Fundamentals of Medicare

Section 2: Medicare Basics


Medicare Program Exclusions

No payment can be made under Medicare Part A or Medicare Part B for certain items and services. The list below includes the general Medicare program exclusions. For details regarding each exclusion, refer to the CMS IOM Publication 100-02, Medicare Benefit Policy Manual and the appropriate chapter and section as indicated.

  • Charges by immediate relative or members of household (Chapter 16, Section 130)
  • Cosmetic surgery (Chapter 16, Section 120)
  • Conditions resulting from war (Chapter 16, Section 70)
  • Custodial care (Chapter 16, Section 110)
  • Dental services (Chapter 16, Section 140): care, treatment, filling, removal or replacement of teeth or structures directly supporting the teeth
  • Excluded investigational devices (Chapter 14, Section 30)
  • Foot care (Chapter 16, Section 30 and Chapter 15, Section 290): supportive devices for feet; routine removal of corns/calluses or trimming of nails
  • Hearing aids (Chapter 16, Section 100)
  • No legal obligation to pay for or provide services (Chapter 16, Section 40): members of religious orders
  • Non-physician services provided to a hospital inpatient which were not provided directly or arranged for by the hospital (Chapter 16, Section 170)
  • Personal comfort items and services (Chapter 16, Section 80)
  • Routine services and appliances (Chapter 16, Section 90): yearly checkups; eyeglasses and contact lenses
  • Services not reasonable and necessary (Chapter 16, Section 20): devices not approved by the FDA
  • Services or items not provided within the United States (Chapter 16, Section 60)
  • Services or items paid or expected to be paid under workers’ compensation (Chapter 16, Section 150)
  • Services or items paid for by another government entity (Chapter 16, Section 50): prisoners, active duty members of the uniformed services; government research grants
  • Services related to and required as a result of services which are not covered under Medicare (Chapter 16, Section 180)

Reviewed 6/4/2024