Do you have tingling, numbness, and pain in your hands and/or arms? It doesn’t matter whether it’s in only one arm or both — either way, it could be a sign of carpal tunnel syndrome. If so, you might also be worried about how expensive carpal tunnel could be under Medicare.
In that case, we have some valuable information that might help put your mind at ease.
Diagnosing and treating carpal tunnel
Carpal tunnel is such a common problem that getting medical treatment is a reasonably straightforward process. First, you must contact your primary care doctor and ask for an evaluation. They may evaluate you themselves, or they may refer you to a physical therapist who specializes in carpal tunnel.
You will then receive specific diagnostic testing such as a nerve conduction study (CNS), electromyography (EMG), x-rays, or any combination thereof. These tests serve several important purposes:
- They help rule out other, more severe conditions (like ALS).
- They help determine the severity and the leading cause of your carpal tunnel.
- They help your doctor decide which treatment approach is best.
- The results can help your doctor determine whether you need physical therapy, splints, braces, or carpal tunnel surgery.
Some Medicare beneficiaries may feel anxious about getting evaluated for carpal tunnel. This is especially true for those uncertain whether Medicare will pay for carpal tunnel surgery, non-surgical treatments, splints, braces, or carpal tunnel prescription drugs. So let’s take a closer look at what Original Medicare does cover for carpal tunnel.
Carpal Tunnel and Medicare Coverage
The unfortunate fact is that most people will get some symptoms of carpal tunnel syndrome in their lifetime. But when is it just a minor inconvenience, and when does it become severe enough to require more advanced treatment, like surgery? And most importantly, how much will your Medicare health insurance cover?
The good news is that Medicare will pay for most of your carpal tunnel costs and treatment options — under certain conditions, that is. It all depends on the type of treatment you need and whether or not your doctor can convince Medicare that it is medically necessary.
Under Medicare Part A, you can get carpal tunnel surgery covered if your condition is so advanced that you require surgery that necessitates an inpatient hospital stay. If you do not have any supplement coverage, your Medicare Part A cost will include:
- The Medicare Part A deductible if you have not met it already during your current benefit period.
- Any applicable coinsurance costs. (which are usually $0 if you are within the first 60 days of your current benefit period)
Medicare Part B helps pay for the doctor visits, diagnostic testing, x-rays, durable medical equipment (DME), and outpatient surgery that most people with carpal tunnel require.
Your Part B costs may include:
- The annual Part B deductible if you have not met it already.
- A 20% coinsurance payment based on the total cost of diagnostic testing, outpatient treatment, and any DME (such as wrist splints or braces) that your doctor deems medically necessary.
Medicare Part D helps pay for any prescription medications your doctor may prescribe. Suppose your symptoms are so severe that they limit your mobility and independence or cause you significant amounts of pain. In that case, several medications could help you. These include:
- Steroid injections
But you will only get discounted prices if your provider prescribes the drugs that are on your Part D provider’s formulary.
Does Medicare Advantage cover carpal tunnel?
The good news is that Medicare Part C plans are legally required to cover the same benefits you would get if you stay with Original Medicare. The less-than-good news, unfortunately, is that it can be hard to budget unless you are intimately familiar with your Medicare Advantage plan. They often have different payment and benefit structures compared to Medicare’s more straightforward, standardized rules.
If you think you need medical treatment for carpal tunnel, call your Medicare Advantage insurance agent. They can help you figure out what sort of out-of-pocket costs to anticipate, such as coinsurance, co-pays, and more.
Do Medicare supplements cover carpal tunnel?
If you’re talking about Medicare Supplement Insurance plans, yes. Medigap supplements are most helpful for people with carpal tunnel who incur any of the following costs:
- The annual Medicare Part B deductible
- Medicare Part B coinsurance costs
- Medicare Part A deductible and coinsurance costs
- Blood transfusions
- Medicare Part B excess charges
Remember that not all Medigap plans cover all the benefits listed above. Contact your Medigap provider for more information on which benefits your Medigap plan covers. You can also inquire whether you may need to switch plans to get your carpal tunnel treated most affordably.
Will Medicare Part D plans cover carpal tunnel prescriptions?
Medicare Part D works a little bit differently when filling your prescriptions. Unlike Medicare Parts A and B, your Part D provider’s drug formulary determines which prescriptions you can fill at a discounted price. It has nothing to do with the physical ailment that the drug is designed to treat.
Suppose your current prescription drug provider doesn’t have the carpal tunnel drugs you need available on their formulary. In that case, you may have to pay out-of-pocket until you can switch providers. And you can do so every year during the Medicare Annual Enrollment Period.
Will Medicare cover non-surgical carpal tunnel therapy?
