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Does Medicare Cover Kidney Stone Removal?

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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.

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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.

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