Does Medicare Cover 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.

The cost of anesthesia depends on several factors, including whether you’re 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.

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 for 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.

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.

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.