Your doctor may wish to consider several treatments before you resort to surgery. If your doctor can justify their medical necessity, Medicare should cover them. Those treatments include:
- Performing targeted exercises to improve median nerve movements.
- Wearing wrist braces or splints to take pressure off the median nerve.
- Steroid injections can (at least temporarily) relieve some of your painful symptoms.
- Changing your posture or how you perform physical activities could be pinching the nerve.
- Taking over-the-counter or prescription drugs (such as nonsteroidal anti-inflammatory drugs or NSAIDs) to reduce pain.
If you require a brace or a splint, that will likely be covered under your Medicare Part B DME benefit. This means you will only have to pay 20% of the cost of the device unless you have a supplement plan. For steroid injections, you will also likely have to pay the 20% coinsurance cost for going into a doctor’s office and receiving the outpatient procedure.
Suppose your doctor prescribes drugs for your carpal tunnel. In that case, that will be covered by Medicare Part D — but only if the drug is on your provider’s formulary. If not, you may have to rely on discount programs like GoodRx, Medicare Extra Help, or assistance from your doctor.
Does Medicare require prior authorization for carpal tunnel surgery?
The first step to figuring out whether or not you need surgery for your carpal tunnel is to visit your doctor. They will give you an examination and determine whether or not diagnostic testing is necessary.
Suppose it is, and your tests show that you need surgery. In that case, you will be approved if your doctor deems the surgery medically necessary.
Does Medicare cover diagnostic testing for carpal tunnel syndrome?
Yes, these costs are covered under Part B of your Medicare coverage. The two most common diagnostic tests for carpal tunnel are nerve conduction studies (NCS) and electromyography, or EMG.
To be approved, these tests must be performed by a physical therapist qualified to use the equipment and experienced with interpreting the test results. Getting these diagnostic tests from a provider who isn’t appropriately trained or credentialed may result in your claim being rejected.
Does Medicare cover carpal tunnel splints?
Yes, Medicare will pay for carpal tunnel splints as long as your doctor can verify that it is medically necessary. The cost will be 80% covered by your Medicare Part B benefits because it qualifies as durable medical equipment (DME).
All you have to pay is your Part B deductible and your 20% coinsurance cost. Be sure to check the Medicare supplier directory to see which contract suppliers near you offer the best price on carpal tunnel splints.
Will Medicare pay for my hand surgery?
If it is deemed medically necessary, Medicare (under your Medicare Part B benefits) will pay for 80% of the total cost plus any applicable coinsurance, copayments, and deductibles. You can reduce your out-of-pocket costs with a Medicare supplement plan.
How much does it cost to fix carpal tunnel?
Surgery can cost anywhere between $4,000-$12,000 per surgical procedure, and it may require multiple procedures to fix.
Does carpal tunnel qualify as a disability?
If you are under 65 and your carpal tunnel interferes with your ability to work, you may qualify for disability. But suppose you are already enrolled in Medicare because you have reached the age of 65, or you enrolled early due to a different disability.
In that case, this is a moot point since you don’t need it to be a qualifying disability to get Medicare to pay for it.
What are the side effects of surgery for carpal tunnel?
The side effects of carpal tunnel release surgery include the following.
- Injuries to local blood vessels
- Damage to the median nerve
- Injury to the nerves that branch from the median nerve
- Development of sensitive scar tissue
If you have other pre-existing medical conditions, they could complicate your recovery. You will also be looking at a recovery time of several weeks to several months.
What is the average age of someone with carpal tunnel?
Most people don’t develop carpal tunnel syndrome until they are between 40 to 60 years of age.
How long does carpal tunnel surgery take?
The average outpatient surgery only takes about 10 minutes to complete. If the surgery requires an inpatient hospital stay, it may take longer.
Does Medicaid cover carpal tunnel surgery?
Both Medicare and Medicaid will cover medically necessary surgeries like carpal tunnel surgery.
Will Medicare cover my surgery if I don’t have carpal tunnel syndrome?
If the surgery is elective, you may have trouble getting Medicare to pay for it. But if your doctor deems it medically necessary, you are much more likely to get your claim approved.
What are the risks associated with carpal tunnel surgery?
The vast majority of carpal tunnel release surgery patients suffer no complications whatsoever. But for those who do, the most frequent symptoms are infection, scarring, pain, nerve damage, weakness, paralysis, loss of sensation, and stiffness in your hand or wrist.
How to Get Help with Medicare Coverage for Carpal Tunnel
Medicare will pay for most of your carpal tunnel medical needs — as long as your doctor insists it is medically necessary. But how do you protect yourself from the extra out-of-pocket expenses?
You might find it best to purchase the right Medicare supplement insurance coverage. And we know just how to help you find it.
Call us today. Or fill out our simple online rate form to get the best rates in your area.