Medicare coverage for lower back pain management is available when necessary. Although, some out of pocket costs could be your responsibility.
By the time most people enter the age of Medicare coverage, they’ve had some lumbar pain.
Recipients feeling lower back pain need to know what treatments and pain management therapies are proper.
The cause of the back pain determines a patient’s eligibility for treatments and pain management therapies.
There are many treatment options, including:
- Physical Therapy
- Chiropractic Treatments
- Injection Based Treatments
- Surgical Intervention
Standard Conditions of Lower Back Pain Requiring Pain Management
Medicare coverage for lower back pain management helps with just one type of pain issue. When you go with a Medigap plan to help cover the out of pocket costs, you save money.
Only those feeling pain starting from the Sacroiliac joint, or SIJ, have true Sciatica.
The SIJ joint connects your hip to your spine. When the SIJ becomes inflamed from irritation or Arthritis, it causes Sciatic pain.
The outer portion of the vertebral disc contains the cushioning between the vertebral bodies of the spine.
A tear on the outer portion of the vertebral disc is disc herniation.
This tear causes the inside, or the nucleus, to extrude through its fibers at a certain level, although this condition can replicate Sciatic pain.
Well, Lumbar Stenosis is in the category of Arthritis. It could also be the narrowing of the spaces within the spine.
This condition affects the surrounding nerves, which then, in turn, can also replicate Sciatic pain.
Facet Joint Arthropathy
The Facets are the joints extending from the spine that provide support and allow movement. Facet Joint Arthropathy refers to the degenerative disease that breaks down the cartilage around these joints.
Other standard terms for Facet Joint Arthropathy is Facet Joint Arthrosis or Facet Joint Osteoarthritis.
Lumbar Spondylolisthesis is the movement or slipping of the vertebral body. This condition causes both pains and squeezing of the nerve, which can also mimic Sciatic pain.
Interventional Pain Management for Lower Back Pain
Interventional Pain Management is to proceed with conservative treatments vs. surgical invention. However, managing the symptoms can help to avoid more invasive treatment plans.
There are two types of pain management doctors:
- Non-interventional: those willing to mask the pain with strong opioid pain medications
- Interventional: those whose sole purpose is to help patients relieve their pain beyond medicine
Why Avoid Surgical Intervention
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 you over 50% improvement, you want to avoid surgery at all costs.
Additionally, 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 and failed all traditional treatments, including Interventional Pain Management.
Medicare Coverage Guidelines for Lower Back Pain Management Injections
Per the standard Medicare guidelines, cortisone injections without needing prior authorization usually have coverage. Also, different doses have different costs.
Make sure to ask your doctor the allowable amount is for each procedure.
However, Medicare only covers 80% of approved medical services. You pay 20% of the cost. Also, you spend out of pocket on deductibles, coinsurance, and copayments.
Supplement coverage is crucial for those with lower back pain management needs. Undergoing Interventional or Non-Interventional Pain Management treatments, Medicare Supplement insurance protects you financially.
There are many different types of injections for treatment for those with either chronic or acute conditions.
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.
Does Medicare Cover Radiofrequency Ablation
When a procedure is medically necessary because a doctor said it’s essential, Medicare will likely cover the treatment. You may need to prove that other methods weren’t successful in getting coverage for this treatment.
You may be responsible for a copayment, deductible, or coinsurance. Also, advantage plan recipients will have different costs.
How do Cortisone Steroid Injections Help with Lower Back Pain
Cortisone is a potent synthetic anti-inflammatory that goes into a specific area of the body.
Also, It helps reduce inflammation, which in turn helps to decrease pain.
For more help on how to beat back pain, you can check out 53 Health & Fitness Experts Tips, where 53 experts, including us, share top tips.
How Many Cortisone Shots Will Medicare Cover
Cortisone shots can help treat inflammation. Although, if a cortisone injection doesn’t help a problem for a sustainable period, it likely won’t be effective at all.
Repeat injections could cause damage to the body over time. Most orthopedic surgeons suggest no more than three cortisone shots annually.
Does Medicare Cover Epidural Steroid Injections
If something is medically necessary, Medicare will usually cover it at 80%. However, some requirements must be met for the coverage to begin.
Such as 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.
Those in need of Medicare coverage for lower back pain management may qualify for an injection.
How Many Epidurals Does Medicare Allow in a Year
Medicare has specific requirements for Epidural Steroid Injections (ESI). However, the injections must be medically necessary to relieve pain.
Six or more weeks of conservative therapy need to fail, and the patient must complete physical therapy. Also, the Patient must complete systemic analgesics, muscle relaxants, and activity modification.
An MRI or CT image study needs to be done to confirm no tumor or another space-occupying lesion is the cause of pain. A physical exam should prove regular radicular pain.
The patient can’t have non-specific lower back pain or failed back syndrome.
No more than two levels of injections can occur during the same session for transforaminal epidural injections. Also, ESI with ultrasound guidance won’t have coverage.
The requirements for continuing epidural injections as well as facet joint injections are different.
Does Medicare Cover Facet Joint Injections
The procedure must be medically necessary for back or neck pain when facet joint syndrome could be suspected.
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
For each, you must meet specific criteria.
Does Medicare Cover Physical Therapy for Back Pain
Medicare may cover physical therapy, depending on where you get your services.
Part B will generally pay for your physical therapy services if received in an outpatient setting. However, it only covers 80%, so you’ll need a Medigap plan to get the remaining 20% covered.
Get Medicare Help with Lower Back Pain Management Coverage
The benefits of a Medicare Supplement/Medigap plan varies, depending on which letter plan you choose. Also, you can compare the top two Medigap plans, Plan F vs. Plan G.
We can help guide you to find the best plan possible for all your individual needs. Click or call today, our agents are here to help, and our services are 100% free.