Does Medicare Cover Back Surgery?
Key Takeaways
Original Medicare (Part A and Part B) will typically cover back surgery if deemed medically necessary by a doctor, with Part A covering inpatient hospital care and Part B covering doctor's services during hospital stays and outpatient services post-release.
Medicare coverage includes common types of back surgeries like discectomy, laminectomy, and spinal fusion, but patients should confirm with their doctor that their specific procedure is covered.
Costs for back surgery with Medicare vary and are difficult to determine upfront due to unknown medical specifics, but could be between around $1,500 and $2,000.
If your back surgery is deemed medically necessary by a doctor, Original Medicare (Part A and Part B) will typically cover it.
Your doctor can explain what type of surgery is recommended and if this procedure is covered by Medicare.
This article reviews Medicare coverage for back surgery, including which types of surgery are covered and costs.
Medicare coverage for back surgery
Medicare coverage for back surgery typically mirrors coverage for other medically necessary surgeries, hospital stays, and follow-ups.
Medicare Part A (hospital insurance)
Medicare Part A covers inpatient hospital care, providing that:
the hospital accepts Medicare
you're admitted per an official doctor's order indicating that you need inpatient hospital care
You may need approval for your hospital stay from the hospital's Utilization Review Committee.
Medicare inpatient hospital care coverage includes:
semi-private rooms (a private room only when medically necessary)
general nursing (not private duty nursing)
meals
drugs (as part of inpatient treatment)
general hospital services and supplies (not personal care items like slipper socks or razors)
Medicare Part B (medical insurance)
Medicare Part B covers your doctor's services during your hospital stay and outpatient services following your release from the hospital.
Other insurance, such as Medicare Supplement plans (Medigap), Medicare Part D (prescription drug), or Medicare Advantage plans are available to you when you qualify for Medicare.
If you have this type of additional insurance along with Medicare, it will affect the price you pay for your back surgery and recovery.
How much does back surgery cost with Medicare?
It's difficult to determine exact costs prior to back surgery because the medical specifics of the services you may need are unknown. For example, you might need an extra day in the hospital beyond what was predicted.
To estimate your costs:
Ask your doctor and hospital how much they think you'll have to pay for your surgery and follow-up care. Check to see if there are recommended services that Medicare doesn't cover.
If you have other insurance, such as a Medigap policy, contact them to see what part of the costs they will cover and what they think you'll have to pay.
Check your Medicare account (MyMedicare.gov) to see if you have met your Part A and Part B deductibles.
This table provides an example of potential costs:
Medicare Part A coinsurance is $0 for days 1 to 60 for each benefit (after you pay your Part A deductible).
Examples of back surgery costs
Medicare.gov makes the prices of certain procedures available. These prices don't include physician fees and are based on national Medicare averages from 2024.
This table can give you an indication of what you might have to pay for some of the services involved in back surgery.
Procedure Average cost
Diskectomy The average cost of a diskectomy (aspiration of lower spine disc, accessed through the skin) in a hospital outpatient department is $14,225, with Medicare paying $12,256 and the patient paying $1,969.
Laminectomy The average cost of a laminectomy (partial removal of bone with release of the spinal cord or spinal nerves of one interspace in the lower spine) in a hospital outpatient department is $7,727, with Medicare paying $6,182 and the patient paying $1,545.
Takeaway
If your doctor indicates that back surgery is medically necessary for you, Original Medicare (Part A and Part B) will typically cover it.
Determining how much back surgery will cost after Medicare payments is difficult because the exact services you will need are unknown. Your doctor and hospital should be able to offer some educated estimates.
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