Does Medicare Cover Laser Spine Surgery?
Medicare Benefits Solutions
Aug 9, 2022
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.
Laser spine surgery is often used for degenerative issues causing neck or back pain such as:
- Herniated discs
- Pinched nerve
- Tumors in the spinal cord
- Spinal stenosis
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.
TIP: check out our companion blog Does Medicare Cover Back Surgery?
Medicare Coverage for Surgical Procedures
Medicare generally doesn’t cover the costs associated with laser spine surgery. However, Medicare benefits will cover inpatient and outpatient surgery when deemed medically necessary by your healthcare provider.
Work with your doctor in advance to confirm whether or not your specific surgical procedure is 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.
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Medicare Benefits for Surgery Under Part A
Part A covers your Medicare benefits for inpatient hospital care, which include:
- Semi-private room
- General nursing
- 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.
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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
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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Other Spine Surgery Options
The top benefits of laser spine surgery include:
- Less invasive than traditional surgery
- Smaller incision(s)
- Saves time
- Usually performed on an outpatient basis
- Typically doesn’t require an overnight stay in hospital
- Quicker recovery time
Laser spine surgery is usually not recommended for anyone with degenerative spine disease.
Other spinal 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.)
Also, if you are researching alternative treatment options, you may want to consider cold laser therapy. Although this type of therapy is typically not covered by health insurance it is a non-invasive procedure that may help you better manage arthritis and back pain.
Medicare Prescription Pain Medication Coverage
Most prescription drugs are covered under your Part D benefits. Check the formulary of your Medicare prescription drug plan or your Medicare Advantage plan to verify if your coverage includes back pain management medications.
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.
Switching Plans or Changing Coverage
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