Overview

Medicare provides coverage for medically necessary surgical procedures performed in hospitals, ambulatory surgical centers, and doctors' offices. Coverage typically includes both inpatient and outpatient surgeries, with different cost-sharing requirements depending on the type of procedure and setting.

  • Medicare Part A covers inpatient hospital surgeries
  • Medicare Part B covers outpatient surgical procedures
  • Surgery must be deemed medically necessary by a healthcare professional
  • Some preventive and elective surgeries may have limited or no coverage
  • Surgical coverage requires pre-authorization in some cases
  • Medicare beneficiaries aged 65 and older
  • Individuals with qualifying disabilities
  • Patients with End-Stage Renal Disease (ESRD)
  • Must be enrolled in Medicare Part A and/or Part B
  • Part A deductible applies for hospital surgeries ($1,600 per benefit period in 2023)
  • Part B typically covers 80% of approved surgical costs after meeting annual deductible
  • Patients responsible for remaining 20% coinsurance
  • Additional costs may apply for surgeon fees, anesthesia, and facility charges
  • Cosmetic surgeries generally not covered unless medically necessary
  • Experimental procedures may be excluded from coverage
  • Some advanced or specialized surgeries might require additional documentation
  • Coverage can vary between Original Medicare and Medicare Advantage plans
  • Consult with your healthcare provider about surgical necessity
  • Verify specific coverage with your Medicare plan
  • Obtain pre-authorization when required
  • Contact Medicare at 1-800-MEDICARE for detailed coverage information
Last updated: 6/15/2025

Quick Information

Provider
Medicare
Last Updated
6/15/2025
Topics
Medicare surgerysurgical proceduresMedicare Part Bhospital surgerymedical coverage

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