Warts are common skin growths that can be bothersome depending on their size and location. Determining whether Medicare covers wart removal depends entirely on the documented purpose of the procedure. Coverage is only provided if the removal is deemed necessary to protect a person’s health or preserve function, not merely for reasons of appearance.
Original Medicare Coverage for Medically Necessary Removal
Original Medicare covers wart removal when a physician determines the procedure is medically necessary to treat a disease, injury, or improve the function of a body part. This coverage falls under Medicare Part B, which handles outpatient services, including doctor visits and procedures performed in a clinic setting. The physician must provide specific documentation to justify the medical necessity for Medicare to process the claim.
A wart removal is considered medically necessary if the lesion is causing pain, bleeding, persistent itching, or has physical evidence of infection. Removal is also covered if the wart interferes with mobility or daily function, such as a painful plantar wart on the sole of the foot. Coverage applies if the wart obstructs an orifice, restricts vision, or if the physician suspects the lesion may be malignant. Covered procedures often involve cryotherapy, surgical excision, cauterization, or laser ablation.
When Wart Removal is Considered Cosmetic and Not Covered
Medicare does not cover any procedure performed solely for cosmetic reasons, which applies directly to the removal of benign skin lesions like warts. If a wart is small, painless, does not bleed, and does not impair function, its removal is considered elective and is not covered.
When removal is cosmetic, the person is responsible for the entire cost of the procedure. Medicare will deny the claim if the removal is not required to maintain health. The distinction relies heavily on the medical record; if the provider documents the removal is solely for appearance or lacks clinical evidence of pain or functional impairment, the claim will be denied.
Patient Costs Under Original Medicare (Part B)
When a medically necessary wart removal is covered by Original Medicare Part B, the beneficiary is responsible for out-of-pocket costs. The person must first meet the annual Part B deductible for that calendar year. If the deductible has not been met, the person must pay the full deductible amount before Medicare begins payment.
Once the deductible is satisfied, the person is responsible for a 20% coinsurance of the Medicare-approved amount for the procedure. Medicare pays the remaining 80% of the approved amount for the outpatient service. Supplemental insurance policies, such as Medigap, may cover this 20% coinsurance.
How Medicare Advantage (Part C) Handles Wart Removal
Medicare Advantage Plans (Part C) must cover at least the same benefits as Original Medicare. Therefore, a medically necessary wart removal covered under Part B must also be covered by a Part C plan. These private plans, however, administer the coverage differently from Original Medicare.
Part C plans often replace the standard 20% coinsurance with a fixed copayment for outpatient procedures. These plans utilize a network of approved providers, and costs may be higher if a person sees an out-of-network dermatologist. Some plans also require prior authorization before the procedure is performed, even if it is medically necessary. Beneficiaries must consult their plan documents to understand their cost-sharing and administrative requirements.