Medicare Coverage of a Glaucoma Screening


What It Is

Screening test for glaucoma

What's Covered

Medicare Part B covers one screening test for glaucoma every year for patients at high risk for the disease. Categories of people considered at high risk include:

  • People with diabetes.

  • People with a family history of glaucoma.

  • African Americans ages 50 or over.

  • Hispanic Americans ages 65 or over.

The test must be performed by an ophthalmologist or other eye doctor who who participates in Medicare and who is certified by the state medical board to perform such screenings.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for glaucoma screening, contact the plan directly.

What Medicare Pays

Medicare Part B pays 80 percent of the Medicare-approved amount.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

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