Does Medicare Cover RFA?

Radiofrequency ablation, or RFA, is a medical procedure that can be used to treat different types of medical conditions, such as tumors, sleep apnea, and chronic pain. How this treatment works is that a needle with an ultrasound or x-ray is inserted in the area meant to be treated. Then the heat of the RFA interrupts the transmission of pain signals sent by nerve endings to the brain.

If you doctor is recommending this treatment and it’s one you want to get, a common question you probably have is, “does Medicare cover RFA?” In this article, we answer that question in clear, plain English. You will also find the average costs of RFA for those who have to pay out of pocket.

The short answer is yes; Medicare will cover the cost of RFA. 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 RFA. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for RFA. Parts A and/or B provide coverage for your RFA if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Coverage for RFA is provided by Medicare Part A if it takes place in an inpatient setting. 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 have a copayment each day of close to $400. After 90 days, Medicare Part A will no longer provide coverage.

Most of the time, however, RFA takes place in an office or outpatient setting. No anesthesia is typically needed. Just a little numbing agent. Usually people who get the RFA procedure go home the same day.

When it takes place in an outpatient setting, coverage for RFA is provided by Medicare Part B. Once approved, Medicare Part B covers 80 percent of the costs of RFA. You will pay for the remaining 20 percent.

Part C Coverage for RFA

Medicare Advantage plans (Medicare Part C) also provide coverage for RFA. This is because Part C plans have to cover all the procedures, treatments, etc. that Original Medicare provides. Part C plan will also offer some additional benefits that Original Medicare does not offer. Exactly what these are and how much the out-of-pocket costs will vary depending on the specifics of your plan.

How Much Does RFA Cost?

The national average cost of having an RFA is $6,000 if you do not have insurance coverage. However, the MDsave national average cost for the procedure is cheaper, costing only $3,200.

How Does RFA work?

During the procedure, the healthcare provider will insert a needle or a catheter to the area of pain. The needle/catheter is equipped with X-ray or ultrasound to monitor the procedure.

Then, the RFA uses its heat to interrupt the pain signals sent by the nerve endings to the brain.

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.