Does Medicare Cover Kidney Stone Removal?
Fair Square Medicare

Does Medicare Cover Kidney Stone Removal?

Kidney stone stock image

By Daniel Petkevich

Nov 23, 2022

Read on to see if you're covered

Kidney stones can be incredibly painful and frustrating to endure. Roughly 11 percent of men and 6 percent of women will experience kidney stones at some point in their lives. Many kidney stones are small enough to where they can be passed, but sometimes they need more medical attention to remove them. In that case, Medicare can help.

Stay up to date on Medicare

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

What are kidney stones and what causes them?

Kidney stones are hard deposits of minerals, like calcium or uric acid, that form inside the kidneys. Kidney stones can vary in size from a grain of sand to an egg. They’re caused by an imbalance of fluids and electrolytes in the body, when there’s too much crystal-forming substances like calcium and uric acid and not enough water to dilute them.

How are kidney stones treated?

Treatment for kidney stones depends on the size and type of stone. Smaller stones can be passed naturally with plenty of water to help keep them moving. For larger stones, medical intervention may be necessary. If a doctor believes you’ll need surgery or another procedure to remove a kidney stone, then Medicare likely will cover it.

Some of the procedures to remove larger kidney stones include:

  • ESWL (extracorporeal shockwave lithotripsy): A non-invasive procedure that uses sound waves to break down stones

  • Percutaneous nephrolithotomy: A surgical operation to remove the stone through a small hole in the back

  • Ureteroscopy: Passing a small camera through the urethra, bladder and up to the stone so it can be destroyed

  • Laparoscopic kidney stone removal: A minimally invasive procedure that removes larger stones with a specialized instrument

Does Medicare cover kidney stone removal?

Yes! Medicare Part B covers kidney stone removal if your doctor determines it is medically necessary for a treatment procedure. Your doctor may decide that surgery is the only way to remove your stones, or they may determine that the stones are too large to pass naturally and need to be broken down by lithotripsy or another procedure. In either case, the removal process will likely be covered by Medicare.

If you have smaller kidney stones, you might not have coverage since it might only involve hydration and over-the-counter pain medications. Some Medicare Advantage plans might offer a credit for those over-the-counter drugs.

Part B means that you would be responsible for 20% of the approved cost. You could receive more coverage with a Medicare Supplement plan that covers some or all of the 20%, or Medicare Advantage plan.

What are the costs associated with getting a kidney stone removed?

The cost of kidney stone removal varies depending on the procedure. Some procedures, like lithotripsy or ureteroscopy, are usually covered by Medicare Part B when deemed medically necessary. Other treatments like laparoscopic surgery might be covered if your doctor determines it is appropriate for your condition.

If you’re required to pay an out-of-pocket cost, it could be anywhere from $500 to $2,000 or more depending on the procedure. The best way to know is to speak with your doctor and check your policy so you understand what is covered.

Conclusion

Before seeking treatment, talk with your doctor to see what is best for your situation. This content is for informational purposes only. If you're experiencing kidney stone problems, you can rest assured knowing that Medicare has you covered. And Fair Square Medicare has you covered when it comes to shopping for Medicare plans. Call us today to speak to an expert.

Stay up to date on Medicare

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.


Learn More About Medicare

heart surgery stock image

How Much Does Open Heart Surgery Cost with Medicare?

2023-01-27

senior african american man feeling pain in his knees from arthritis while on a couch stock photo

How Much Does Xeljanz Cost with Medicare?

2023-01-25

Doctor talking to patients are explaining the treatment of a patient's illness stock photo

How Much Does Rexulti Cost with Medicare?

2023-01-24

Human hands holding healthy lung shape made from paper on light blue background. stock photo

How Much Does Trelegy Cost with Medicare?

2023-01-24

Female physiotherapist helping elderly man in wheelchair do exercises with dumbbells at health center stock photo

What Does Medicare Cover for Stroke Patients?

2023-01-20

Doctor demonstrating upper cervical spine anatomy stock photo

Does Medicare Cover Cervical Disc Replacement?

2023-01-20

Medicare Set Aside funds stock image

What Happens to Unused Medicare Set-Aside Funds?

2023-01-20

older man suffering from stomach pain due to IBS stock photo

Does Medicare Cover Xiafaxan?

2023-01-19

senior woman doing botox stock photo

Is Botox Covered by Medicare?

2023-01-19

Health insurance form on a table with pen, calculator and glasses stock image

What You Need to Know About Creditable Coverage

2023-01-18

Acute psoriasis on elbows is an autoimmune incurable dermatological skin disease stock photo

Does Medicare Cover Light Therapy for Psoriasis?

2023-01-17

wart on the sole of a white man's foot stock photo

Does Medicare Cover Wart Removal?

2023-01-17

woman sitting on sofa feeling pain in her foot at home stock photo

Does Medicare Cover Qutenza?

2023-01-13

Nasal spray stock image

Can Medicare Help with the Cost of Tyrvaya?

2023-01-12

Gloved hands with a scalpel begin a knee replacement surgery

Does Medicare Cover Iovera Treatment?

2023-01-11

A doctor with a clipboard consults a female patient with cancer

Does Medicare Cover Inqovi?

2023-01-11

Physiotherapist showing workout record on exercise bike

Does Medicare Cover Exercise Physiology?

2023-01-11

A women's restroom sign that has been modified to show the stick figure woman needing to use the toilet

Does Medicare Cover Bladder Sling Surgery?

2023-01-11

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap.

100% free.

Fair Square Medicare

LEGAL

Privacy Policy

CONTACT

1-888-454-2383

MORE


Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M