Does Medicare Cover Back Surgery?

Low back pain (LBP) is one of the most common health complaints among seniors and the second most common cause of disability among adults in the U.S, In fact, studies have found that in older adults 65+ reporting musculoskeletal pain, 36% to 70% mention they suffer with back pain.

The Centers for Disease Control and Prevention (CDC) describes how lower back pain is classified in terms of duration of symptoms:

• Acute: less than four weeks
• Subacute: four to 12 weeks
• Chronic: more than 12 weeks

Is Back Surgery an Option?

Many people with acute lower back pain do not seek medical care because the condition resolves itself. If you do visit a doctor, the first course of treatment may be anti-inflammatory drugs, heat and/or physical therapy.

If non-surgical approaches do not alleviate your pain, your doctor may talk to you about the pros and cons of back surgery. If the surgery is medically necessary, Medicare benefits may help cover the cost of the procedure, the facility and the surgeon’s fees.

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Medicare Benefits for Back Surgery

If you have surgery in the hospital, Part A Medicare benefits cover your:

• Semi-private room
• Meals
• General nursing services
• Necessary medication and other supplies
• Inpatient rehabilitation care if your doctor certifies you need intensive rehabilitation, your doctor’s oversight and coordinated care

You are responsible for the Part A deductible ($1556 in 2022). If you require an inpatient stay beyond 60 days, you are responsible for coinsurance, starting at $389 per day.

Part B Medicare benefits cover:

• Hospital outpatient diagnostic and treatment services
• Outpatient surgery, X-rays and casts
• Physical therapy
• Your doctor’s services, whether you are an inpatient or outpatient
• Second surgical opinion

Your share of the cost is the Part B deductible ($233 in 2022) and 20% coinsurance. If you use the services of a hospital outpatient department, the facility can charge you a copayment.

Use your Part D Medicare benefits for any medications your doctor prescribes to mitigate your pain or facilitate your recovery. Part D plans vary, so make sure that medications prescribed are included in your plan’s formulary or list of covered drugs.

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Different Types of Back Surgery

Depending on your situation, your surgeon may perform one of the following surgical procedures:

• Discectomy: Removing all or a portion of a vertebral disc
• Foraminotomy: Relieving pain associated with a compressed nerve
• Artificial disc replacement: Implanting an artificial disc that mimics the functions of a natural disc
• Spinal fusion: Joining two vertebrae
• Laminectomy: Removing bone and widening the spinal canal
• Minimally invasive interlaminar implant: Leveraging medical advancements and innovative techniques for a faster recovery and fewer complications

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Tips for Preventing Back Pain

The National Spine Health Foundation offers these suggestions for avoiding back and neck pain:

• Maintain good posture so that your spine is aligned correctly.
• Learn about workplace ergonomics, so you can protect your back and neck when you work in an office.
• Practice safe lifting to reduce stress on your back.
• Try relaxation exercises to lower your overall stress level.
• Find the best sleeping position for your back.
• Be aware that smoking impacts your bone density, connective tissues and spinal health.
• Follow healthy behaviors for proper nutrition and weight management.
• Exercise to help prevent back pain and hasten recovery if the pain does develop.

TIP: for additional information on back pain, check out our companion blog on laser spine surgery.

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