Does Medicare Cover Robotic Surgery?

Technology has improved greatly over the last few decades. We now use robotics in many different fields, including medicine. In some cases, surgeons now use the help of robots to perform medical procedures and surgeries.

So a common question many people have is, “does Medicare cover robotic surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of robotic surgery, as well as other helpful info.

Does Medicare Cover Robotic Surgery?

The short answer is yes; Medicare will cover the cost of robotic surgery. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your robotic surgery. 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 robotic surgery. Part A and Part B always provide coverage for any surgery as long as it is medically necessary. This includes any medically necessary robotic surgery.

The surgery must take place in a Medicare-approved facility for Original Medicare to cover it. The surgeon operating the robot must also be Medicare-enrolled for Medicare to cover it.

One of the common robotic surgeries that Original Medicare covers is called Da Vinci robotic hysterectomy. Medicare often covers it as most of the time it is medically necessary. However, if you will be having a voluntary hysterectomy for a non-medically necessary reason, Medicare will not cover it.

Coverage for robotic surgery is provided by Medicare Part A if the procedure takes place in an inpatient setting. After the robotic surgery, Medicare Part A may also provide coverage for an inpatient stay in a skilled nursing facility.

On the other hand, coverage for robotic surgery is provided by Medicare Part B if it takes place in an outpatient setting. Medicare Part B will also provide coverage for any outpatient services, such as rehabilitation services after the surgery.

Once approved, Medicare Part B covers 80 percent of the costs of your robotic surgery. You pay for the remaining 20 percent.

Part C Coverage for Robotic Surgery

Medicare Advantage plans (Medicare Part C) also provide coverage for robotic surgery. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and your out-of-pocket costs are will vary depending on the specifics of your plan.

Why Is Robotic Surgery More Expensive Than Traditional Surgery?

The reason why robotic surgery is more expensive than its traditional counterpart is that a single robot often costs at least 2 million dollars. To add to that, there are single-use attachments that you replace after each use which adds to the cost.

Compared to traditional laparoscopic surgery, robotic surgery usually costs from $3,000 to $6,000 more. However, one of the benefits of undergoing robotic surgery is that it reduces hospitalization time. And by reducing hospitalization time, the patient also reduces the cost of the hospital bill.

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.