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Does Medicare Cover Kyphoplasty?

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By Daniel Petkevich
Dec 9, 2022

You're covered if you meet these requirements

Dealing with back pain suffered from a fracture related to osteoporosis can be challenging. A kyphoplasty procedure is an appealing option to those who need more than just medication but don't want to endure major surgery. Medicare covers Kyphoplasty under Part B, but you must meet certain conditions. Let's see what those are below.

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What is Kyphoplasty?

Kyphoplasty, also known as vertebroplasty, is a minimally invasive procedure used to treat painful vertebral fractures that can be caused by osteoporosis or another injury. It involves the insertion of medical balloons into the fractured bone and then filling them with bone cement. With kyphoplasty, most people who get the procedure are sent home the same day. The benefits of kyphoplasty include reduced pain, improved posture, better mobility, and improved quality of life.

How does Medicare cover Kyphoplasty?

In order to be eligible for Medicare coverage, you must meet certain Medicare requirements:
  • The procedure must be performed in an outpatient hospital setting that is certified by Medicare.
  • It must be determined to be medically necessary by your doctor or a Medicare-approved provider.
  • You must have proof of a vertebral fracture (such as an X-ray or MRI).
Talking with your doctor is critical before opting for this procedure. This content is for informational purposes only and does not constitute medical advice.

What are the costs associated with Kyphoplasty?

The cost of kyphoplasty varies depending on the facility and other factors. Medicare will typically cover 80% of the cost, but you may be responsible for any remaining costs or copayments. Be sure to check with your healthcare provider and Medicare before having the procedure done.

How to find a doctor who performs Kyphoplasty procedures?

Before having Kyphoplasty, you'll need to find a qualified healthcare provider who can perform the procedure. You can search online for doctors and hospital listings that specialize in Kyphoplasty procedures and contact them for more information. Be sure to ask about their experience with the procedure, qualifications, and costs. Also, check your Medicare Advantage plan to see if it covers Kyphoplasty.

The risks and side effects of Kyphoplasty

Potential side effects should also be discussed with your doctor prior to the procedure. While Kyphoplasty is generally considered safe, it can cause complications such as infection and nerve damage, so it is important that you understand all of the risks before proceeding.

Takeaway

Kyphoplasty is a minimally invasive procedure that can help reduce pain, improve posture, and improve mobility. Medicare Part B covers Kyphoplasty under certain conditions, but it is important to check with your healthcare provider and Medicare before having the procedure done. This content is for informational purposes only. Call a Fair Square Medicare expert today for all your Medicare-related questions.

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

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