List of Procedures Medicare Part B Covers

Below you will find a listing of things that are covered under Medicare Part B. If you do not see your medical need here, or if you need more info, check with your doctor or hospital to see if your neeeds can be paid for under Medicare Part B.

Social Security handles payment of Part B. You can reach them at 1-800-772-1213.

 

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Listing of Services Paid By Medicare Part B

If you don't find the item you are looking for below contact your doctor or medical facility about coverages not listed.

For info an what Medicare Part B is and what it covers CLick Here

How Can I sign up for Parts A & B? | Medicare.gov


  • Listing of Items Medicare Part B Covers


    (A)

    Abdominal Aortic Screening: You get one if you are at risk and it must be a referral from a professional. Family history or smoking can put you at risk.

    Alcohol Misuse Screening and Counseling: If a healthcare professional determines you are misusing alcohol you can get up to four brief face-to-face counseling sessions.

    Ambulance Service: Medicare will only pay to take you to the nearest facility that provides the care you need. That may not be your hospital of choice. Your Part B deductible applies.

    Ambulatory Surgical Centers: If you need minor surgery and will be released in 24 hours Medicare Part B will pay service fees for an ambulatory surgical center.


(B)

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Blood:If the facility has to pay a blood bank or other source for blood you will pay a copayment and/or handling fee for each unit of blood you receive and Part B deductible applies. You can offset this charge by either giving blood yourself or having someone else donate it.

Bone Mass Measurement (bone density): A test is covered every 24 months (more often if medically necessary). You pay nothing if the provider accepts Medicare. Always check before hand.

Breast Cancer Screening (mammograms): Once every 12 months for all women, with Medicare, who are over 40 are covered. No charge if the provider accepts Medicare for payment.


(C)

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Cardiac Rehabilitation: Covers exercise, education and counseling for patients who meet certain conditions. Also may cover more rigorous rehabilitation. You’ll pay 20% in a doctor’s office or a hospital copayment if you are treated there. Part B deductible also applies.

Cardiovascular Disease (behavioral therapy): Covers one visit a year with a primary care doctor to assist you in lowering your risk of cardiovascular disease. Aspirin use, blood pressure and tips on eating well might be discussed. No charge if the doctor accepts Medicare.

Cardiovascular Disease Screenings: Covers tests for cholesterol, lipid, lipoprotein, and triglyceride levels to detect conditions that might lead to heart attack or stroke. No charge for the tests but you may have to pay 20% of the Medicare approved amount for the doctor and the Part B deductible may apply.

Cervical and Vaginal Cancer Screening: Covers Pap tests, pelvic exams, and clinical breast exam once every 24 months or every 12 months for high risk patients. No payment is your provider accepts Medicare.

Chemotherapy: Covered in doctor’s office, freestanding clinic, or hospital outpatient setting if you have cancer. You pay a 20% of the Medicare approved amount in your doctor’s office you pay copayment for hospital outpatient setting. If you are and inpatient (formally admitted to the hospital) Medicare Part A pays that part.

Chiropractic Services (limited coverage): Covers subluxation (bones moved out of position). You will pay 20% of any Medicare approved amount and Part B deductible applies. You will also pay for any X-Rays, massage therapy and any costs not covered under Medicare.

Clinical Research Studies: If you take part in a qualifying clinical study Medicare covers some costs, like office visits and tests. You might have to pay 20% of the Medicare approved amount and Part D deductible may apply. NOTE: If you’re in a Medicare Advantage Plan such as an (HMO or PPO),some costs may be covered by your plan, and some by Medicare.

Colorectal Cancer Screening: Medicare covers these screenings to help find precancerous growths or find cancer early, when treatment is most effective. One or more of these tests may be covered:

Screening Fecal Occult Blood Test – Every 12 months if you are 50 or older. Pay nothing if Medicare is accepted.

Screening Flexible Sigmoidoscopy: Covered once every 48 months if you’re 50 or older, or every 10 years if you are not at risk. Covered 100% if Medicare is accepted.

Screening Colonoscopy: Every ten years (high risk every 2 years) or 4 years after a previous flexible sigmoidoscopy. No minimum age. Covered if Medicare is accepted. NOTE: If polyp is found or removed you may have to pay 20% of the Medicare approved amount and a possible copayment if done in a hospital or medical facility.

