Medicare Part B covers glaucoma screening once every 12 months for people in specified higher-risk groups. It is a defined screening benefit, not general payment for every routine vision exam or every test offered at an optical store.
Who meets the screening risk criteria?
- A person with diabetes.
- A person with a family history of glaucoma.
- An African American person age 50 or older.
- A Hispanic person age 65 or older.
An eye doctor legally authorized to perform glaucoma tests in your state must perform or supervise the screening. Ask the office to confirm your eligibility and when the last covered screening occurred.
Plan for separate charges
| Service | Payment distinction |
|---|---|
| Qualifying glaucoma screening | Part B deductible and generally 20% of the approved amount. |
| Hospital outpatient screening | An additional facility copayment can apply. |
| Routine refraction for glasses | Generally excluded from Original Medicare. |
| Further medical evaluation | Reviewed under the rules for the actual service. |
Before your appointment
Tell the practice whether the visit is for screening, a diagnosed condition or a glasses prescription. Ask which tests are planned and which charges may be separate. A preventive label does not automatically mean a zero-cost service.
If you have Medicare Advantage, confirm the provider network and any referral requirements with your plan. Use your current plan documents rather than another member's allowance.
If the claim is questioned
Check whether the issue concerns the screening interval, risk documentation, provider or billing. Request the written explanation and appeal instructions. The screening schedule for insurance payment does not replace your clinician's judgment about symptoms or necessary follow-up care.
Related coverage questions
- Medicare Vision Coverage: Eye Exams, Glasses and Costs
- Diabetic Eye Exams and Medicare: Annual Coverage and Costs
- Medicare Advantage Vision Coverage: What to Verify