Does Medicare Cover Robotic Surgery

Medicare covers medically necessary services; robotic surgery is no exception. Robotic surgery is FDA approved; thus, coverage may be available for some robotic surgery procedures through Original Medicare. The use of robotic technology can improve the patient’s overall outcome following a surgical procedure, produce detailed results, and in most cases, leave minimal scarring when compared to traditional surgery. For many, robotic surgery is a no-brainer. 

One of the most common types of robotic surgery is abdominal surgery. Surgeons often perform this minimally invasive procedure when repairing organs or receiving tissue samples in the abdomen. Other common robot-assisted surgeries include several procedures. Such as, colectomies, hysterectomies, and 20% of prostate removal surgeries are performed robotically.

Is Robotic Knee Replacement Covered by Medicare?

Yes, if your physician determines knee replacement surgery to be medically necessary, your Medicare coverage should cover robotic knee replacement. However, the surgery must be performed at a Medicare-approved facility by an approved physician. 

Like most robotic surgeries, robotic knee surgery is minimally invasive. This means that you will end up with less scarring and, in most cases, a quicker healing time. Rather than using a large incision to replace the knee joints, surgeons using robotic surgery will create 2-3 small incisions used to insert the tools. Less incision means less blood loss, which means less time in surgery.

Is Robotic Prostate Surgery Covered by Medicare?

The Centers for Medicare and Medicaid Services (CMS) do not currently have a policy for national coverage of radical prostatectomy. Procedures to remove the prostate may be open, laparoscopic, or robot-assisted surgery.

As it stands, robot surgery for prostate cancer is a service Medicare covers. Additionally, reimbursement for providers is the same as the compensation for traditional (laparoscopic) prostatectomies.

Is the da Vinci Robotic Hysterectomy Covered by Medicare?

Medical procedures like hysterectomies are often a medically necessary form of treatment, so Medicare benefits pick up the coverage. For patients having a voluntary hysterectomy (non-medically necessary), such as for sterilization, then Medicare won’t cover the costs.

The da Vinci Robotic hysterectomy cost and coverage depend on if the procedure is done at an inpatient or outpatient facility. Part A benefits cover patients who have a hysterectomy in an inpatient hospital setting. Part B pays for outpatient services and hysterectomies.

Both Parts may have deductible amounts that must be met before Medicare will cover costs for any procedure. After the deductible is met, either Part covers 80% of the Medicare-approved expenses. Beneficiaries are responsible for the remaining 20% of the bill.

Does Medicare Advantage Cover Robot Surgery?

Medicare Advantage plans are required to cover the same inpatient and outpatient services as Original Medicare. The difference is how much they will cover for that service and what your out-of-pocket costs will be. Before enrolling in a Medicare Advantage plan, it is essential to understand how your plan pays and what costs will be left for you.

While Medicare Advantage plans are better to have than no supplemental coverage at all, if you can afford a Medigap plan, you’ll have fewer out-of-pocket costs than Medicare Advantage.

Do Medicare Supplements Cover Robot Surgery?

Medicare Supplement plans are an insurance policy that pays secondary to Original Medicare. Thus, if Original Medicare covers a test or procedure, your Medicare Supplement (Medigap) plan will pay its portion after Original Medicare. So, if you know your Medicare approves the surgery, then your Medicare Supplement will fill in the gaps that Medicare doesn’t cover. Depending on what letter plan you choose, you could end up having zero out-of-pocket costs.

How to Get Supplemental Coverage for Robotic Surgery with Medicare

If you have questions about coverage and plan options or are looking to enroll in a plan to cover robotic surgery, give us a call. Our team of licensed Medicare agents can answer any healthcare questions you may have and are dedicated to helping you find the best coverage possible.

Understanding your plan and what options you have is important for your finances. We can compare all supplemental Medicare options in your area, including Medigap, Medicare Advantage, and Part D. You can also use our compare rates form to see options in your area now.