Screening Barium Enema: Covered once every 48 months for 50 and older (24 months for high risk) when used instead of a sigmoidoscopy or colonoscopy. You pay 20% of approved Medicare amount for doctor services. There may be a hospital copay as well.



(D)

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Defibrillator (implantable automatic):  Medicare covers these devices for some people diagnosed with heart failure. If the surgery takes place in an outpatient setting, you pay 20% of the Medicare-approved amount for the doctor’s services. If you get the device as a hospital outpatient, you also pay the hospital a copayment. In most cases, the copayment amount can’t be more than the Part A hospital stay deductible. The Part B deductible applies. Surgeries to implant defibrillators in a hospital inpatient setting are covered under Part A.

Depression Screening:  Medicare covers one depression screening per year when done in a primary care setting (like a doctor’s office) that can provide follow-up treatment and referrals. Test is covered if the doctor or other qualified health care provider accepts Medicare. If you get the depression screening and another service, you may need to pay 20% of the Medicare-approved amount for the other service and the Part B deductible may apply.

Diabetes screenings:  Medicare covers these screenings if your doctor determines you’re at risk for diabetes. You may be eligible for up to 2 diabetes screenings each year. Test is covered if your doctor or other qualified health care provider accepts Medicare.

Diabetes self-management training: Medicare covers diabetes outpatient self-management training to teach you to cope with and manage your diabetes. The program may include tips for eating healthy, being active, monitoring blood sugar, taking medication, and reducing risks. You must have diabetes and a written order from your doctor or other health care provider. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Diabetes Supplies: Medicare covers blood sugar testing monitors, blood sugar test strips, lancet devices and lancets, blood sugar control solutions, and therapeutic shoes (in some cases). Medicare only covers insulin if it’s medically necessary to use with an external insulin pump to administer the insulin. You pay 20% of the Medicare approved amount, and the Part B deductible applies.


NOTE: Medicare prescription drug coverage (Part D) may cover insulin, certain medical supplies used to inject insulin (like syringes), and some oral diabetic drugs. Check with your plan for more information.


IMPORTANT: If you get your diabetic testing supplies by mail, you’ll need to use a national mail-order program Medicare contract supplier for Medicare to pay. You can also get your supplies at a store, but you should check if your payment would be more. Visit Medicare.gov/supplier to find a contract supplier.

Doctor and Other Healthcare Provider Services: Medicare covers medically necessary doctor services (including outpatient services and some doctor services you get when you’re a hospital inpatient) and covered preventive services. Medicare also covers services provided by other health care providers, like physician assistants, nurse practitioners, social workers, physical therapists, and psychologists. Except for certain preventive services (for which you may pay nothing), you pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Durable Medical Equipment (Like Crutches or Walkers): wheelchairs

Medicare covers items like oxygen equipment and supplies, wheelchairs, walkers, and hospital beds ordered by a doctor or other health care provider enrolled in Medicare for use in the home. Some items must be rented. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.


IMPORTANT: In all areas of the country, you must get your covered equipment or supplies and replacement or repair services from a Medicare-approved supplier for Medicare to pay. For more information, visit Medicare.gov/publications to view the booklet “Medicare Coverage of Durable Medical Equipment and Other Devices.” You can also call 1-800-MEDICARE (1-800-633-4227) to find out if a copy can be mailed to you. TTY users should call 1-877-486-2048.

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: You must use Medicare approved suppliers called “Contract Suppliers” or Medicare will deny your claim and you will bear the full cost of the item(s). Medicare.gov/supplier has a list of approved suppliers in your area. If your ZIP code is in a competitive bidding area, the items included in the program are marked with an orange star. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.


(E)

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EKG (Electrocardiogram Screening): Medicare covers a one-time screening EKG if referred by your doctor or other health care provider as part of your one-time “Welcome to Medicare” preventive visit. You pay 20% of the Medicare approved amount, and the Part B deductible applies. An EKG is also covered as a diagnostic test. If you have the test at a hospital or a hospital owned clinic, you also pay the hospital a copayment.

Emergency Department Services: these services are covered when you have an injury, a sudden illness, or an illness that quickly gets much worse. In addition to the 20% of Medicare approved amount you pay for the doctor’s or other healthcare provider’s services you may also pay a specified copayment for the hospital emergency department visit. Be aware that Part B deductible applies and there may be additional costs if you are admitted to the hospital.

