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How Do I Find Pain Management Doctors Near Me That Accept Medicare?


Original Medicare will cover pain management services when medically necessary. Yet, some services or treatments may require payment based on your specific situation.

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Additionally, costs for some pain management services may vary based on your diagnosis. It is important to find a pain management doctor near you that accept Medicare.

Below, we review Medicare coverage for pain management, when it is covered, and how to find a doctor in your area that accepts Medicare.

Medicare Coverage for Pain Management Treatment Options

Medicare coverage for pain management looks different depending on the circumstances and method of treatment. In certain situations, Medicare will cover treatment options that may not receive coverage under other circumstances.

Medicare only covers pain management when medically necessary for your specific condition.

Pain management treatment options may include:

While some individuals may require surgery for pain management, 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, it is recommended to defer surgery in favor of alternate routes of pain relief.

If your physician deems pain management treatment, you will be responsible for the applicable Medicare copayment, coinsurance, and deductible(s). If you undergo outpatient treatment, you may need to meet the Medicare Part B deductible, then cover the 20% coinsurance.

If you are hospitalized for your treatments, you must cover the Medicare Part A deductible and any applicable coinsurance for your visit.

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Additionally, a Medicare Part C (Medicare Advantage) or a Medicare Supplement (Medigap) plan will cover pain management per the policy’s guidelines. If Original Medicare covers your treatment, you should receive coverage from your Medicare Advantage or Medicare Supplement plan.

Medicare Supplement plans pick up the coinsurance for which you are responsible with Original Medicare only. However, your Medicare Advantage plan may require you to receive a referral to see a pain management specialist.

If you require medication to treat your condition, your Medicare Part D plan or Medicare Advantage Prescription Drug Plan (MAPD) will be responsible for covering your medication. You will want to ensure your plan’s formulary covers the drug before picking it up at your pharmacy.

Medicare Coverage Guidelines for Lower Back Pain Management Injections

Per the standard Medicare guidelines, cortisone injections for lower back pain usually receive coverage without prior authorization through Medicare Part B. However, different doses have different costs. So, make sure to ask your doctor about the allowable amount for each procedure.

Regardless of the cost of your injection, you may be responsible for the Medicare Part B deductible, then 20% of the remaining cost.

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.

When you enroll in a Medicare Supplement plan, you will likely receive coverage for the Medicare Part B 20% coinsurance. Depending on the Medigap plan you choose, you also may not be responsible for copayments.

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.

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How Much Does Radiofrequency Ablation Cost With Medicare?

Radiofrequency ablation is also known as RFA or rhizotomy. It is 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, Medicare covers it. However, to be deemed medically necessary, your pain must be extreme, and receive no relief with alternative pain management solutions.

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. Costs may vary on Medicare Advantage plans, so contact your carrier for details.

Does Medicare Cover Epidural Steroid Injections in 2023?

Epidural steroid injections are minimally invasive and long-lasting pain relief treatments. During this procedure, your doctor injects a corticosteroid and an anesthetic numbing agent into the spine. You must meet specific requirements for Medicare coverage to begin.

Like with other injections, you will have to prove that alternative treatments were unsuccessful before Medicare will cover an epidural injection.

If your doctor stated this treatment is medically necessary after failed attempts to relieve your pain, Medicare Part B will cover its portion of this treatment.

Is Spinal Decompression Covered by Medicare?

Medicare does not consider certain spinal decompression therapies as a medically necessary service, even if they provide relief to your pain. However, in rare circumstances, you may receive Medicare coverage for spinal decompression.

Often, if you receive spinal decompression or any other chiropractic service, you will be responsible to pay out-of-pocket unless your physician deems it medically necessary. However, due to the short-term relief, this treatment is rarely medically necessary.

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Under the rare circumstance spinal decompression is medically necessary for your condition, you will receive the standard Medicare Part B coverage.

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. Medicare Part B will pay for physical therapy services 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.

How to Find Medicare Coverage for Lower Back Pain Management

To receive successful pain management treatment, you must find a physician skilled in this specialty. Once you find a physician who accepts Medicare, you will want ensure you are on the right Medicare plan to cover your out-of-pocket responsibilities.

To review Medicare plans in your area and compare benefits, fill out our online rate form today. We've helped countless people with their coverage, and we hope to do the same for you.

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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.

61 thoughts on “How Do I Find Pain Management Doctors Near Me That Accept Medicare?

  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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