Does Medicare Cover Knee Replacement?
Based on your medical records, history, and failed non-surgical treatments Medicare may cover 80% of your knee replacement cost.
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How Do You Avoid Denial of Claim for Knee Replacement?
To avoid denial of knee replacement claims, your medical records must document medical necessity.
A patient’s medical history should include the following :
A detailed description of the pain
Limitations of specific activities of daily living
Safety issues
Contraindications to non-surgical treatments
Examples of failed non-surgical treatments may include:
Medications
Weight loss
Physical therapy
Occupational therapy
Intra-articular injections
Braces, orthotics or assistive devices
Home exercise plans
Assistive devices (such as cane, walker, etc.)
In addition to the above patient medical history, records must document a doctor’s physical findings. Descriptions of physical findings may include:
Deformity
Loss of range of motion
Crepitus (grating sound between bone and cartilage)
Effusions (fluid around the knee)
Tenderness
Gait description
Investigations should include test results, like X-rays and other imaging records. A statement of clinical judgment may be included.
What Does Knee Replacement Surgery Cost With Medicare?
Your Medicare knee replacement surgery costs depend on the services you need, whether you are an outpatient or inpatient, and your Medicare health plan.
According to national averages , Medicare patients typically pay more for total knee arthroplasty in ambulatory surgical centers ($2,054) than in hospital outpatient departments ($1,818).
Your Medicare surgery costs depend on your hospital status . To become a hospital inpatient, your doctor must write an order of admission, and the hospital must formally admit you. In this case, you may pay the Part A hospital deductible of $1,556 in 2022. Otherwise, you may pay the Part B outpatient deductible of $170.10 in 2022.
You are also responsible for paying your coinsurance and copayments. Original Medicare may only cover 80%, so you’ll pay the remaining 20% coinsurance.
Instead of paying thousands of out-of-pocket costs, call the licensed agents at Senior Healthcare Direct at 1-833-463-3262, TTY 711, or click here to get your quote.
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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.