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If you’re looking to get shock wave therapy and want to know if Medicare will cover it, the answer probably is no. However, there’s more to the story which we’ll cover below.
Whether you’re struggling with chronic pain or a specific medical condition, Shock Wave Therapy might be on your radar. Stick around to learn what this treatment involves, who can benefit from it, and what the science says about its effectiveness.
- Get the lowdown on what Shock Wave Therapy actually is
- Understand the costs and whether insurance might cover it
- Find out what conditions it can help treat
- Learn about the science behind it, and whether it really works
Ready to dive in? Let’s get started.
Table of Contents
Does Medicare Cover Shock Wave Therapy?
In most cases, the answer is no. Medicare will not cover the cost of shock wave therapy.
With that said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your shock wave therapy.
Original Medicare Coverage of Shock Wave Therapy
Original Medicare (consisting of Part A and Part B) does not provide coverage for shock wave therapy unless it is performed for a medically necessary reason.
If the purpose of shock wave therapy is to preserve life and treat a serious health condition, then it is possible you may be able to receive coverage.
In most cases, however, if you choose to try out Extracorporeal shock wave therapy (ESWT), you will have to pay 100 percent of the costs. Again, Medicare does not provide coverage for procedures if they are done for non-medically necessary reasons.
But what about other Medicare plans?
Medicare Advantage Coverage of Shock Wave Therapy
Similarly, Medicare Advantage plans (Medicare Part C) also do not cover shock wave therapy. These plans cover the same things Original Medicare covers but goes above and beyond to provide coverage for some treatments Original Medicare does not cover.
Exactly what a Medicare Advantage plan covers and how much your out-of-pocket costs are will vary depending on your plan.
How to Advocate for Coverage
- Talk to Your Doctor: First, talk to your doctor. They can help argue your case to Medicare by explaining why the treatment is needed for your health issue. Your doctor can also guide you through filling out any forms that Medicare might need. If Medicare says no, your doctor can suggest other treatments like physical therapy, medication, or even surgery.
- Petition Medicare: You can also challenge Medicare’s decision by filing a petition with their Appeals Council.
- Alternative Coverage Options for Shock Wave Therapy: Lastly, look into other insurance options like private insurance, workers’ compensation, or disability insurance, as they might cover the treatment.
How Much Does Shock Wave Therapy Cost?
The average cost of shockwave therapy is $300. However, the costs of shock wave therapy may either be higher or lower than that. However, it will usually fall between $250 and $400.
Out-of-Pocket Costs to Consider
Additional Costs with Medicare
Medicare usually won’t pay for shock wave therapy, so you’ll have to cover all the costs yourself. This includes not just the treatment but also any extra fees like copays and deductibles.
On top of the treatment cost, you might have other fees. These can change based on your Medicare plan and may include:
- Copays: A set fee you pay for each session, maybe around $50.
- Deductibles: Money you pay before Medicare starts covering costs, possibly around $1,000.
- Additional fees: Extra costs like anesthesia or travel to and from treatment.
Financial Assistance and Other Insurance Options
There are some programs that might help you pay for shock wave therapy. These can be from your state, local community, or health insurance company.
You could also look at different insurance plans, like private health insurance or disability insurance, to see if they cover shock wave therapy. But make sure to check the details of your plan first.
Several resources can help you with the costs:
- Your health insurance: They might have programs or discounts.
- Your state: Check if there are state programs for medical costs.
- Your community: Local programs might exist to help with medical costs.
- Nonprofits: Some organizations offer help with medical expenses.
Understanding Shock Wave Therapy
Shock wave therapy is a non-surgical, non-anesthetic medical treatment. It employs high-energy sound waves to address issues like scar tissue and calcified deposits within soft tissues.
A device generates a high-pressure air or water pulse to create shock waves. These waves are directed at the targeted area through a handpiece.
The waves induce minor damage to the tissue, initiating the body’s natural healing mechanisms, including the release of substances that promote tissue repair.
This therapy is utilized for various medical conditions, including:
- Plantar fasciitis
- Achilles tendinitis
- Epicondylitis (tennis elbow or golfer’s elbow)
- Shoulder impingement syndrome
- Frozen shoulder
- Carpal tunnel syndrome
- Peyronie’s disease
- Ingrown toenails
- Kidney stones
Benefits and Risks:
Advantages of shock wave therapy include its non-invasive nature, effectiveness for multiple conditions, and low risk of side effects. Potential risks involve:
- Minor pain or bruising at the treatment site
- Temporary swelling or redness
- In rare instances, complications like nerve damage or bone fracture may occur.
