Does Medicare Cover Spinal Surgery?

Not all back complications need surgery. Treatments like physical therapy, spinal injections, and medications may do the trick. However, surgery may be needed if the spine is unstable and needs correction.

Spinal surgery prevents other conditions that may occur due to having an unstable spine. And spinal surgery may be needed to remedy the symptoms and prevent permanent impairment for conditions that inflict tingling, muscle weakness, pain, numbness, and more, such as disc herniation.

So a common question many people have is, “Does Medicare cover Spinal Surgery?” In this article, we answer the question in clear, plain English. You will also find the average costs of spinal surgery and other helpful info.

Does Medicare Cover Spinal Surgery?

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

Medicare Part A and B

Original Medicare (Medicare Part A and Part B) provides coverage for spinal surgery and other back surgeries. Original Medicare provides coverage for some back surgeries but not all of them. Among those, Original Medicare covers include spinal surgery.

Original Medicare provides coverage for spinal surgery if it is considered medically necessary. Your healthcare provider must first order the operation for Original Medicare to provide coverage.

Coverage for spinal surgery is provided by Medicare Part A if your spinal surgery takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.

From the 61st day to 90 days, Medicare Part A will still provide coverage. However, you will pay a copayment each 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 a copayment of around $800 per day.

Coverage for spinal surgery is provided by Medicare Part B if the surgery takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of spinal surgery costs. You will pay for the remaining 20 percent.

Medicare Part C and D

Medicare Advantage plans (Medicare Part C) also provide coverage for spinal surgery. They cover everything Original Medicare covers, as well as some additional benefits.

Precisely what it covers and how much the out-of-pocket costs vary depending on your plan’s specifics.

Medicare Part D plans provide coverage for medications that you need after spinal surgery. Medicare Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does Spinal Surgery Cost?

Laminectomy may cost starting from $50,000 to $90,000. On the other hand, a spinal fusion may cost $80,000 to $150,000 or more.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. 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.