Medicare Coverage for Cortisone Shots

Short answer: Yeswhen your doctor says a cortisone (corticosteroid) injection is medically necessary, Medicare typically helps pay. The longer answer (with money-saving tips, 2025 numbers, and a tiny dash of humor) is below.

What counts as a “cortisone shot,” exactly?

People use “cortisone shot” as a catch-all for corticosteroid injections given into a joint, bursa, tendon sheath, or around the spine to calm inflammation and pain. Common targets include knees, shoulders, hips, thumbs, plantar fascia, and the spine (epidural steroid injections). These are office or outpatient procedures performed by orthopedists, rheumatologists, pain specialists, sports-medicine doctors, and some primary-care clinicians.

Does Medicare cover cortisone shots?

Generally, yes. When a licensed medical professional administers the drug and the injection is medically necessary, it’s covered as a Part B outpatient service. “Medically necessary” means there’s a diagnosis and a treatment plannot an elective or cosmetic use. The injection can be billed under procedure codes (for example, 20610 for a major joint injection) and the steroid medication is billed as a Part B drug given by a clinician. Coverage is similar for many non-spinal injections and, if clinically appropriate, for certain spinal injections (e.g., epidural steroid injections) following local Medicare policies.

Which part of Medicare pays?

• Part B (Original Medicare): Covers medically necessary outpatient services and clinician-administered drugs. After you meet the annual Part B deductible, Medicare pays 80% of the Medicare-approved amount and you pay 20% (coinsurance).
• Part A: Only becomes relevant if you’re formally admitted as an inpatient (rare for simple injections). If an injection happens during an inpatient stay for another reason, Part A covers the stay and Part B usually covers the doctor’s services.
• Medicare Advantage (Part C): Must cover at least what Original Medicare covers, but rules and costs differ by plan. Prior authorization, network, and site-of-service rules can apply.
• Part D: Covers outpatient prescription drugs you take yourself at home (like an oral steroid taper). It does not pay for a clinician-administered injection in the officethat’s Part B.

What will I pay in 2025?

Here are the key 2025 numbers and how they affect a typical injection:

• Part B premium (2025): $185/month (most enrollees).
• Part B deductible (2025): $257 per year. You pay this first for Part B services before coinsurance kicks in.
• Coinsurance: After the deductible, you generally pay 20% of the Medicare-approved amount for the injection, the drug, and the professional service if your provider accepts assignment.
• Medigap (Supplement): If you have a Medigap plan, it can pay some or all of that 20% depending on the plan (e.g., Plan G commonly covers the Part B coinsurance).
• Hospital outpatient departments: If you receive the injection in a hospital outpatient clinic instead of a doctor’s office, expect an additional facility copayment for the hospital. In most cases, each service’s copayment can’t exceed the Part A deductible for that service, but multiple services can add up.

Realistic cost snapshots

• Office setting, deductible already met: Medicare approves $200 total for the injection + drug. Medicare pays 80% ($160). You pay 20% ($40). A Medigap plan may cover some or all of that $40.
• Office setting, deductible not yet met: The first $257 you spend on Part B services in the year goes toward your deductible. After that, you pay 20% of approved amounts.
• Hospital outpatient setting: Same 20% coinsurance to the doctor plus a separate hospital outpatient copayment for the facility. Depending on local pricing, your out-of-pocket can be noticeably higher than in an office.

Common billing codes you might see (no need to memorize)

• 20610 Aspiration/injection of a major joint or bursa (e.g., knee, shoulder, hip), without ultrasound guidance.
• 20611 Same as above, with ultrasound guidance.
• 20550 Injection into a tendon sheath, ligament, or aponeurosis (for example, plantar fascia).
• Drug “J-codes” The actual steroid (e.g., methylprednisolone acetate, triamcinolone acetonide) is billed with a drug code and quantity. Under Part B you still pay 20% of the Medicare-approved drug cost after the deductible.

Why it matters: The combination of procedure code + drug code + site of service drives your final bill. Ultrasound guidance, imaging, or hospital facility charges can increase the total.

Are there limits on how many shots I can get?

Medicare doesn’t publish one universal “three per year” rule for every injection, but many clinicians follow clinical guidance that spaces injections by roughly three months and limits them to a few per year to reduce risks. For spinal injections, local Medicare contractors often have more formal policies (Local Coverage Determinations, or LCDs) that specify diagnoses, documentation, and frequency ceilings. Your doctor’s office usually knows the local rules.

What about risks and side effects?

Like any procedure, steroid injections have possible downsides: temporary pain flare, facial flushing, temporary rise in blood sugar (especially if you have diabetes), skin or tendon changes at the site, infection (rare), andover time and with frequent dosingpotential cartilage effects within a joint. That’s a big reason clinicians cap frequency and track response to each shot.

Original Medicare vs. Medicare Advantage (Part C)

• Original Medicare + optional Medigap + Part D: See any provider who takes Medicare nationwide. You’re subject to the standard deductible/coinsurance; Medigap can reduce your share.
• Medicare Advantage: Same clinical benefit (if medically necessary), but you’ll need to follow plan rulesnetwork providers, prior authorization if required, and plan-specific copays/coinsurance. Costs vary by plan and site of service. If you get an injection out of network (and it’s not an emergency/urgent situation), the plan may not cover it.

