When Medicare Covers Sebaceous Cyst Removal and What It Costs

Medicare may consider the removal of benign skin lesions, including sebaceous cysts, medically necessary if you have one or more of the following symptoms:

• bleeding
• intense itching
• pain
• changes in physical appearance, such as color changes, increased size, or increased number of lesions
• inflammation or infection, which may look like pus, swelling, or color changes around the lesion

Other features of your lesion may also make removal medically necessary. This can include whether the lesion:

• obstructs an orifice, such as the mouth, nose, or anus
• affects eye function, vision, or tear production
• is located in a spot where it's regularly irritated from physical trauma, and you've experienced this physical trauma
• could potentially be malignant, or if you have a history that makes malignancy more likely

Removal may also be medically necessary for sebaceous cysts, specifically if they:

• have recently gotten larger
• have previously ruptured or became inflamed
• are at risk of rupturing

If you have Medicare Part C (Medicare Advantage), your plan must cover at least what Medicare covers.

What is the cost of sebaceous cyst removal with Original Medicare?

Sebaceous cyst removal is typically an outpatient procedure covered by Medicare Part B, which covers care you receive in a doctor's office or other outpatient facility.

If you have Medicare Part B, you will be responsible for paying 20% of the cost of the removal after you've paid your deductible. The Part B deductible is $240 in 2024 and $257 in 2025.

You will need to have the cyst removed at a Medicare-participating facility; otherwise, Medicare may not cover the removal.

Your costs may also be higher if the doctor or facility does not accept the Medicare-approved amount as full payment. You can find out by asking if a provider "accepts assignment" or the Medicare-approved cost of a procedure.

What is the cost of sebaceous cyst removal with Medicare Advantage?

If you have a Medicare Part C plan, you must check with your insurance provider to determine what you may pay for sebaceous cyst removal.

While Part C must cover at least the services that Original Medicare does, the cost may vary.

Many Part C plans require you to visit in-network providers for medical care. If you have a skin lesion removed at an out-of-network facility, you may pay a higher price.

How to find a dermatologist

You can also use the Medicare website's physician finder tool to find a dermatologist who participates in Medicare and accepts the Medicare-approved cost of a procedure.

If you have Medicare Advantage, you can either check the insurance provider's website for a list of in-network dermatologists or contact the company by phone.

The bottom line

Medicare covers the removal of sebaceous cysts and other benign skin lesions if medically necessary. It does not cover cosmetic surgery to improve appearance.

Medicare may consider removal medically necessary if the cyst causes symptoms or the doctor has reason to suspect it is malignant.