government agencies, or other third parties. (b) Low vision aid exclusion—(1) Scope. The scope of the eyeglass exclusion encompasses all devices irrespective of their size, form, or technological features that use one or more lens to aid vision or provide magnification of images for impaired vision. (2) Exceptions. (i) Post-surgical prosthetic lenses customarily used during convalescence for eye surgery in which the lens of the eye was removed (for example, cataract surgery). (ii) Prosthetic intraocular [...]”

42 CFR § 411.15, Subpart A -- General Exclusions and Exclusion of Particular Services -- § 411.15 Particular services excluded from coverage.
Published2026-04-06 Captured2026-04-06
sha256:d35878e8…86e2fd4b · Source

What our AI found in the sources

Medicare Part B excludes the following services from coverage: routine physical checkups (except specified preventive screenings); low vision aids (eyeglasses and contact lenses, except post-cataract surgery); eye examinations for prescribing eyeglasses; hearing aids and related exams; most immunizations (except those for injury treatment, pneumococcal, hepatitis B, influenza, and COVID-19); orthopedic shoes and foot supports (except as part of leg braces); custodial care (except in hospice); cosmetic surgery (except for injury repair or malformed body members); most dental services (except when inextricably linked to covered medical services like organ transplants, cancer treatment, or jaw fractures); personal comfort items like TV or telephone; services not reasonable and necessary for diagnosis or treatment; routine foot care; and services of an assistant-at-surgery in cataract operations without prior approval or in procedures where assistants are used less than 5% nationally.

Also cited

If this comes up on one of your claims

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