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Does Medicare Cover Thyroid Tests and Screenings


There is Medicare coverage for thyroid testing and screenings. Coverage would fall under Part B if done in an outpatient setting. If done in an inpatient setting, then Part A would cover it.

How Much Does Medicare Pay for Thyroid Tests?

When your doctor performs your thyroid tests in outpatient settings, you’ll have 80% coverage under Part B. Therefore, you’ll be responsible for the Part B deductible as well as the 20% coinsurance. Any thyroid tests given during a stay at the hospital would fall under Part A. You’ll be responsible for the Part A deductible and any other cost-sharing.

If you have a Medicare Supplement plan, any coinsurance will be covered by the plan. Depending on what letter plan you enrolled in, you may also have coverage for any deductibles. Leaving you with zero out of pocket costs.

How Often Will Medicare Cover Thyroid Testing?

In patients that are not at risk of hyperthyroidism or hypothyroidism, a test may be conducted up to two times per year. Patients who are at risk, if your doctor finds it medically necessary to test more than twice per year, Medicare may cover it.

Thyroid Tests Covered by Medicare

Doctors or health care providers may order a variety of tests to determine the status of a patient’s condition.

Below are some thyroid tests Medicare will cover:

  • Thyroid-stimulating hormone levels (TSH)
  • Free thyroxine (fT-4)
  • Total thyroxine (T4)
  • Triiodothyronine (T3)

Indications for Coverage:

  • Monitor thyroid hormone levels
  • Monitor the effectiveness of thyroid medications
  • Determine if it’s primary or secondary hypothyroidism
  • Confirm if it’s hypothyroidism or hyperthyroidism
  • Rule out if it’s hypothyroidism or hyperthyroidism
  • Monitor effectiveness of any therapies

Conditions Where Medicare Considers a Thyroid Test Medically Necessary

Below is a list of some of the conditions where Medicare will consider a thyroid test medically necessary.

  • metabolic disorders
  • malnutrition
  • hyperlipidemia
  • certain types of anemia
  • psychosis and non-psychotic personality disorders
  • unexplained depression
  • ophthalmologic disorders
  • various cardiac arrhythmias
  • disorders of menstruation
  • skin conditions
  • myalgias
  • alterations in consciousness
  • malaise
  • hypothermia
  • symptoms of the nervous and musculoskeletal system
  • skin and integumentary system
  • cardiovascular
  • gastrointestinal system

Types of Thyroid Diseases

The thyroid gland helps regulate the body’s metabolism, regulated by the thyroid-stimulating hormone (TSH). Different diseases and disorders may affect how the thyroid functions or the structure of the gland itself.

Hypothyroidism

Hypothyroidism is the result of a lack of production of thyroid hormones. Individuals with this condition may experience several signs or symptoms; while others may not have any.

Signs of hypothyroidism are dry skin, fatigue, feeling “foggy” or having poor concentration, slow reflexes, loss of hair, digestive issues (constipation), and weight gain. Other symptoms include feeling cold, fluid retention, aching muscles, and joints, slow speech, and depression. In some cases, women have had abnormally long cycles or excessive menstrual bleeding.

Hyperthyroidism

Although, not as common hyperthyroidism is the opposite. This condition is an overactive gland, excessively producing thyroid hormones.

In such cases, patients may have a higher metabolism. Signs may include tremors, nervousness, increased heart rate, anxiety, and excessive sweating. Individuals may notice a heat intolerance, more bowel movements than usual, unintentional weight loss, and even difficulty concentrating.

Many individuals with hyperthyroidism notice an enlargement of their thyroid gland. Those with hyperthyroidism will need a bone mass density test.

FAQs

Does Medicare cover Armour?
No, Medicare does not cover Armour at this time.
Does Medicare cover NP Thyroid?
No, Medicare does not cover NP Thyroid at this time.
Will Medicare cover an ultrasound on the thyroid?
Yes, if your doctor deems it medically necessary, the ultrasound would be covered under Part B if performed in an inpatient setting and Part A if performed at the hospital.
How much does Medicare pay for thyroid sonography?
If coverage for the sonography falls under Part B, Medicare will cover 80% of the costs. If it falls under Part A, you could have to pay up to $1,484 to met the inpatient deductible if you don’t have supplemental coverage such as Medigap.

How to Get Help with Cost-Sharing for Thyroid Testing and Screenings Under Medicare

Many beneficiaries don’t know Part B does not cover 100% of your medical costs. You’re left with deductibles and coinsurance with zero caps on your maximum out of pocket costs. You can get most, if not all, your cost-sharing covered by enrolling in a Medicare Supplement plan. Medicare also does not cover any thyroid medications given at home. That’s where a stand-alone Part D plan comes into play.

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

4 thoughts on “Does Medicare Cover Thyroid Tests and Screenings

  1. I had my thyroid ablated 27 years ago for Grave’s disease. My thyroid has been relatively stable over the years with thyroid supplements, but occasional changes in dosage have been needed. This year Medicare is denying payment on having my thyroid levels (tsh and free T4) checked. It has been a little over a year since they were last checked. Why would they deny this-claiming “frequency”?

    1. Hi Della! Medicare will cover thyroid testing two times per year. If you adjust the medications and need to test again to make sure the dosage is accurate, Medicare will also cover the test. Even if you already received two tests within the year. If Medicare denied the claim, I would talk to your doctor and submit an appeal. I hope this helps! If you have a policy through us, our Client Care Team can help you with the appeal!

  2. I am scheduled for ultrasound of thyroid next week at doctors clinic will I have to pay the 20%

    1. Hi Imogene! Yes, if you only have Part A and Part B without any supplemental coverage, you’ll be responsible for the 20% coinsurance as well as the Part B deductible of $198. If you have a Medigap plan, you’ll have coverage for the 20% coinsurance. Depending on the letter plan you enrolled in, you may also have coverage for the Part B deductible. I hope this helps!

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