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The carpal tunnel is a narrow pathway in our wrists. It contains a nerve known as the median nerve.
If you experience tingling, numbness and/or weakness in your hand, it could be a symptom of carpal tunnel syndrome. Carpal tunnel syndrome occurs due to a narrowing of the carpal tunnel. The pressure this puts on the median nerve causes the pain and numbness in both the hands and the wrists.
The good thing is that you can get carpal tunnel syndrome corrected by undergoing carpal tunnel surgery. So a common question many people have is, “Does Medicare cover Carpal Tunnel Surgery?”
In this article, we answer that question in clear, plain English. You will also find the average costs of carpal tunnel surgery and other helpful info.
Does Medicare Cover Carpal Tunnel Surgery?
The short answer is yes; Medicare will cover the cost of carpal tunnel surgery. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your carpal tunnel surgery. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for carpal tunnel surgery.
Medicare provides coverage to pretty much any surgery so long as it is medically necessary. For Medicare to consider a surgery to be medically necessary, it has to either treat a medical condition or improve/restore the function of a body part.
So carpal tunnel surgery checks to box of being medically necessary because it treats carpal tunnel syndrome and improves the function of your wrists.
Medicare Part A will provide coverage if you are admitted to a hospital for carpal tunnel surgery.
Most of the time, however, carpal tunnel surgery is done in an outpatient setting. So that means Medicare Part B usually provides coverage for the operation. Part B covers 80 percent of the costs of your carpal tunnel surgery.
Medicare Advantage Plans / Part D
Medicare Advantage plans (Medicare Part C) also provide coverage for carpal tunnel surgery. They cover everything Original Medicare covers as well as some additional benefits. However, exactly what it covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan.
Aside from covering the carpal tunnel surgery itself, Medicare Part B or Part C will also cover the following if it is related to your carpal tunnel surgery:
- Visits to the doctor’s office
- Physical Therapy
- Occupational Therapy
- Wrists or hand braces that you will wear at home that are necessary for recovery
- Medications that are given to you during the carpal tunnel surgery or your appointments
Medicare Part D also provides coverage for medications that you need to take at home after your carpal tunnel surgery. This includes pain medications.
How Much Does Carpal Tunnel Surgery Cost?
The exact costs of your carpal tunnel surgery will depend on where the surgery will take place. For those with insurance, carpal tunnel surgery costs an average of $1,000. For those without insurance, the average cost is around $7,000.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover psychotherapy?