Your carpal tunnel is a narrow pathway in your wrist that contains a nerve called the median nerve.
When you have carpal tunnel syndrome, your carpal tunnel becomes narrowed. This puts pressure on your median nerve, causing pain and numbness in your hand and wrist.
Many people who have carpal tunnel syndrome need surgery to correct the condition.
Medicare will cover carpal tunnel surgery as long as your doctor says that itâ€™s medically necessary. Youâ€™ll be covered under Part B or Medicare Advantage (Part C), and your costs will vary depending on your plan.
Medicare coverage for carpal tunnel surgery
Medicare covers any surgery thatâ€™s considered â€œmedically necessary.â€ A medically necessary surgery is one that a doctor orders to treat a medical condition or that will improve the function of a body part.
Carpal tunnel surgery treats carpal tunnel syndrome and can improve the function of your wrist. Itâ€™s considered medically necessary when your doctor determines that itâ€™s the best way to treat your carpal tunnel syndrome.
Your exact Medicare coverage will depend on the type of plan you have and where you have the surgery. If youâ€™re using whatâ€™s known as original Medicare, which is made up of parts A and B, your coverage will primarily come from Medicare Part B.
If youâ€™re enrolled in a Medicare Advantage plan, then youâ€™re using Medicare Part C. Medicare Advantage plans are required to offer as much coverage as original Medicare, and many offer extra benefits as well.
Medicare Part B and Part C will cover your outpatient medical care. In the case of carpal tunnel surgery, this might include:
- doctorâ€™s office visits
- physical therapy
- occupational therapy
- carpal tunnel surgery if itâ€™s performed in a doctorâ€™s office or outpatient clinic
- wrists or hand braces you need to wear at home during recovery
- any medication youâ€™re given during your surgery or appointments
Keep in mind that youâ€™ll need to receive these services from a healthcare provider who participates in Medicare. You can use a tool on the Medicare website to find participating providers in your area.
If you have Medicare Advantage, check whether your physician is in your planâ€™s network to avoid higher copay or coinsurance costs.
Some other parts of Medicare could also apply to your carpal tunnel treatment:
- Medicare Part A. Medicare Part A is hospital insurance. It covers your inpatient care at hospitals, skilled nursing facilities, and rehab centers. It will cover you if youâ€™re admitted to a hospital for carpal tunnel surgery.
- Medicare Part D. Medicare Part D is prescription drug coverage. Itâ€™ll cover medications you need to take at home after the surgery, including pain medication.
- Medicare supplement insurance. Medicare supplement insurance, also known as Medigap, is designed to help cover your out-of-pocket costs if you have original Medicare. It will cover many of the costs of your carpal tunnel surgery that would typically fall to you, like coinsurance and copayments.
What are the out-of-pocket costs for carpal tunnel surgery?
Your exact costs will depend on the details of your plan and procedure. However, there are some costs you can count on.
When youâ€™re using Medicare Part B, youâ€™ll need to pay your:
- Monthly premium. In 2021, the standard Part B premium is $148.50.
- Annual deductible. The 2021 Part B deductible is $203.
- Coinsurance costs. Youâ€™ll pay 20 percent of the Medicare-approved cost for the surgery; Medicare will pay the other 80 percent.
You can use Medicareâ€™s cost lookup tool to see what your 20 percent might look like. For example, according to the tool, the average costs for a release or relocation of the median nerve â€” a common type of carpal tunnel surgery â€” are:
- $1,242 at an ambulatory surgery center. Medicare would pay $994, and youâ€™d pay the remaining $248.
- $2,165 at a hospital-based outpatient surgery center. Medicare would pay $1,732, and youâ€™d pay the remaining $432.
If you have Medicare Advantage, your costs will depend on your specific plan. Youâ€™ll have at least the same amount of coverage as original Medicare, but your deductibles, copayments, and other costs will vary.
Contact your plan directly to get details on what costs you can expect.
What should I expect from carpal tunnel surgery?
No matter what type of surgery youâ€™re having, it can help put your mind at ease if you know what to expect ahead of time.
Hereâ€™s a basic overview of what happens during the entire carpal tunnel surgery process â€” from preparation to recovery.
Preparing for the procedure
Youâ€™ll likely meet with your doctor several times before you have carpal tunnel surgery. Theyâ€™ll take X-rays to confirm that surgery is the right treatment for you.
You and your doctor will also go over any medications you take and discuss your smoking history. If you do smoke, they might recommend you stop smoking for a few weeks around the procedure.
You might also need to stop taking certain medications for a few days if youâ€™re able. Your doctor will let you know safe ways to do this.
Since carpal tunnel surgery is most often done as an outpatient procedure, you wonâ€™t have to plan for a hospital stay. However, itâ€™s a good idea to make arrangements in advance. This will make the day of surgery and the weeks after easier.
It can be a big help to plan things like transportation to and from and your procedure and have a few meals already prepared at home.
The day of surgery
On the day of surgery, your hand and wrist will be numbed. This is typically done with a local anesthetic, so youâ€™ll be awake during the surgery.
The goal of surgery is to widen the carpal tunnel itself and relieve the pressure on your median nerve. Your doctor will use one of two methods for your surgery:
- Open release surgery. In open release surgery, the doctor will cut a 1- to 2- inch incision in your wrist. Theyâ€™ll then cut the carpal ligament using surgical tools and widen your carpal tunnel.
- Endoscopic release surgery. In an endoscopic release, the doctor will make two small half-inch incisions â€” one in your wrist and the other in your palm. Theyâ€™ll then insert a tiny tube camera through one incision. The camera will guide them as they perform the surgery and release the carpal ligament.
Your wrist will be stitched and bandaged after either surgery. You also might be given a wrist brace.
Youâ€™ll keep the bandages and any brace on your wrist for about 2 weeks. The doctor will remove them during a follow-up appointment.
Once the bandage is removed, youâ€™ll likely start physical therapy to help you regain strength in your hand.
Recovering after the surgery
You can usually go home shortly after the procedure. Youâ€™ll be given a prescription to help you manage any pain.
You should be able to do most light activities, such as driving and self-care tasks, while you recover. Your doctor will tell you when you can return to work or more strenuous activities.
Recovery can take anywhere from 2 months to a full year, depending on how severe your nerve damage was before surgery.
Most people have complete relief of their carpal tunnel syndrome after recovery is complete. Recovery can be slowed by other conditions that affect your joints and tendons. In rare cases, carpal tunnel syndrome can reoccur.
Your doctor will continue to monitor you after surgery to make sure youâ€™re making progress.
What are the alternatives to surgery?
Not everyone will need surgery to treat their carpal tunnel syndrome. Your doctor might recommend various alternatives, especially if your symptoms are mild. Some alternatives to surgery include:
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