Medicare Coverage and Financial Implications for Spinal Cord Stimulators
Going Under the Knife: Spinal Cord Stimulator Therapy and Your Medicare Coverage
Feeling the Burn? Spinal cord stimulator therapy might be your future, but first, let's check if you're eligible and what it's going to cost you.
Chronic pain can be a real pain in the neck, and when it's intractable (read: resistant to treatment), it's time to give spinal cord stimulator therapy a shot. This therapy targets chronic pain related to the nervous system and may be your best bet when traditional treatments are failing you.
Before your doc suggests spinal cord stimulators, they'll usually try nonsurgical treatments like physical therapy, prescription meds, and psychological therapy first.
Who's Cutting the Mustard?
To qualify for spinal cord stimulator therapy, you'll need to meet Medicare’s eligibility requirements.
A potential candidate for spinal cord stimulators must have:
- No active substance misuse issues
- Thorough understanding of the benefits and risks of spinal cord stimulation therapy through educational resources
- Passed a psychological screening
If you tick all these boxes, you'll need to undergo a trial with a temporary neurostimulator to gauge your body's response. This trial is usually an outpatient procedure.
The trial is essential for determining whether you're a good fit for a permanent stimulator. A positive response would include:
- 50% reduction in pain
- 50% reduction in pain relief medication
- some degree of functional improvement
If you're showing signs of relief during the trial, you might get a permanent stimulator. The procedure will take place in a hospital or ambulatory surgical center.
How Much Will it Cost Me?
If you're a Medicare Part B beneficiary, the cost of spinal cord stimulator therapy falls under Part B, as it's typically an outpatient procedure.
You can expect the Medicare Part B deductible of $257, along with a 20% coinsurance on the cost of the procedure.
For the trial neurostimulator electrodes, Medicare enrollees usually pay around $1,070 at ambulatory surgical centers and $1,384 at hospital outpatient departments on average. For the permanent procedure, costs average around $3,762 at ambulatory surgical centers and $1,799 at hospital outpatient departments.
If the surgery takes place in a hospital setting, a copayment may apply. Medicare Advantage (Part C) plans would also cover the procedures, but costs would vary based on the plan.
Want to know more about Medicare's specific eligibility criteria for spinal cord stimulator therapy? Get in touch with a Medicare representative or your healthcare provider to get the whole scoop.
- To be eligible for spinal cord stimulator therapy under Medicare, you must meet the eligibility requirements which include having no active substance misuse issues, understanding the benefits and risks through educational resources, and passing a psychological screening.
- If you pass the Medicare eligibility requirements, you'll undergo a trial with a temporary neurostimulator to gauge your body's response.
- During the trial, if you achieve a 50% reduction in pain, a 50% reduction in pain relief medication, and some degree of functional improvement, you might receive a permanent spinal cord stimulator.
- If you're a Medicare Part B beneficiary, the cost of spinal cord stimulator therapy falls under Part B and includes a $257 deductible and a 20% coinsurance on the cost of the procedure.
- The trial neurostimulator electrodes typically cost around $1,070 at ambulatory surgical centers and $1,384 at hospital outpatient departments, while the permanent procedure costs around $3,762 at ambulatory surgical centers and $1,799 at hospital outpatient departments.