Eyeglasses (limited): Medicare covers one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. Note: Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare.


(F)

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Federally Qualified Health Center Services: Medicare covers many outpatient primary care and preventive services you get through certain community health centers. Generally, you’re responsible for paying a federally qualified health center 20% of its reasonable costs, but these health centers must offer you a discounted rate if your income is under a certain amount (this amount changes, so check with the health center). The Part B deductible doesn’t apply. You pay nothing for most preventive services. To find a Medicare participating, federally qualified health center near you, visit hrsa.gov.

Flu Shots: Covers one flu shot per season. There is no charge if the health provider giving the shot accepts Medicare.

Foot Exams and Treatment: Covers foot exams and treatments related to diabetes related nerve damage and/or meet certain conditions. You pay 20% of Medicare approved amount and Part B deductible applies. If you are treated in a hospital outpatient setting you also pay the hospital copayment.


(G)

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Glaucoma Test: Covered each year for those at high risk of glaucoma. You’re at high risk if you have diabetes, a family history of glaucoma, are African-American and 50 or older, or are Hispanic and 65 or older. An eye doctor who is legally allowed by the state must do the tests. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.


(H)

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Hearing and balance exams: Exams are covered is your doctor or other healthcare provider orders them to see if you might need medical treatment. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.
NOTE: Original Medicare does not cover Hearing aids or exams for fitting hearing aids. You may want to consider purchasing a separate vision plan.

Hepatitis B Shots: Covered for people at medium or high risk for Hepatitis B. Some risk factors include hemophilia, End-Stage Renal Disease (ESRD), diabetes, if you live with someone who has Hepatitis B, or if you’re a health care worker and have frequent contact with blood or body fluids. Check with your doctor to see if you’re at medium or high risk for Hepatitis B. No charge if the doctor or other qualified health care provider accepts Medicare.

HIV screening: Medicare covers HIV (Human Immunodeficiency Virus) screenings once per year for people at increased risk for HIV, including anyone who asks for the test. Medicare also covers HIV screenings for pregnant women up to 3 times during a pregnancy. You pay nothing for the HIV screening if the doctor or other qualified health care provider accepts assignment.

Home Health Services: Medicare covers medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for people with a continuing need for occupational therapy.

A doctor, or certain health care providers who work with a doctor, must see you face-to-face before a doctor can certify that you need home health services. A doctor must order your care, and a Medicare-certified home health agency must provide it.

Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home. You must be homebound, which means both of these are true:


1. You’re normally unable to leave home and doing so requires a considerable and taxing effort.


2. Because of an illness or injury, leaving home isn’t medically advisable or isn’t possible without the aid of supportive devices, use of special transportation, or the assistance of another person.
You pay nothing for covered home health services.


(K)

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Kidney Dialysis Services and Supplies: Generally, Medicare covers 3 dialysis treatments per week if you have End-Stage Renal Disease (ESRD). This includes all ESRD — related drugs and biologicals, laboratory tests, home dialysis training, support services, equipment, and supplies. The dialysis facility is responsible for coordinating your dialysis services (at home or in a facility). You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Kidney disease education services:  Covers up to 6 sessions of kidney disease education services if you have Stage IV chronic kidney disease, and your doctor or other health care provider refers you for the service. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.


(L)

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Laboratory Services: Medicare covers laboratory services including certain blood tests, urinalysis, and some screening tests. You generally pay nothing for these services.


(M)

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Medical Nutrition Therapy Services: Medicare may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant in the last 36 months, and your doctor or other health care provider refers you for the service. You pay nothing for these services if the doctor or other qualified health care provider accepts Medicare.

Mental health care (Outpatient): Medicare covers mental health care services to help with conditions like depression or anxiety. Coverage includes services generally provided in an outpatient setting (like a doctor’s or other health care provider’s office or hospital outpatient department), including visits with a psychiatrist or other doctor, clinical psychologist, nurse practitioner, physician assistant, clinical nurse specialist, or clinical social worker. Lab tests are also covered. Certain limits and conditions apply.
Generally, you pay 20% of the Medicare-approved amount and the Part B deductible applies for:

    • Visits to a doctor or other health care provider to diagnose your condition or monitor or change your prescriptions
    • Outpatient treatment of your condition (like counseling or psychotherapy)

Note: Inpatient mental health care is covered under Part A.


