Does Medicare Cover Carpal Tunnel Surgery?

Medicare covers any surgery that’s considered “medically necessary.” 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. It’s considered medically necessary when your doctor determines that it’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 you’re using what’s known as original Medicare, which is made up of parts A and B, your coverage will primarily come from Medicare Part B.

If you’re enrolled in a Medicare Advantage plan, then you’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:

• doctor’s office visits
• physical therapy
• occupational therapy
• carpal tunnel surgery if it’s performed in a doctor’s office or outpatient clinic
• wrists or hand braces you need to wear at home during recovery
• any medication you’re given during your surgery or appointments

Keep in mind that you’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 plan’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 you’re admitted to a hospital for carpal tunnel surgery.
• Medicare Part D. Medicare Part D is prescription drug coverage. It’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.

Your exact costs will depend on the details of your plan and procedure. However, there are some costs you can count on.

When you’re using Medicare Part B, you’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. You’ll pay 20 percent of the Medicare-approved cost for the surgery; Medicare will pay the other 80 percent.

You can use Medicare’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 — a common type of carpal tunnel surgery — are:

• $1,242 at an ambulatory surgery center. Medicare would pay $994, and you’d pay the remaining $248.
• $2,165 at a hospital-based outpatient surgery center. Medicare would pay $1,732, and you’d pay the remaining $432.

Tips for using Medicare’s cost lookup tool

You can see the average prices of procedures at hospitals and ambulatory surgery centers using this handy tool.

1. First, you can try entering the name of your specific procedure in the search box, if you know it.
2. If the procedure isn’t found on your first search, you can try entering the name of your condition to see several treatment options.
3. If you’re not sure of the exact name of the procedure you’ll be having, ask your doctor.
4. Click on your procedure to see the average prices and your share of these costs in different clinical settings.

If you have Medicare Advantage, your costs will depend on your specific plan. You’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.

No matter what type of surgery you’re having, it can help put your mind at ease if you know what to expect ahead of time.

Here’s a basic overview of what happens during the entire carpal tunnel surgery process — from preparation to recovery.

Preparing for the procedure

You’ll likely meet with your doctor several times before you have carpal tunnel surgery. They’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 you’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 won’t have to plan for a hospital stay. However, it’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 you’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. They’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 — one in your wrist and the other in your palm. They’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.

You’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, you’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. You’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 you’re making progress.

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:

• Physical therapy. A physical therapist can help lessen the pain in your wrist by teaching you specific exercises called nerve gliding exercises. These exercises help your median nerve move to get relief. Physical therapy services will be covered by Medicare Part B or a Medicare Advantage plan.
• Braces and splints. Braces and splints can help keep your wrist straight, which reduces the stress on your median nerve. Medicare Part B or Medicare Advantage will cover braces and splints.
• Medications. You might be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) to help manage your pain. Your prescription will be covered by Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage.
• Lifestyle changes. Carpal tunnel symptoms can be aggravated by certain actions or activities. Your doctor might recommend you modify these activities in your daily life to reduce your pain.
• Steroid injections. Corticosteroid is a strong anti-inflammatory that can relieve pain. However, the effects of steroid injections are often only temporary. An injection will be covered by Part B or a Medicare Advantage plan.

• Carpal tunnel surgery is generally an outpatient procedure covered under Medicare Part B.
• Medicare Advantage plans will also cover your carpal tunnel surgery.
• Alternatives to surgery, like physical therapy and medications, are also covered.
• Talk with your doctor about what treatment may work best for you.