Shock Wave Therapy vs. Acoustic Wave Therapy
- Technique: Shock Wave Therapy focuses high-pressure sound waves on a specific body part. Acoustic Wave Therapy uses softer sound waves over a larger area.
- Uses: Shock Wave Therapy mainly treats chronic joint pain like in the heel, knee, and shoulder. Acoustic Wave Therapy treats a broader range of issues, like plantar fasciitis, tendinitis, and even erectile dysfunction.
- Results: Shock Wave Therapy is generally more effective for chronic conditions, giving more noticeable relief. Acoustic Wave Therapy also works but may give less dramatic results.
| Shock Wave Therapy | Acoustic Wave Therapy | |
|---|---|---|
| Technique | Focuses high-pressure sound waves on a specific body part. | Uses softer sound waves over a larger area. |
| Uses | Mainly treats chronic joint pain like in the heel, knee, and shoulder. | Treats a broader range of issues, like plantar fasciitis, tendinitis, and even erectile dysfunction. |
| Results | Generally more effective for chronic conditions, giving more noticeable relief. | Also works but may give less dramatic results. |
Which One is Right for You?
To know which treatment suits you best, consult your doctor. They can review your symptoms and suggest the most fitting option.
Factors to Consider When Choosing Between the Two Therapies
- Your Condition: Shock Wave is better for specific joint pains, while Acoustic Wave can be used for more types of conditions but may be less powerful.
- Pain Level: For serious pain, Shock Wave Therapy is usually quicker at providing relief.
- Cost: Shock Wave Therapy usually costs more than Acoustic Wave Therapy.
More information on Extracorporeal Shock Wave Therapy
ESWT can be used regularly to treat many physical conditions.
- Calcific tendinopathy of the shoulder,
- Elbow tendinopathy (lateral/medial epicondylitis),
- Carpal tunnel syndrome (CTS),
- Greater trochanteric pain syndrome (GTPS),
- Fractures and delayed unions/nonunions,
- Osteonecrosis of the femoral head (ONFH),
- Erectile dysfunction (ED)
- Patellar tendinopathy (PT.)
How Does Extracorporeal Shock Wave Therapy Relieve Pain?
ESWT is a type of therapy that relieves pain in the areas treated. But how does it do this exactly?
A lot of research suggests that ESWT relieves pain in the following ways:
- It disrupts fibrous tissue, allowing for tissue revascularization and healing.
- The shock waves’ direct and indirect effects on cell membranes may reduce nociceptors’ ability to send pain signals and improve healing.
- Shock waves reduce pain and improve function by breaking up calcium deposits, loosening structures, and promoting calcium resorption.
Does Other Health Insurance Cover Shock Wave Therapy For ED?
The short answer to that is no. Other well-known health insurance companies such as Aetna, Cigna, United Healthcare, and AARP do not provide coverage for shock wave therapy for treating erectile dysfunction.
Conclusion
This article talks about if Medicare pays for Shock Wave Therapy, a treatment some people get for long-term health problems. We showed what Medicare will and won’t pay for, and shared other ways to help pay for it. It’s important to know if Medicare covers this so you can plan your healthcare and know how much you might have to pay.
If you’re thinking about getting this treatment, this info can help you decide and know how to save money for it.
We hope this helps you! If you have your own story or questions about using Medicare for Shock Wave Therapy, please share. Your thoughts can help others like you. You can also read more on our website.
Frequently Asked Questions
Will Insurance Cover Shockwave Therapy?
Who Should Avoid Getting Shockwave Therapy?
Don’t use Shockwave therapy if you: are pregnant, have problems with blood clotting, are taking blood thinners, got a steroid shot in the last 6 weeks, have a pacemaker or have tumors where you’d get the treatment.
Are a TENS Unit and Shockwave Therapy the Same Thing?
Shockwave therapy uses strong sound waves to help heal body tissues. TENS uses small electric shocks delivered through sticky pads on the skin. There are over 3000 studies on shockwave therapy, and it’s being researched all the time. Unlike TENS, which just treats the feeling of pain, shockwave aims to fix what’s causing the pain.
How Many Shockwave Therapy Treatments Are Needed?
Most people feel better right away and usually need only 2 or 3 sessions over 6 to 12 weeks to fully heal. The great thing about this method is that if it’s going to help, you’ll likely feel better right after the first session.
Will Medicare Cover Shockwave Therapy for Plantar Fasciitis?
Medicare doesn’t cover the cost of shock wave therapy for foot pain caused by plantar fasciitis. They don’t consider this treatment medically needed or reasonable for muscle and bone conditions like plantar fasciitis.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always 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
Also, you can check out other articles in this series such as does Medicare cover pelvic floor therapy and Medicare coverage for IVIG for CIDP.
