Surgery
Medicare Coverage Information
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
Related Coverage Topics
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