Medicare can cover carpal tunnel syndrome surgery when it’s medically necessary. Discuss the benefits and risks with your doctor to better understand if it’s right for your situation.
Carpal Tunnel Syndrome (CTS) is a common condition that affects people of all ages. Anyone suffering from CTS will tell you this pesky condition is not only a nuisance, but it’s also downright painful!
The condition itself is from damage to the median nerve, one of the major nerves in the hand. However, with carpal tunnel syndrome, the median nerve becomes compressed as it travels through the wrist.
This compression causes symptoms of numbness, tingling and pain in the hand and wrist, which can also travel up to the arm.
If the median nerve continues with compression, it can lead to eventual nerve damage. In some severe cases, carpal tunnel release surgery is a requirement to take the pressure off the nerve in order to prevent permanent nerve damage.
Does Medicare Cover Carpal Tunnel Syndrome Surgery
Part A will pay for any inpatient hospital stays and services upon admittance. Medicare Part B will pay for any outpatient procedures, doctors office visits, physical therapy, home rehabilitation, lab work, and diagnostic testing.
Regardless of Medicare benefits, Traditional coverage only provides 80% of the costs. That’s after the deductible has been met.
The remaining 20% will be left for the Medicare beneficiary.
So, will carpal tunnel release surgery will have coverage? The answer is yes, once the deductible is met.
These days this simple surgery is done at an outpatient surgery center. With outpatient surgeries, the patient sometimes has the choice of deciding between a hospital outpatient department or an ambulatory surgery center.
Carpal Tunnel Follow Up Care
Keep in mind, once complete there may be follow up care with your physician as well as physical therapy to get your hand and wrist in top shape.
This may include some post-op pain medications and/or nerve stabilizing medications.
Medicare Part B will continue to cover your post-op care with your surgeon and any physical therapy appointments. It also covers a portion of any wrist splint requirements after your surgical intervention.
Unfortunately, medications of any kind only have coverage during the hospital stay. Any outside medications are considered out of pocket costs unless you have a Medicare Prescription Drug Plan.
A Medicare Prescription Drug Plan or Medicare Part D Plan is by private insurance carriers to provide prescription drug benefits.
For all Medicare beneficiaries, not just post-op patients, this is vital as most individuals over the age of 65 will likely require multiple medications.
The out of pocket costs alone can break the bank. You’ll seriously want to consider a Medicare Part D Plan as most beneficiaries live on a pre-set income, so every outgoing penny needs to count!
Additional Medicare Help
Another option to consider is a Medicare Supplement Plan.
A Medicare Supplement Plan is a stand-alone plan that works in conjunction with your Traditional Medicare benefits.
There are 10 individual letter plans by the private insurance companies in your local area. The individual plans consist of a variety of coverage benefits based on your individual needs.
The amazing thing about a Medicare Supplement Plan is that it can pick up coverage for those items Original Medicare won’t cover. Items like your deductible, copayments, coinsurance and other out of pocket costs could have coverage.
This is great news for those living off social security retirement benefits. Those with Medicare and a Medicare Supplement Plan can end up with little to no cost for all their healthcare needs!
What Causes Carpal Tunnel Syndrome
While compression of the median nerve as it travels into the hand is the major cause of carpal tunnel syndrome, the pain itself is from the inflammation and swelling around the nerve.
Usually, the cause of the inflammation is due to an underlying medical condition.
Some of these medical issues include:
- Hypertension (high blood pressure)
- Autoimmune disorders that cause widespread inflammation like systemic lupus erythematosus
- Fluid retention from pregnancy and menopause
- Thyroid disease
- Heavy alcohol consumption or alcoholism
- Cigarette smoking
- Use of caffeine
- Injuries like trauma or a fractured wrist
- Poor diet, high salt intake, sugar, and refined carbohydrates
There are other risk factors that may contribute to carpal tunnel syndrome:
- The positioning of the hand and wrist: Activities in which the wrist is either in the flexion or extension position for prolonged periods can cause nerve compression.
- Repetitive hand use: Overuse of the hand and wrist can cause irritation on the tendons surrounding the nerve which in turn can apply pressure onto the median nerve.
- Heredity: Anatomic differences like the amount of space around the nerve, can run in families. Therefore, carpal tunnel syndrome may be more likely in some families rather than others.
It’s also a well-known fact that certain careers make the carpal tunnel a more likely condition to develop over time. Also, those working in construction, manufacturing, assembly line work and those working on computers daily, are all at higher risk to develop CTS over time.
Symptoms of Carpal Tunnel Syndrome Diagnosis
Carpal tunnel syndrome usually presents with pins and needles-like sensation, called paresthesia’s, usually affecting the thumb, index, middle and ring finger of the hand.
The pain or, “tingling”, the sensation can travel up the arm and even into the shoulder and neck area.
Occasionally, sharp, stabbing pain can radiate from the thumb and fingers into the wrist.
Weakness can occur in severe cases, causing individuals to have difficulty with simple tasks like grasping or buttoning shirts. Dropping items is common as pain increases when doing fine motor tasks.
Pain is typically worse at night with CTS and patient’s often will, “shake”, the hand to try and lessen the numbness feeling.
It’s common to feel a loss of sensation in the hand and those often say, “I can’t feel my hand.”
Keep in mind, with most people, CTS gets worse over time. The earlier a diagnosis, then the earlier a person can start treatment.
Diagnosing carpal tunnel syndrome can be done in a variety of ways. Most commonly, your physician can do a physical exam to test strength, reproduce symptoms and check for atrophy.
Once your physician suspects carpal tunnel, he or she may then send you for an EMG/NCS study (electromyogram/nerve conduction study).
This test stimulates the nerve and measures the response time to see if the signals in the nerves are conducting effectively. It also stimulates the muscles and measures the electrical activity in the specific area being tested.
Once and EMG/NCS is done, it tells your physician if you have any nerve or muscle damage and if so, how severe. Then, your physician can go on and determine the next course of action for your treatment regimen.
Non-surgical Alternatives for Carpal Tunnel Syndrome
In some cases, if the carpal tunnel is found early enough; symptoms can go away with conservative care and then surgery isn’t necessary.
Non-invasive treatments include:
- Activity Modification: CTS symptoms will typically present after the hand and wrist have been held in a specific position for too long of periods. Avoiding the flexion/extension position for too long or taking breaks if your job requires you to repetitively use your hands can help alleviate some of the painful side effects.
- NSAIDS (nonsteroidal anti-inflammatory drugs): medications like over the counter Ibuprofen or Advil
- Nerve Medications: medications like Gabapentin and Lyrica are for neuropathic pain conditions. These types of medications work by changing the way in which certain nerves send messages to your brain. By depressing the nerve transmission, it can in turn help to alleviate pain.
- Bracing: using a brace or neutral wrist splint at night helps prevent bending at the wrist.
- Physical/Occupational Therapy: Therapeutic exercises are to rehabilitate the hand and wrist and restore its function.
- Cortisone Injections: cortisone, a powerful anti-inflammatory, can be injected directly into the wrist effect by carpal tunnel. The cortisone decreases inflammation around the nerve which can in turn decrease pain.
Additional Medicare Coverage Can Cover Carpal Tunnel Syndrome Surgery
Regardless of whether you’re having surgery or non-invasive treatment for your carpal tunnel syndrome, it’s plain to see having insurance coverage is of utmost importance.
While Medicare will cover most treatments and surgical interventions, the remaining 20% can easily add up. Consider pairing a Medicare Supplement Plan with a Medicare Part D Plan with your Traditional Medicare benefits.
You can contact us directly or fill out the online form for more information on all the additional insurance benefits that are available.