Does Medicare Cover Back Surgery? 

Surgery of any kind can be a big deal, but back surgery tends to be one of the most intensive types of surgical procedures. Seniors may require back surgery for any number of reasons, including to correct herniated discs, repair damage caused by a degenerative condition or remove spinal tumors. Back surgery often requires a lengthy recovery period, and some seniors will need ongoing physical therapy and medicinal support during recovery from back surgery.

Medicare benefits for outpatient back surgery

Although back surgery isn’t a first-line treatment for most seniors who experience back problems, Medicare recipients will be happy to know that Original Medicare coverage is available for back surgery if required. Medicare benefits help to pay for outpatient surgical procedures through Part B. Medicare Part B is the outpatient portion of the program, and it also covers doctor visits, durable medical equipment (DME) and diagnostic testing.

Under Part B, Medicare recipients will need to pay a monthly premium and meet an annual deductible to make full use of their benefits. In most cases, outpatient services are paid at 80% by Medicare, leaving the remaining 20% to be covered by Medicare recipients. This also applies to the purchase or rental of approved DME that may be ordered by your doctor following back surgery.

Inpatient hospital coverage for back surgery

Medicare Part A covers inpatient care in Medicare-approved hospitals and skilled nursing facilities. The premium for this coverage is usually free due to taxes paid during working years, but a deductible still applies. For 2023, the Part A deductible is $1,600.

If you are hospitalized prior to or after back surgery, Medicare Part A covers your care for up to 60 days, beyond which you can pay a per-day rate to continue coverage for an additional 30 days. Medicare benefits under Part A will pay for up to 20 days in a skilled nursing facility, after which you can receive an additional 80 days at a per-day cost.

Prescription drug coverage and back surgery

Many seniors who undergo back surgery will be prescribed medications to take following the procedure. Some of these medications may include pain relievers, but antibiotics may also be required.

Medicare benefits help to pay for prescription drugs through Medicare Part D. This part of Medicare insurance only offers coverage for drugs that are purchasable through retail pharmacies. 

Does Medicare cover physical therapy following back surgery?

As mentioned, physical therapy is often required after back surgery. Because the back and its associated tissues and structures provide support for the entire body, physical therapy often follows back surgery. Physical therapy can help seniors regain mobility and flexibility faster when supervised by a licensed and Medicare-approved physical therapist.

Medicare coverage is available for post-surgical physical therapy through Medicare Part B. Depending on your situation, you may need to have your doctor reauthorize physical therapy every 30 days. This may also mean that you will need to regularly visit with your doctor in person to discuss your recovery and determine whether ongoing physical therapy is a medical necessity.

There is no limit to the number of physical therapy visits Medicare covers. As long as your monthly premium is up to date and you have met your deductible, you should be able to receive physical therapy coverage for as long as your doctor believes is medically necessary.

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