Does Medicare Cover TB tests?

Medicare Benefits Solutions
Jul 9, 2021

TB was once considered a rarity in developed countries. However, it is still a concern for the following reasons:

  • People with weakened immune systems, such as those with HIV, are at high risk of exposure to TB germs.
  • Many strains of TB are drug-resistant.
  • Averting antibiotic resistance and eradicating TB infection requires taking multiple medications for the long term.

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What is Tuberculosis?

Tuberculosis (TB) is an infectious disease caused by bacteria known as Mycobacterium tuberculosis. If an infected person coughs or sneezes, and the bacteria spreads to other people, the consequences can be serious.

This may have you wondering if Medicare covers the costs of a TB test.

Medicare Benefits for TB Testing

According to the Centers for Medicare & Medicaid Services (CMS), “Medicare Part B, which includes a variety of outpatient services, covers medically necessary clinical diagnostic tests when a doctor or other practitioner orders them.”

Medicare benefits cover laboratory tests under Part B if performed in a lab that satisfies Medicare requirements. If approved by Medicare, you would not typically have to pay anything for these tests.

  • Clinical – certain tests, including some screenings, using samples of blood, urine and tissue
  • Diagnostic – tests to uncover or rule out suspect disorders, and some screenings and preventive tests

Medicare benefits for non-laboratory tests, including X-rays and other diagnostic testing, are covered under Part B as well.

Out-of-pocket costs non-lab tests:

  • 20% coinsurance
  • Part B deductible
  • Copayment to hospital outpatient facility, if applicable

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Two Types of Tuberculosis

Here is a brief outline to explain how physicians categorize TB.

Latent Tuberculosis:

  • TB infection
  • Inactive bacteria
  • No symptoms
  • Not contagious

Active Tuberculosis:

  • TB disease
  • Feel sick
  • Potentially contagious

It’s important to note that latent tuberculosis infection (LTBI) can become active, so you still need to be treated. Active TB can surface weeks or years after you are infected by TB bacteria.

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Types of TB Tests

Your doctor will determine which of the two types of TB tests are appropriate for suspected TB infection:

  • Mantoux tuberculin skin test (TST): Fluid is injected into the skin, and your skin’s reaction is examined by a trained professional.
  • Blood test: QuantiFERON®-TB Gold Plus and T-SPOT® are approved by the Federal Drug Administration (FDA).

If you have a positive test result, your doctor will order additional testing, which will likely include a chest X-ray.

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Who Should Get Tested for TB?

TB tests are generally not necessary if your risk of being infected with TB bacteria is low, according to the Centers for Disease Control and Prevention (CDC). “Many people who have latent TB infection never develop TB disease.”

Some people are at a higher risk of infection than others. The CDC recommends that you get tested if you:

  • Are exposed to high-risk adults or people who have TB disease
  • Came from a country where TB disease is not uncommon, such as Latin America, Africa, Asia, the Caribbean, Russia and Eastern Europe
  • Reside or work in certain settings, such as a prison, long-term care center, nursing home or shelter
  • Are employed as a health-care practitioner caring for high-risk patients

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