Does Medicare Cover Laser Spine Surgery?
Laser spine surgery sounds innovative, but you may be surprised to learn that disc decompression using lasers began in the 1980s. Laser spine surgeries have been practiced for more than 20 years.
Health professionals have questioned the advantages and expressed concerns about the risks of laser spine surgery. Although the procedure has been in use for decades, some insurers still view laser spine procedures as experimental. With a wide-ranging price tag anywhere between $4,000 and $90,000, be sure it’s covered before you proceed.
Medicare Benefits Solutions
Dec 8, 2021
3 minutes read
Other surgical options include:
- Traditional (open approach) surgery: requires a long incision to open the back and expose the soft tissue and muscles surrounding the area that the surgeon needs to access
- Minimally invasive spine surgery (MISS): smaller incision, less blood loss and a shorter hospital stay (Laser surgery is a type of MISS.)
Medicare benefits cover medically necessary inpatient and outpatient surgery. Work with your doctor in advance to confirm your specific procedure will be covered. Once you verify Medicare benefits will apply, refer to Part A if you will be formally admitted into a hospital or Part B if you are having outpatient surgery.
Medicare benefits for surgery under Part A
Part A covers your Medicare benefits for inpatient hospital care, which includes:
- Semi-private room
- Meals
- General nursing
- Drugs
- Other services and medical supplies necessary for your treatment
You are responsible for:
- Part A deductible ($1,484 in 2021)
- Coinsurance if you stay more than 60 days
If you have a Medicare Supplement plan, the Part A deductible and coinsurance are fully covered.
Part B Medicare benefits cover your doctor’s services while you are in the hospital. Coverage is generally 80% of the Medicare-approved amount.
Medicare benefits for surgery under Part B
Part B covers your Medicare benefits for outpatient hospital services and supplies:
- Diagnostic treatment and services
- Outpatient surgery
- X-rays
- Casts
- Stitches
You are responsible for:
- Part B deductible ($203 in 2021)
- Coinsurance: 20% of the Medicare-approved amount
- Copayment to the hospital outpatient unit
All Medicare Supplement plans cover at least a portion of Part B coinsurance and copayments for covered services. If you have Plan C or Plan F, your Part B deductible is covered as well.
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Prescription drugs
Most prescription drugs are covered under your Part D benefits. Check the formulary of your Medicare prescription drug plan or your Medicare Advantage plan if your plan includes drug coverage.
Part D approved drug lists (formularies) are typically structured in tiers. The higher the tier, the more expensive the drug. Your plan materials will help you determine the out-of-pocket costs your plan requires.
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