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Does Medicare Cover Heavy Metal Testing

Does Medicare Cover Heavy Metal Testing?

Heavy metals in inorganic form can cause gastrointestinal irritation. This can cause symptoms such as nausea, vomiting, abdominal pain, and diarrhea. 

Heavy metal toxicity can be a dangerous thing. A heavy metal test measures multiple heavy metals in our body in just a single test sample. 

Heavy metal testing can come in the form of a urine test or a blood test. If you or a loved one are in need of this type of test, a common question for many is “does Medicare cover heavy metal testing?” 

In this article, we answer that question in clear, plain English. You will also find the average costs of going through heavy metal testing for those who don’t have insurance.

Does Medicare Cover Heavy Metal Testing?

The short answer is yes; Medicare will cover the cost of a heavy metal testing. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your heavy metal testing. Below we look at what these are so you know what to expect.

Original Medicare Coverage

Original Medicare (Medicare Part A and Part B) provides coverage for heavy metal testing. It will provide coverage for your heavy metal testing if it is considered medically necessary. 

The test must also be first ordered by your healthcare provider in order for Original Medicare to provide coverage.

Part C Coverage for Heavy Metal Testing

Medicare Advantage plans (Medicare Part C) also provide coverage for heavy metal testing. These plans are required to cover the same testing, procedures, treatments, etc. that Original Medicare covers.  

Part C plans will also provide coverage for some services that Original Medicare does not. But exactly what a Parc C plan covers and how much the out-of-pocket costs are will depend on the specifics of the plan you have.

More on Heavy Metal Tests

Testing for heavy metals must be ordered by a healthcare provider with a detailed medical history of the patient. This includes careful documentation of occupational and avocational exposure to these toxins.

This test does not include iron or lithium as the former is tested through a different test and treatment known as Intravenous Iron Therapy as well as Serum Iron Studies. 

The metals included in heavy metal testing are the following:

  • Aluminum
  • Antimony
  • Arsenic
  • Barium
  • Beryllium
  • Bismuth
  • Cadmium
  • Chromium
  • Cobalt
  • Copper
  • Lead
  • Manganese
  • Mercury
  • Molybdenum
  • Nickel
  • Selenium
  • Thallium
  • Tin
  • Titanium
  • Zinc

Although Original Medicare provides coverage for heavy metal testing, there is currently no National Coverage Determination also known as NCD. 

Yet, there is a Local Coverage Determination, or LCD for this treatment. 

How Much Does Heavy Metal Testing Cost?

The exact costs of having a heavy metal testing depends on a few different factors. The main factors that go into the cost are exactly what metals you are testing for, whether it is a urine or blood test, and if you complete it at home or in a lab.

The costs for these tests range from $100 to $550 if you do not have health insurance coverage.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare Cover Denosumab Injections?

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