Does Medicare Cover Radio Frequency Ablation?

Radio frequency ablation is a procedure that uses radio waves to generate heat. These waves can then target tissues in a specific area. The most common reason this procedure is done is to manage pain. For pain treatment, the ablation procedure targets nerves, specifically those that produce pain signals. Your Medicare benefits will likely cover some of the associated costs of a radio frequency ablation, and the exact out-of-pocket expenses vary based on your specific plan.

Medicare Benefits Solutions

Nov 14, 2020

 4 minutes read

What is a radio frequency ablation?

The most common areas where this is performed are the neck, back, sacrum area, hip joints, and shoulder joints. By targeting nerves, it can help relieve pain triggered by twisting or bending, associated with whiplash, or that radiates or spreads down extremities. This procedure is done on an outpatient basis, which means that you will be able to return home the say day of the surgery with no overnight hospital stay being required.

Before the procedure, your physician may conduct certain testing to ensure an ablation is the proper choice for you. This is often done by triggering nerves in a specific area and seeing if that stimulation replicates your pain. If so, it is likely that using radio frequency ablation could help reduce pain levels and alleviate symptoms.

These procedures involve having a needle placed through the skin and into the area causing you pain. The physician will use visual imaging scans to ensure that the needle is placed in the correct area to effectively target the tissues. The most common visualization technique is fluoroscopy, and various forms of x-ray and ultrasound can be used to confirm needle location.

Prior to needle placement, you will be given a local injection of numbing medication in the area where the needle will be inserted. This will reduce discomfort during the procedure. You may also receive IV medications to help you relax and be more comfortable. After the surrounding area is numb, the needle will be inserted and guided using x-ray or ultrasound.

Once the needle is properly positioned, radio waves will be delivered though the needle and into the targeted nerves. The electrical current and generated heat work to disrupt nerve transmissions to prevent pain from being transmitted from the tissues to the brain and spinal cord. While this procedure can be very effective, it is not permanent. Because of this, you may be required to repeat the procedure once the pain begins to return.

What are the associated risks?

While generally quite safe, undergoing is associated with a few potential side effects and risks. Afterwards, you may have temporary numbness or pain at the injection site, but this should alleviate quickly. While rare, more severe side effects may occur as well, including bleeding, infection, or nerve damage.

Do Medicare benefits cover radio frequency ablation?

For Medicare to provide reimbursement for this procedure, it must be deemed medically necessary by your provider. In addition, since this treatment is more invasive, you will likely need to provide proof that you have attempted to use other therapy options and that they have failed to relieve your symptoms.

You must also be sure to have the ablation completed in a facility and by a physician that are both approved by Medicare. Using a provider or facility that does not accept Medicare assignment can result in significantly higher out-of-pocket costs.

The part of Medicare that covers the procedure will depend on where it is performed. Since radio frequency ablations are generally outpatient procedures, Medicare Part B will cover the costs much of the time. In this case, you will pay 20 percent of the Medicare-approved amount of the procedure, any amount to reach your deductible, and your monthly premium payment.

If the procedure is done while you are admitted to an inpatient facility, it will be covered by Medicare Part A. Part A is not usually associated with a premium payment, but you will have to ensure your deductible is met. Medicare Advantage plans must provide the same coverage as Original Medicare, but the exact costs will depend on your plan.

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