Medicare can cover carpal tunnel syndrome surgery when the patient requires treatment. Carpal tunnel is a common 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. This is a condition that tends to get worse with time, so it’s imperative to receive an early diagnosis and a treatment plan from your doctor.
Medicare and Carpal Tunnel
Fortunately, Medicare covers most surgical and non-surgical treatments for carpal tunnel syndrome. However, beneficiaries are still responsible for 20% of Medicare costs after the deductible is met.
Carpal tunnel is painful and when a doctor says surgery is medically necessary to relieve pain, then the beneficiary qualifies for carpal tunnel syndrome surgery.
Although, beneficiaries with additional coverage may have lower out of pocket cost. Before we talk about coverage, let’s discuss carpal tunnel symptoms and causes.
What Causes Carpal Tunnel and Who is at Risk
There can be several factors that may contribute to your carpal tunnel syndrome. Injury to the wrist or hand, an underactive thyroid, rheumatoid arthritis, fluid retention, cysts, or stress are just a few.
Women tend to be more likely to develop this condition rather than men. In fact, women tend to be three times as likely to develop carpal tunnel.
What are the Symptoms
Some of the most common symptoms experienced are numbness, burning and tingling in the hand and fingers. Some patients describe their fingers as feeling swollen.
A lot of times these symptoms will appear in the middle of the night because of how they may position their wrists at night. Some people may even find that they can’t distinguish hot and cold feelings when touching items, because of the carpal tunnel.
How Does Medicare Cover Carpal Tunnel Syndrome Surgery
Medicare can cover carpal tunnel syndrome surgery for inpatient and outpatient services when medically necessary.
Before a doctor can perform surgery, diagnostic testing is necessary. After diagnostic testing, the doctor can determine if surgery is a requirement. If surgery is medically necessary, beneficiaries have coverage.
If you suffer from carpal tunnel your physician will review symptoms and check sensation in your fingers and strength of muscles in your hand. This is coverage is available under Part B.
An X-ray of your wrist can help to exclude other causes of pain, like arthritis and fractures.
Then, an electromyogram will measure electrical discharges produced in your muscles. Your doctor will insert an electrode into specific muscles to review electrical activity when the muscles contract and relax. This test identifies muscle damage.
Nerve Conduction Study is when two electrodes will be taped to your skin. A small shock is passed through your median nerve. This will see if electrical impulses are slowed in the carpal tunnel.
All of these diagnostic, outpatient tests have coverage under Part B.
Non-Surgical Therapy Treatment
Wrist splinting for carpal tunnel syndrome has coverage under Part B. These are splints that hold your wrist while you sleep. These can help relieve any symptoms you may experience at night.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have coverage under Part D. Medications such as Motrin, Ibuprofen, and Advil can help ease discomfort from carpal tunnel. This is a short-term solution.
Corticosteroids have coverage under Part D. You may receive an injection of a corticosteroid into your carpal tunnel. This will help ease pain by reducing the swelling that’s responsible for putting pressure on the median nerve.
Endoscopic surgery is inpatient and has coverage under Part A. The surgeon uses a device with an endoscope (itty bitty camera) attached to see inside of the carpal tunnel.
The ligament will then be cut through a small incision in either your hand or wrist. This is considered to typically be a little less painful of recovery than that of open surgery.
Open surgery for carpal tunnel syndrome has coverage under Part A. An incision is made through the palm of your hand. Your surgeon will then cut through the ligament and will free the median nerve.
Recovery and follow up visits have coverage under Part B. Ligament tissue will grow back together and will allow more room for the median nerve.
Internally, your healing process can take a few months, but your skin will typically heal in several weeks. It is possible that recovery may even take a full year in some cases.
Hand Therapy has coverage under Part B. Occupational and physical hand therapy may help to reduce pain-related symptoms associated with carpal tunnel syndrome.
Ultrasound Therapy has coverage under Part B. Ultrasounds increase the temperature of an area of body tissue which can help ease the pain.
Importance of Carpal Tunnel Syndrome Medicare Coverage
If untreated, this can lead to nerve damage. Your doctor may suggest several different pathways to treatment. More than likely, you’ll begin with diagnostic testing to see just what you’re working with, and to rule out other possible conditions.
There are several options that may not necessarily require surgery, such as splints, therapies, or the use of medications to help with your pain.
In some circumstances, surgery helps prevent any permanent damage to your nerves.
Whether you find that you need surgery to treat carpal tunnel, or you’re taking a different treatment route, it’s important to make sure you have insurance coverage.
So, while Medicare covers most of your treatment options, remember that you’ll still be responsible for your 20% portion for these services.
This is when Medicare Supplement Plans become incredibly beneficial. Our agents are here to assist you and answer any questions you may have regarding coverage for your carpal tunnel syndrome. Give us a call today or fill out the online form for more information!