(O)

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Obesity Screening and Counseling: If you have a body mass index (BMI) of 30 or more, Medicare may cover up to 22 face-to-face intensive counseling sessions over a 12-month period to help you lose weight. This counseling is covered when provided in a primary care setting (like a doctor’s office). Talk to your primary care doctor or primary care practitioner to find out more. You pay nothing for this service if the primary care doctor or other qualified primary care practitioner accepts Medicare.


(P)

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Physical Therapy: Medicare covers evaluation and treatment for injuries and diseases that change your ability to function when your doctor or other health care provider certifies your need for it. There may be a limit on the amount Medicare will pay for these services in a single year and there may be certain exceptions to these limits. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Pneumococcal Shot: Medicare covers pneumococcal shots to help prevent pneumococcal infections (like certain types of pneumonia). Most people only need this shot once in their lifetime. Talk with your doctor or other health care provider to see if you should get this shot. You pay nothing for getting the shot if the doctor or other qualified health care provider accepts assignment for giving the shot.

Prescription Drugs Limited: Covers a limited number of drugs like injections you get in a doctor’s office, certain oral anti-cancer drugs, drugs used with some types of durable medical equipment (like a nebulizer or external infusion pump), and under very limited circumstances, certain drugs you get in a hospital outpatient setting. You pay 20% of the Medicare-approved amount for these covered drugs, and the Part B deductible applies.

If the covered drugs you get in a hospital outpatient setting are part of your outpatient services, you pay the copayment for the services. However, other types of drugs in a hospital outpatient setting (sometimes called “self-administered drugs” or drugs you would normally take on your own), aren’t covered by Part B. What you pay depends on whether you have Part D or other prescription drug coverage, whether your drug plan covers the drug, and whether the hospital’s pharmacy is in your drug plan’s network. Contact your prescription drug plan to find out what you pay for drugs you get in a hospital outpatient setting that aren’t covered under Part B.
Other than the examples above, you pay 100% for most prescription drugs, unless you have Part D or other drug coverage.

Prostate Cancer Screenings: Covers a Prostate Specific Antigen (PSA) test and a digital rectal exam once every 12 months for men over 50 (beginning the day after your 50th birthday). You pay nothing for the PSA test. You pay 20% of the Medicare-approved amount, and the Part B deductible applies for the digital rectal exam. In a hospital outpatient setting, you also pay the hospital a copayment.

Prosthetic/Orthotic Items: Covers arm, leg, back, and neck braces; artificial eyes; artificial limbs (and their replacement parts); some types of breast prostheses (after mastectomy); and prosthetic devices needed to replace an internal body part of function (including ostomy supplies, and parenteral and enteral nutrition therapy) when ordered by a doctor or other healthcare provider enrolled in Medicare. For Medicare to cover your prosthetic or orthotic, you must go to a supplier that’s enrolled in Medicare.

IMPORTANT: DMEPOS Competitive Bidding Program: To get enteral nutrition therapy in some areas of the country, you generally must use specific suppliers called, “Contract Suppliers,” or Medicare won’t pay and you’ll likely have to pay full price.

Pulmonary Rehabilitation: Covers a comprehensive pulmonary rehabilitation program if you have moderate to very severe chronic obstructive pulmonary disease (COPD) and have a referral from the doctor treating this chronic respiratory disease. You pay 20% of the Medicare-approved amount if you get the service in a doctor’s office. You also pay the hospital a copayment per session if you get the service in a hospital outpatient setting. The Part B deductible applies.


(R)

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Rural Health Clinic Services: Covers many outpatient primary care and preventive services in rural health clinics. Generally, you pay 20% of the charges, and the Part B deductible applies. However, you pay nothing for most preventive services.  Just make sure they accept Medicare.


(S)

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Second Surgical Opinions: Medicare covers second surgical opinions in some cases for surgery that isn’t an emergency. In some cases, Medicare covers third surgical opinions. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Sexually Transmitted Infections Screening and Counseling: Covers sexually transmitted infection (STI) screenings for chlamydia, gonorrhea, syphilis, and Hepatitis B. A primary care doctor or other primary care practitioner covers these screenings for people with Medicare who are pregnant, and for certain people who are at increased risk for an STI when the tests are ordered. Medicare covers these tests once every 12 months or at certain times during pregnancy.


