Medicare covers anesthesia for surgery as well as diagnostic and screening tests. Coverage includes anesthetic supplies and the anesthesiologist’s fee. Also, Medicare covers general anesthesia, local anesthetics, and sedation. Most anesthesia falls under Part B.
Does Medicare Pay for Anesthesia?
Medicare pays for anesthesia for necessary procedures. Including local or general anesthesia for heart surgery, a colonoscopy, a hip replacement, or a biopsy. But, Medicare won’t cover anesthesia for cosmetic procedures. And it only pays for dental anesthesia in a few situations.
How Much Will Medicare Pay for Anesthesia?
The cost of anesthesia depends on several factors, including location, admission status, and if you have supplemental coverage. If you are an inpatient at a hospital when you have your procedure, Part A pays for your hospital stay and the hospital’s anesthesia costs.
But, Part A doesn’t cover the doctors that treat you while you’re in the hospital. Instead, Part B covers doctors’ services. If you have the procedure outpatient or at a doctor’s office, care falls under Part B. Now, Medicare will pay 100% of the anesthesia cost for a routine screening colonoscopy.
How Much Does General Anesthesia Cost?
Because anesthesia billing is based on a formula, it’s almost impossible to give a one-size-fits-all cost estimate for general anesthesia. But there are some general guidelines.
Anesthesia for a 30-minute procedure will cost less than a five-hour surgery. It may cost less in a small city than in New York or San Francisco. And anesthesiology for a complicated operation with many potential complications will be more expensive than anesthesia for a routine procedure.
Most of this is beyond your control. But if you have Medicare, your costs will be much lower if you have a Medigap plan. For example, suppose the anesthesiologist’s bill is $1000. Medicare will pay 80%, or $800. Your Medigap plan can cover the other $200.
How Much Does Medicare Reimburse for Anesthesia Time?
Medicare reimburses anesthesiologists using a formula that takes several factors into account:
- The base rate. The base rate depends on the type of anesthesiology procedure and the amount of skill and difficulty involved.
- The amount of time the anesthesiologist spends caring for you
- Modifying factors, such as a patient’s health or an emergency
The above three items are added together and multiplied by a conversion factor. The conversion factor depends on the part of the country where the procedure is performed. It’s intended to compensate for different healthcare costs in different localities.
Does Medicare Advantage cover Anesthesia?
Medicare Advantage plans cover necessary anesthesia. But, Advantage plans establish their costs that usually differ from Medicare. Advantage plans also operate with provider networks. You may get a costly surprise medical bill if your anesthesiologist isn’t in your plan’s network. If you’re having elective surgery, be sure to request an in-network anesthesiologist.
FAQs
How to Get Help with Anesthesia Costs with Medicare
Many people are in shock over the bill from the anesthesiologist after surgery. A Medigap plan can cover almost all of the costs you'd otherwise get an invoice to pay yourself. Our agents can walk you through the details of Medicare and help you identify the best policy for you. The option that brings you the most value is the plan that you'll want.
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My pain doctor’s office called, through an anesthesia contractor, and said that anesthesia for my back injections is no longer covered in 2021 by Medicare and my supplemental plan, and that I will have to pay for it out of pocket. In the past it was covered. I don’t understand. Is this true?
Hi Jerry! Your best option is to do a three-way call between Medicare and your doctor to figure out why the anesthesia is no longer covered.
My father needs to have PRP/Stem Cell Therapy on his back. The Orthopedic Specialist performing the procedure is out of network while the anesthesiologist is a contracted Medicare provider. Will Medicare cover the anesthesia portion of the office surgery?
Hi Gayle! In theory, yes, Medicare should cover their portion of the cost for the anesthesia. However, I would confirm this with the anesthesiologist. They should know if they will be able to bill Medicare for it.
My brother in law has Downs Syndrome (he is 51) and he must have anesthesia for dental cleaning. He has a medicare supplement (Aetna Medicare Premier (HMO)), medicare part a and b and also medicaid, yet I’m finding it hard to get this approved. Any suggestions? The dentist is approved by his supplement, but the anesthesia takes place at an out of network hospital, but wouldn’t the straight medicare pick up this portion? Thanks for any help you can give me.
Hi Tammy! Medicare Supplements and Medicare Advantage plans are not the same. An Aetna Medicare Premier HMO is a Medicare Advantage plan. If your brother-in-law has a Medicare Advantage plan, he no longer has straight Medicare. If the anesthesia takes place at an out-of-network hospital, unfortunately, he won’t receive coverage for it from his Advantage plan. Original Medicare won’t pick up the costs because you ONLY have coverage from the Advantage plan & Medicaid, not Medicare. You may be able to receive coverage for it if the doctor says it’s medically necessary, however, the issue of the anesthesia being given at an out-of-network hospital is still an issue.