Pro tips to avoid surprise bills

1. Ask about “assignment.” Providers who accept assignment agree to the Medicare-approved amount as full payment. That keeps your share predictable.
2. Confirm the site of service. An office visit typically costs less out of pocket than a hospital outpatient clinic because there’s no separate facility copay.
3. For Medicare Advantage members: Confirm network status, prior authorization requirements, and where the shot will be done (office vs. hospital clinic).
4. Ask about add-ons. Ultrasound guidance, imaging, or aspiration can be medically appropriate, but they also affect cost. If your clinician plans to use imaging, ask why it’s needed.
5. Bring your other coverage cards. If you have Medigap, it may pay your 20% Part B coinsurance. If you’re on Part C, bring the plan card; rules differ from Original Medicare.
6. If you need a home steroid taper too: The injection is Part B, but take-home pills are under Part D. Make sure your pharmacy has the prescription on your drug plan’s formulary.

Frequently asked questions

1) Does Medicare cover ultrasound-guided injections?

When medically necessary and properly documented, yes. Some guidance services are bundled with the main injection for payment policy reasons, while others are separately payable. Bottom line: if your clinician says guidance is needed for accuracy and safety, Medicare coverage generally follows the policy rules in your area.

2) Are epidural steroid injections covered?

They can be, when medically necessary and documented according to your local Medicare policy (LCD). Those policies often limit the number of levels per session and how often you can receive them per year.

3) How many cortisone shots can I get in a year?

There’s no single national number for every body part. Many clinicians limit to no more than about three per site per year, spacing them by roughly three months. Your doctor will tailor frequency based on your condition, response, and risks.

4) Can I get a cortisone shot during the same visit as imaging?

Yes, and it’s common. Imaging can confirm the target or guide the needle. Expect separate professional and/or facility charges depending on the setting.

5) Will my costs be lower in a doctor’s office?

Often, yes. Hospital outpatient departments add a separate facility copayment. If cost matters (and when medically appropriate), ask whether the injection can be done in an office.

Bottom line

Cortisone shots are typically covered by Medicare when they’re medically necessary and performed by a licensed clinician. Under Original Medicare in 2025, you’ll meet the $257 Part B deductible, then pay 20% of the approved amount; a Medigap plan may reduce or eliminate that share. Medicare Advantage plans cover the service too, but cost-sharing, prior authorization, and network rules vary. Ask about assignment, site of service, and any add-on imaging to keep bills predictable.

SEO details for publishers

• Prior authorization doesn’t have to be a headache. A Pennsylvania pain clinic created a simple checklist for Medicare Advantage patients: (1) diagnosis and imaging summarized in one note, (2) failed conservative therapy documented (PT, oral meds), (3) specific spinal level(s) and approach, and (4) expected frequency. Submitting that packet once sped up approvals for follow-ups because the plan already had a complete baseline. Patients got procedures on the calendar faster, and denials dropped. Pro tip: ask your clinician’s office to confirm what your plan needs and whether they’ll handle submission electronically.

  Medigap can make the 20% disappear. An Arizona pickleball enthusiast with severe thumb arthritis had two cortisone shots last year. He carries Plan G Medigap. After the Part B deductible, his bills for the injections showed Medicare’s approved amount and a patient responsibility of $0his supplement picked up the standard 20% coinsurance. Plan G isn’t right for everyone (premiums vary), but if you need musculoskeletal care frequently, it’s worth comparing plans during your guaranteed-issue window.

  Diabetes? Time your shot and your meals. A California patient with well-controlled type 2 diabetes noticed her glucose spiked for 48 hours after a shoulder injection. Her clinician warned her in advance and suggested closer monitoring for a few days. She wore a CGM, hydrated, and adjusted meal timing (with her clinician’s guidance) during the brief spike. It smoothed out quickly, and the shoulder pain relief made PT possible again. Tip: if you have diabetes, ask how long your sugars might run high and what precautions your care team recommends.

  Why documentation matters. A New England clinic saw a claim delay when the note simply read “knee injection for pain.” Once the clinician added the specific diagnosis (e.g., osteoarthritis), failed conservative measures, and the exact joint and laterality (“right knee, intra-articular”), the claim sailed through. That level of detail also helps if your plan limits frequency; clear documentation shows medical necessity for a repeat injection.

  Ultrasound guidance is worth asking aboutbut not always needed. For small targets (like the thumb CMC joint) or when prior attempts weren’t effective, ultrasound guidance can improve accuracy. Patients often report better relief when the medication reaches the exact spot. That said, if your clinician is confident and the joint is easy to access (like a large knee effusion), blind landmark technique may be perfectly appropriate and less costly. Ask what your clinician prefers and why.

  Know your post-injection plan. Many patients feel great the next day and overdo it (“I can finally vacuum the whole house!”). Gentle activity is good; sudden heroics are not. Patients who paired their shot with a structured home exercise program (or PT) often got longer-lasting benefit. Plan ahead: if you respond well, schedule PT within a week while pain is quiet.

  Finally, expect a reasonable cap on repeats. Even when shots help, most clinicians won’t keep repeating them endlessly in the same spot, both for safety (cartilage and tendon health) and because repeated need suggests there’s an underlying biomechanical issue to fix. Patients who combined weight management, strengthening, footwear or brace changes, and activity tweaks tended to space out injectionsor avoid the next one entirely.

  Bottom line from real life: clarify the setting, pre-check any prior auth, ask about assignment and add-ons, and pair the shot with the right follow-through. That’s how you maximize relief while keeping your Medicare costs in check.

  Oliver Grant

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  Tags: 2025 Medicare deductible Medicare Advantage prior authorization Medicare coverage for cortisone shots Medigap coinsurance steroid injection Medicare Part B