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Does Medicare Cover Carpal Tunnel Surgery


Medicare can cover carpal tunnel surgery when treatment is medically necessary. Carpal tunnel is an ailment that may cause numbness, pain, and tingling in the arms and hands. Pain occurs when the median nerve squeezes while traveling to the wrist. Carpal Tunnel gets worse with time; an early diagnosis and therapy plan is essential. We know understanding Medicare coverage for Carpal Tunnel can be challenging. We’re here to clarify your benefits. Below we give you all the details on how Medicare covers carpal tunnel.

What Does Carpal Tunnel Surgery Cost with Medicare?

Medicare will cover 80% of the costs. You’ll pay a portion of the bill that Medicare doesn’t cover, like deductibles, coinsurance, or copayments. Unless, of course, you have supplement coverage. There are different routes that your doctor may take to treat carpal tunnel; surgery may be the way to go.  The cost of release or relocation of the median nerve is between $4,000 and $12,000. Also, treatment may be more than one procedure.

Do Medicare Supplements Cover Carpal Tunnel Surgery?

Medicare Supplement coverage for carpal tunnel treatment is available. Once a doctor deems your treatment necessary, you qualify for benefits. If Medicare pays for it, so will Medigap.

Do Medicare Advantage Plans Cover Carpal Tunnel Surgery?

Many people can’t afford Medigap coverage. Some coverage is always better than none. The cost of carpal tunnel surgery with an Advantage plan depends on which plan you have. Each county had a different variety of plan options.

Some advantage plans have a set copayment for surgeries like $150 or more. Then, some only offer benefits like Medicare, leaving you to pay 20% of the costs. For those that go out of network on an HMO, you’ll pay 100% of costs. If you have a PPO plan, you may pay 40% or more.

Does Medicare Require Prior Authorization for Carpal Tunnel Surgery?

Prior authorizations require your doctor to get approvals through Medicare before services. Surgery for carpal tunnel must be necessary for coverage. Medicare Advantage plans could ask for prior authorization. But Medicare doesn’t ask for pre-authorization for surgery.

Does Medicare Cover Diagnostic Testing Carpal Tunnel Syndrome?

Yes, Medicare will cover diagnostic testing for Carpal Tunnel Syndrome. Diagnostic tests help doctors diagnose you with carpal tunnel syndrome.

There are several tests your doctor may conduct:

  1. Exams fall under Part B Your doctor will run through your symptoms and inspect your hands.
  2. X-rays are part of your Part B benefits. The images better determine the cause of pain.
  3. Electromyograms Part B covers. It includes a measure of your muscle’s electrical activities to look for any damage.
  4. Nerve Conduction Study is another outpatient test. The nerve conduction study checks for electrical pulsing within the carpal tunnel.

Talk to your doctor about the options that are the most beneficial for you.

Will Medicare Cover Medications for Carpal Tunnel?

The medication cost and coverage depend on the prescription your doctor provides. Let’s discuss a few different scenarios. So, there are over-the-counter options like Ibuprofen that don’t have coverage. But Ibuprofen only costs a couple of dollars at the drug store.

Then, other options cost over $200 without insurance, such as the Flector patch. If you’re in severe pain, talk to your doctor about a sample while you wait for surgery. Diclofenac comes in gel and pill forms. Some Part D plans offer coverage for this medication. Costs for the policy could be as low as $15 a month and $2 or more for the prescription.

Will Medicare Cover Non-Surgical Carpal Tunnel Therapy?

Another form of non-surgical therapy for carpal tunnel syndrome comes with wrist splinting. Wrist splinting will fall under Part B benefits.

Alternative Therapies

If you’d like to seek alternative therapies to help to treat carpal tunnel. Hand therapy falls under Part B coverage. Treatment can include both physical and occupational therapies to help reduce aggravating symptoms. Ultrasound therapy also falls under Part B benefits. Ultrasound therapy uses ultrasounds to increase the temperature of your body’s tissue.

Surgical Procedures

Carpal tunnel release surgeries can come in a variety of two different operations. If your doctor feels surgery is necessary for you, Medicare covers the procedure. You can call the facility beforehand to find out your costs for surgery. Also, ask about aftercare costs.

Sometimes the procedure can be an outpatient procedure. You can choose between an outpatient center or an ambulatory center. If inpatient for surgery, you’ll want to double-check your deductible beforehand. Before Medicare begins to cover your surgery, you will have to meet your deductible.

Endoscopic surgery is an inpatient procedure. It falls under Part A benefits. Your surgeon will use a tool with an endoscope to see the inside of your carpal tunnel.

The endoscopic procedure tends to be less painful than open surgery. Part A covers open surgery. A surgeon frees the median nerve of pressure. Any necessary recovery and follow-up doctor visits fall under your Part B coverage. You can plan on healing to take several weeks or months.

FAQs

What is the cost of endoscopic carpal tunnel surgery?
Endoscopic surgery tends to be more costly than open surgery. The cost of endoscopic surgery generally falls between $2,600 to $4,000.
Does Medicaid cover carpal tunnel surgery?
Medicaid is a form of health coverage at the state-level. The health care program helps low-income individuals get necessary health care services.

Medicaid covers inpatient and outpatient surgeries.

How much is carpal tunnel surgery without insurance?
Carpal tunnel surgery can be costly if you don’t have proper coverage. Depending on several factors, you could face charges anywhere from $4,000 up to $12,000.

How to Get Help with Medicare Coverage for Carpal Tunnel

Medicare, by itself, is costly; you don't want to risk losing savings when your health declines. Enrolling in Medigap protects you from outrageous costs. Your agent will ask you a few questions to better understand your needs and budget. Once you decide which policy makes the most sense, your agent can walk you through the application process.

All of this is done over the phone—no need to go anywhere or call a bunch of companies. Our agents represent the top insurance carriers in the nation. So, you save time and money. Give an agent a call at the number above to discover the best options in your area. If you can't call now, fill out an online rate form to get the process started today.

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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