Does Medicare Cover Back Surgery?

Chronic back pain often requires a multi-faceted treatment plan that includes physical therapy, medication or surgical intervention. In some cases, surgery is chosen when other treatments have been tried and do not work. In others, the condition may be so severe that surgery is required. Medicare coverage for back surgery can vary due to several factors.

Types of Back Surgery

Whether your back pain is due to injury, degenerative disease or complications with aging, the condition of your spine and the source of the pain will determine what type of surgery may work best for you. An orthopedic specialist will assess your needs and discuss your options with you. They will also perform a physical exam and may order certain diagnostic imaging tests, such as an MRI or x-ray, to review which surgery may be medically necessary.

The most common types of back surgery include the following:

• Spinal fusion. If the spine is unstable or there is a deformity, permanently fusing damaged vertebrae with a bone graft and metal rods or plates can correct or improve the condition.
• Laminectomy. Connective tissue between the vertebrae may be cut or removed in order to decompress the spine and relieve pressure on your spinal cord or nerves. This surgery is also used if the compression’s cause is related to other damages, such as the presence of a tumor, bone spur or disc fragment, which must be removed.
• Discectomy. In conditions that involve herniated discs, the surgeon will remove any part of the disc that compresses nerves or the spinal column.
• Artificial discs. Vertebral implants made with synthetic materials are sometimes used in place of spinal fusion but may not be suitable for all conditions that spinal fusion treats.

Risks Associated with Back Surgery

Although many surgical procedures that relieve back pain can now be performed with minimally invasive procedures, it is still considered a major surgery. With any major surgery, there can be numerous risks. These risks include, but are not limited to, allergic reactions to anesthesia and other drugs, excessive bleeding, blood clots and infection. Certain people can be at a higher risk for a heart attack or stroke during surgery. Your surgical team should be aware of your medical history and any current medications you take in order to minimize risk.

Due to the complexity of the spinal column, there is an elevated risk of experiencing paralysis, loss of control in the bladder or bowels, pain, weakness and sexual dysfunction if the spinal cord or surrounding nerves are damaged during surgery. These complications may be temporary or reversible, but they can also become permanent. Your surgeon will help you understand if you are at an increased risk for these issues.

Additionally, some patients do not experience pain relief even after back surgery. They may also experience limited mobility in the case of surgeries that fuse vertebrae together or weaken the structure of the spine. Non-surgical treatment for chronic back pain may still be required after surgery in certain situations.

Medicare Coverage for Back Surgery

Original Medicare Part A, also known as hospital insurance, provides coverage for inpatient hospital procedures, but Part B may also contribute to covering certain costs associated with back surgery. Part A benefits cover certain costs associated with the hospital stay itself, while Part B may help pay for diagnostic tests, doctor fees and any additional outpatient services. If you require prescription medication during recovery, you may need a Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage to help keep your costs down.

If you choose to enroll in a Medicare Advantage plan, commonly referred to as Medicare Part C, you will have at least the same Original Medicare Part A and Part B benefits, but many plans provide additional coverage and your out-of-pocket costs for surgery may be reduced. Part C plans also provide extra benefits that also often include prescription drug coverage. These plans are offered by a private insurance companies, so check with a representative about the options available to you.