Medicare also covers up to 2 individual 20–30 minute, face-to-face, high-intensity behavioral counseling sessions each year for sexually active adults at increased risk for STIs. Medicare will only cover these counseling sessions if they’re provided by a primary care doctor or other primary care practitioner and take place in a primary care setting (like a doctor’s office). Counseling conducted in an inpatient setting, like a skilled nursing facility, won’t be covered as a preventive service.
You pay nothing for these services if the primary care doctor or other qualified primary care practitioner accepts Medicare.

Speech-Language Pathology Services: Medicare covers evaluation and treatment given to regain and strengthen speech and language skills, including cognitive and swallowing skills, when your doctor or other health care provider certifies you need it. There may be a limit on the amount Medicare will pay for these services in a single year, and there may be certain exceptions to these limits. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Surgical Dressing Services: Medicare covers these services for treatment of a surgical or surgically treated wound. You pay 20% of the Medicare-approved amount for the doctor’s, or other health care provider’s services. You pay a fixed copayment for these services when you get them in a hospital outpatient setting. You pay nothing for the supplies and the Part B deductible applies.


(T)

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Telehealth: Medicare covers limited medical or other health services, like office visits and consultations provided using an interactive, two-way telecommunications system (like real-time audio and video) by an eligible provider who isn’t at your location. These services are available in some rural areas, under certain conditions, and only if you’re located at one of these: a doctor’s office, hospital, rural health clinic, federally qualified health center, hospital-based dialysis facility, skilled nursing facility, or community mental health center. For most of these services, you pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Tests (Other Than Lab Tests): Medicare covers X-rays, MRIs, CT scans, EKGs, and some other diagnostic tests. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. If you get the test at a hospital as an outpatient, you also pay the hospital a copayment that may be more than 20% of the Medicare-approved amount, but in most cases, this amount can’t be more than the Part A hospital stay deductible.

Tobacco-Use Cessation Counseling: If you use tobacco and you’re diagnosed with an illness caused or complicated by tobacco use, or you take a medicine that’s affected by tobacco, Medicare covers up to 8 face-to-face visits in a 12-month period. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.

If you haven’t been diagnosed with an illness caused or complicated by tobacco use, Medicare coverage of tobacco use cessation counseling is considered a covered preventive service. Medicare covers up to 8 face‑to‑face visits in a 12-month period. You pay nothing for the counseling sessions if the doctor or other qualified health care provider accepts assignment.

Transplant and Immunosuppressive Drugs: Covers doctor services for heart, lung, kidney, pancreas, intestine, and liver transplants under certain conditions and only in a Medicare certified facility. Medicare covers bone marrow and cornea transplants under certain conditions.
Medicare covers immunosuppressive drugs if the transplant was eligible for Medicare payment of an employer or union group insurance plan was required to pay before Medicare paid for the transplant.

You must have Part A at the time of the transplant, and you must have Part B at the time you get immunosuppressive drugs.

You pay 20% of the Medicare-approved amount for the drugs, and the Part B deductible applies.

If you are thinking about joining a Medicare Advantage Plan (like an HOM or PPO) and are on a transplant waiting list or believe you need a transplant waiting list or believe you need a transplant, check with the plant before you join to make sure your doctors, other health care providers, and hospitals are in the plan’s network. Also, check the plans coverage rules for prior authorization.

NOTE: Medicare drug plans (Part D) may cover immunosuppressive drugs, even if Medicare or an employer or union group health plan didn’t pay for the transplant.

Travel (Healthcare Needed When Traveling Outside The U.S.): Medicare generally doesn’t cover health care while you’re traveling outside the U.S. (The “U.S.” includes the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.) There are some exceptions, including cases where Medicare may pay for services that you get while on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare may pay for inpatient hospital, doctor, or ambulance services you get in a foreign country in these rare cases:

  • A. You’re in the U.S. when an emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
  • B. You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
  • C. You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

Medicare may cover medically necessary ambulance transportation to a foreign hospital only with admission for medically necessary covered inpatient hospital services. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.


(U)

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Urgently Needed Care: Medicare covers urgently needed care to treat a sudden illness or injury that isn’t a medical emergency. You pay 20% of the Medicare approved amount for the doctor’s or other health care provider’s services, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.

 

 

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