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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.

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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.

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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 insurance agents can answer any questions you may have and are dedicated to helping you find coverage that fulfills your healthcare needs.

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 plans, Medicare Advantage plans, and Medicare Part D Prescription Drug plans. You can also use our compare rates form to see plans available in your area.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare educator serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

4 thoughts on "Does Medicare Cover Robotic Surgery"

  1. my surgeons want to be paid extra for using the robotic assist in hernias, gallgladders, appendix. they asked me to use code S2900 but those claims are being denied. Now what?

    1. Lucy, thank you for reaching out. Denials can be based on a number of things. When changing the CTP code used for billing, be sure that you are using corresponding ICD codes that prove the procedure to be medically necessary. You can view the CMS guidelines for billing codes at CMS.gov

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