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Medicare Coverage for Outpatient Surgery

http://www.medicare.gov

What is outpatient surgery?

Outpatient surgery is done without admission to the hospital. It may be done in a hospital, doctor's office, clinic, or surgical center. Usually you go home the same day.

What is Medicare?

Medicare is a federal government program. It provides healthcare coverage for people 65 and older. It also provides coverage for people of any age who have certain disabilities.

Medicare is divided into 2 parts: Part A and Part B. Each part covers different services. Both parts pay some of the costs for needed medical services. Rules about what Medicare covers can be confusing. Rules also change from time to time. Your local Social Security office can answer your questions about Medicare.

Does Medicare cover outpatient surgery?

Part B of Medicare covers surgery if it is medically necessary. Your healthcare provider must tell you if he or she thinks Medicare will judge the surgery to be necessary.

First you pay the deductible. Then Medicare will pay 80% of the approved charges. You will pay the other 20%.

Healthcare providers can choose or not choose Medicare assignment.

  • If they choose Medicare assignment, it means that they agree to accept the amounts Medicare will pay as payment in full.
  • If they do not accept Medicare assignment, Medicare may pay for part of the bill. You will owe the amount that Medicare doesn’t pay.

If a surgeon does not accept Medicare assignment, he or she must give you a written estimate of the charges.

For more information, call 1-800-MEDICARE (1-800-633-4227). Or visit the Web site at http://www.medicare.gov.


Written by Carolyn Norrgard, RNC, BA, MEd; Carol Matheis-Kraft, PhD, RNC; and Mercedes Bern-Klug, MSW, MA, for RelayHealth.
Adult Advisor 2012.1 published by RelayHealth.
Last modified: 2011-07-07
Last reviewed: 2011-07-05
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2012 RelayHealth and/or its affiliates. All rights reserved.
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