Does Medicare Cover All Surgical Trays?
A surgical tray, otherwise known as a custom procedure tray (CPT), is an assortment of medical devices lined up for surgery, custom-designed for a particular procedure. For example, an angiography, biopsy pacemaker, or rotator cuff operation each requires a unique set of implements prepackaged in one sterilized metal surgical tray.
Here are a few examples of CPT contents:
- Surgical blades
- Lesion dressing
- Surgical wipes
- Surgical drapes
- Heart catheters
If you’ve ever watched a movie or television series that has a scene in an operating room, you’ve probably seen a surgical tray. It’s where all the sterile tools and equipment needed for the surgery are carefully placed at close range so the assistants can find them and quickly hand them to the surgeon.
Medicare Benefits Solutions
Nov 30, 2020
Surgical Instrument Tray Billing
In the medical world these surgical trays are known as custom procedure trays (CPTs), and they are set up in advance of a surgical procedure so they have all the sterile tools that will be necessary for the specific surgery or medical procedure.
Doctors use custom procedure trays for both inpatient and outpatient procedures, so your Medicare benefits cover them accordingly. In general, Medicare Part A covers inpatient surgical procedures, and Medicare Part B covers outpatient surgical procedures.
Custom procedure trays are not items that you would commonly see listed separately on your itemized hospital or medical bill. They are generally bundled under medical and surgical supplies and devices and included in your Medicare coverage when the final bill is approved. In other words, a surgical tray is considered as part of the surgical procedure.
If another surgical tray is necessary, the provider will file a separate claim for additional supplies and materials. Medicare would evaluate the claim, reviewing the reason given for the extra expense.
The Centers for Medicare & Medicaid Services (CMS) provides guidelines for a doctor performing a procedure in the physician’s office versus a hospital or outpatient department. In that case, the cost of medical supplies, including surgical trays, is part of the business expense of running the practice.
If you have to have a surgical procedure done at some time in your life, it’s important for you to be aware of how your benefits cover them and what your possible costs may be. Here’s a look at the facts about custom procedure (surgical) trays and coverage through your Medicare benefits.
How Does Medicare Cover Surgical Trays?
If your physician orders a medically necessary surgical procedure, your Medicare benefits probably cover it.
If you must have surgery as an inpatient, and you meet all the requirements, your Original Medicare Part A benefits cover your care.
Here are the requirements for eligibility:
• The surgical procedure is certified as medically necessary
• Your admitting health care provider and the hospital accept Medicare assignment
As an inpatient, Medicare Part A covers your room, meals, general nursing care, drugs used in the hospital, and some other services and supplies. Before going in for surgery, you are responsible for your Part A deductible which is $1,408.00 per benefit period as of 2020. If your inpatient stay is under 60 days, your coinsurance is $0.00.
Even if you are an inpatient, any doctors’ services you get during your stay are covered by your Medicare Part B benefits. Part B pays for 80 percent of the approved charges and you pay the remaining 20 percent.
Surgical procedures that your healthcare providers perform on an outpatient basis are covered by your Medicare Part B benefits. These days, more and more medical procedures are taking place in an outpatient setting. Physicians can perform procedures like cataract removal, gallbladder removal, biopsies, and gastric bypass, just to name a few, with same-day surgery in hospitals, outpatient clinics, or in their medical offices. All of these medical procedures require using custom procedure trays containing the necessary equipment and supplies. The cost of this equipment use is generally considered as part and parcel of the procedure and is included in the cost, not billed separately.
For Medicare to approve your Part B coverage, the procedure must be medically necessary, and it must be done by a healthcare provider and in a medical facility that accept Medicare assignment.
With Part B benefits, Medicare pays for 80 percent of the final approved cost. You are responsible for the remaining 20 percent, your Part B deductible, and your monthly premium.
Custom procedure trays are also necessary when your healthcare provider is caring for a surgical or surgically treated wound. Your Part B (medical insurance) benefits cover the cost of the medical services and there is no separate cost for the supplies your physician uses.
If you are uncertain about your Medicare coverage for supplies used during surgical procedures, make sure to ask your health care provider or a Medicare representative any questions before you have your surgery.
Medicare Benefits for Surgical Procedures
Medicare benefits cover the cost of surgery based on where the operation is performed.
Part A covers inpatient hospital care. Medicare considers you an inpatient if the hospital formally admits you into the facility with an order from your doctor. You are not necessarily an inpatient solely based on the hospital setting. Even if you spend a night in the hospital, you are an outpatient in the absence of a formal inpatient admission process.
If your surgery is covered under Part A, your responsibility is the Part A deductible plus the coinsurance that begins on day 61.
Part B covers outpatient surgeries. You pay the Part B deductible, 20% coinsurance and a copayment to the hospital outpatient facility.
Benefits of Using Surgical Trays
According to CPT medical, a company that manufactures standard and custom trays, both health care providers and their patients benefit from CPTs. Providers gain cost efficiency, sterilization and waste reduction. From a patient perspective, these are the top benefits:
- Less prep and procedure time because each tool is precisely placed for the surgeon to access
- Higher quality surgery resulting from reduced risk of human error
- Sterilized instruments lowering the risk of infection
- Reduced costs to the facility, which can be passed onto patients
Read on to discover what surgical benefits Medicaid provides and what if any, aftercare or rehabilitation services are covered following surgery.