Which services are specifically excluded from Medicare coverage under 42 CFR 411.15? Answer in under 100 words.
Details / How it works
The regulation lists over a dozen categories of services excluded from Medicare coverage, with specific exceptions for certain preventive services, prosthetic lenses, immunizations (pneumococcal, hepatitis B, influenza, COVID-19), and dental services linked to covered medical procedures. Exclusions also encompass services not reasonable and necessary for diagnosis or treatment, custodial care, cosmetic surgery, and foot care, among others.
Exceptions & edge cases
Notable exceptions include: (1) routine physicals that are part of preventive services like screening mammography and annual wellness visits; (2) prosthetic lenses after cataract surgery; (3) pneumococcal, hepatitis B, influenza, and COVID-19 vaccinations; (4) dental services integral to covered medical services such as organ transplants or cancer treatment; and (5) certain implantable auditory devices like cochlear implants.
Sources
- [1]U.S. National Archives, Electronic Code of Federal Regulations — 42 CFR 411.15 — Particular services excluded from coverage · as of 2026-08-26
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