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Gastroesophageal reflux disease, or GERD, is a medical condition where your stomach acid backs up into your esophagus more often than usual. In other words, it is acid reflux but is more severe and/or frequent. In some cases, a surgery is required to treat GERD. One such surgery is known as LINX® surgery.
If this type of surgery is one that you may need, a very common question is “Does Medicare cover LINX surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of LINX surgery for people who have to pay for it out of pocket.
Does Medicare Cover LINX Surgery?
The short answer is yes; Medicare will cover the cost of LINX 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 LINX 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 LINX surgery. Medicare provides coverage for your LINX surgery if it is considered medically necessary. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Coverage for GERD surgery and treatment is provided by Medicare Part A if it takes place in an inpatient setting. However, Medicare Part A does not necessarily have set guidelines with regards to coverage of LINX surgery. So that means that coverage decisions for LINX surgery are made on a case-by-case basis by Medicare Part A.
To be eligible for Medicare Part A’s coverage for surgery, you need to complete your pre-tests and be a candidate for LINX.
Coverage for LINX surgery is provided by Medicare Part A if it takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days. For days 61 to 90, Medicare Part A will still provide coverage. However, you will pay a copayment of close to $400 per day. After 90 days, Medicare Part A will no longer provide coverage.
However, Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days, but you will pay for a copayment of around $750 per day.
Coverage for GERD treatment is provided by Medicare Part B if it takes place in an outpatient setting. Medicare Part B provides coverage for doctor’s visits as well as certain tests or screenings for GERD.
Medicare Part B covers 80 percent of the costs of covered GERD services. You will pay for the remaining 20 percent as coinsurance or copayment.
Part C Coverage for LINX Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for LINX surgery. These plans must provide coverage for the same things as Original Medicare but will provide coverage for other treatments and services too. Exactly what these other treatments and services are, as well as the out-of-pocket costs, vary from plan to plan.
How Much Does LINX Surgery Cost?
In 2019, the average cost of a LINX surgery was around $14,000. This cost will vary depending on the provider.
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 routine foot care?