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Medicare Coverage for Lower Back Pain Management


Medicare coverage for lower back pain management is available when necessary. Yet, some costs you may pay for entirely.

By the time most people reach eligibility, they’ve had some lumbar pain. Those feeling lower back pain need to know about treatments and pain management therapies. The cause of the back pain determines a patient’s eligibility for treatments and therapies.

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Medicare Coverage for Lower Back Pain Treatment Options

There are many treatment options, including:

While some individuals may require surgery, others consider it a last resort. There’s no guarantee that surgery will provide pain relief. Unless an orthopedic or neurosurgeon can guarantee over 50% improvement, you want to avoid surgery at all costs.

Also, any surgery with the lumbar spine includes the risk of complications. You want to consider surgery as a very last resort. Meaning you have tried all traditional treatments, including interventional pain management, and they’ve failed.

Medicare will cover lower back surgery when it’s medically necessary. We’ll go over coverage for the treatments you should seek before you resort to surgery to help your lower back pain.

Medicare Coverage Guidelines for Lower Back Pain Management Injections

Per the standard Medicare guidelines, cortisone injections usually receive coverage without prior authorization. Also, different doses have different costs. Make sure to ask your doctor about the allowable amount for each procedure.

Coverage through Medicare Supplement plans is crucial for those with lower back pain management needs. When undergoing pain management treatments, supplemental insurance protects you financially.

There are many different types of injections for treatment available to those with either chronic or acute conditions. We’ll acquaint you with some of the most common examples below.

Types of Pain Management Injections

  • SIJ Injections: These are therapeutic injections where cortisone goes directly into the joint through the needle.
  • Lumbar Facet Injections: These are therapeutic injections where cortisone goes directly into the joints from a needle.
  • Lumbar Medial Branch Blocks: Diagnostic procedure in which Lidocaine “tests” the joints nerve endings verifying one responds with pain relief. Doctors hit the correct nerve when the patient feels relief, making them a candidate for a Radiofrequency Ablation.
  • Radiofrequency Ablation or RFA: Therapeutic procedure where nerve findings come from the Medial Branch Blocks (or MBB’s); these nerves then receive cauterization for long-lasting relief.
  • Lumbar Epidural Steroid Injection: Therapeutic injection where cortisone goes around the hurt disc and nerve endings for pain relief.

Medicare Coverage for Pain Management Injections

Usually, Medicare covers pain management injections when they’re determined to be medically necessary. Suppose you’re receiving an injection during an inpatient stay at a hospital. In that case, it will receive coverage from Part A. If your doctor administers the procedure in an outpatient setting, Part B covers the injection.

Does Medicare Cover Radiofrequency Ablation?

Radiofrequency ablation is also known as RFA or rhizotomy. It’s a minimally invasive procedure using heat to stop nerve fibers from carrying pain signals to the brain. The non-surgical procedure results in immediate, long-lasting pain relief.

When a doctor deems RFA medically necessary, it gets coverage. To determine this, you may need to prove that other methods weren’t successful in managing your pain. You could be responsible for a copayment, deductible, or coinsurance. If you have a Medicare Advantage plan, costs may vary, so contact your plan for details.

Medicare Coverage for SIJ Injections

Sacroiliac joint injections are also known as SIJ injections. They are therapeutic injections that treat pain and inflammation. The practitioner injects numbing medication and cortisone into the sacroiliac joint, which is located by the buttocks. If doctors consider this injection necessary for pain relief, it will get coverage from Medicare.

Medicare Coverage for Lumbar Facet Injections

Lumbar facet injections diagnose the joints as the patient’s pain source. The procedure is necessary if facet joint syndrome is suspected as the cause of back or neck pain.

The request should be for one or more of the following:

  • Diagnostic facet injections
  • Therapeutic or repeat doses
  • Trigger point injections
  • Sacroiliac joint injections
  • Repeat sacroiliac injections

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Medicare Coverage for Lumbar Medial Branch Blocks

Lumbar medial branch blocks refer to a diagnostic procedure where injection of an anesthetic “tests” the joint’s nerve endings. This is done to verify the pain relief response and receives coverage when medically necessary. When the patient feels relief, they’re a candidate for radiofrequency ablation.

Does Medicare Cover Lumbar Epidural Steroid Injections?

Epidural steroid injections are minimally invasive and long-lasting pain relief treatments. During the procedure, the practitioner injects a corticosteroid and an anesthetic numbing agent into the spine. Some requirements must be met for Medicare coverage to begin.

For example, the reason for pain and details of failing to get relief from other treatments. If the pain isn’t sciatica or radicular pain, the injections are less useful.

Medicare Coverage for Conditions of Lower Back Requiring Pain Management Treatments

Below, we’ll go over some spine-related ailments the details of coverage for each treatment.

Sciatica

Only those feeling pain starting from the sacroiliac joint, or SIJ, have true sciatica. Those suffering from sciatica can obtain coverage for lumbar epidural steroid injections.

Disc Herniation

Sometimes, surgery, known as a discectomy, is performed to fix a herniated disc. But, Medicare doesn’t cover discectomies because patients can often get relief for a herniated disc through non-surgical approaches. These avenues for relief include exercise, physical therapy, massage, and pain medication. Epidural steroid injections can also help.

Lumbar Stenosis

Medicare doesn’t consider the treatment of percutaneous image-guided lumbar decompression (PILD), so there is no coverage.

Facet Joint Arthropathy

If medically necessary, epidural steroid injections for this condition obtain coverage from Medicare. Physical therapy may also help with this condition but might not get coverage unless a doctor refers you.

Lumbar Spondylolisthesis

Medicare doesn’t cover lumbar artificial disc replacement (LADR) surgery. Alternative treatments are pain management medications and physical therapy. The latter have coverage when a doctor refers you to help get back on your feet.

FAQs

How often is RFA covered by Medicare?
Radiofrequency ablation receives coverage from Medicare as long as it’s medically necessary. But, it’s a long-lasting treatment that can provide relief from pain for over a year in some cases.
Does Medicare cover physical therapy for back pain?
Medicare may cover physical therapy, depending on where you get your services. Part B will pay for physical therapy services if done in an outpatient setting.
How many epidural steroid injections will Medicare cover per year?
Medicare will cover epidural steroid injections as long as they’re necessary. But, most orthopedic surgeons suggest no more than three shots annually. Yet, if an injection doesn’t help a problem for a sustainable period, it likely won’t be effective. Repeat injections could cause damage to the body over time.
Does Medicare cover piriformis syndrome surgery?
Piriformis syndrome consists of the irritation of the sciatic nerve by the piriformis muscles in the buttocks. As treatments for this syndrome include anti-inflammatory drugs and massage, Medicare isn’t likely to cover the surgery.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

59 thoughts on “Medicare Coverage for Lower Back Pain Management

  1. Hi Marvin! There is no limit on how many injections you can get as long as they are considered medically necessary. I would recommend contacting you Medicare Advantage carrier to confirm.

  2. Hi Georgia! There is no limit on the number of injections a patient can get as long as they are considered “medically necessary.”

  3. Hi Poppy! Yes, as long as it’s considered medically necessary, Medicare will cover the anesthesia.

  4. Hi Robert! As long as it’s considered medically necessary, your Medicare Advantage plan should cover it. I would recommend contacting UnitedHealthcare to confirm.

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