Medicare Coverage of a Repeated Medical Procedure


What It Is

A medical procedure that has been performed previously on the same patient

What's Covered

For any particular type of medical procedure, Medicare Part A, Medicare Part B, or a Medicare Part C plan provides coverage only if the care is "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. With a procedure that's being repeated, any coverage depends on whether there's a reasonable likelihood that the repeated procedure will have meaningful success when measured against the outcome of the previous same procedure (which failed or was only partially or temporarily successful). For help getting a repeat procedure covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

What Medicare Pays

If Medicare Part A, Medicare Part B, or a Medicare Part C plan covers a repeat procedure, it will pay the same amount for the procedure that it paid the first time it was performed.

Physical, speech, or occupational therapy: If the repeat procedure is physical therapy, speech therapy, or occupational therapy, the amount Medicare Part B or a Medicare Part C plan will pay depends on the yearly cap on the amount it pays for each type of therapy.

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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