Is disc replacement surgery covered by Medicare?

Asked by: Terrance Muller  |  Last update: July 25, 2022
Score: 4.1/5 (27 votes)

Medicare does not currently have a national coverage determination (NCD) on lumbar artificial disc replacement. Coverage for the procedure is overseen by local Medicare contractors. Medicare also does not have a NCD for other spinal surgeries for degenerative disc disease.

Who is eligible for artificial disc replacement?

Artificial disc replacement may be recommended for patients between the ages of 18 and 60 with DDD at one or two levels of the spine whose condition has not responded to at least six previous months of non-surgical therapy.

Does Medicare cover artificial cervical disc replacement?

On the national level, cervical artificial disc replacement isn't covered because Medicare has ruled that the procedure is not medically necessary for people over the age of 60.

Who is not a candidate for disc replacement surgery?

Artificial disc replacement is not recommended for patients with facet joint syndrome or a bony compression on spinal nerves. Patients with spinal deformities such as scoliosis or bone weakness from osteoporosis would not benefit from this procedure.

Does Medicare pay for discectomy?

Spine surgeries covered by Medicare — if they are deemed medically necessary — typically include: discectomy. spinal laminectomy/spinal decompression. foraminotomy.

Disc Replacement Surgery ~ Haley's Story

35 related questions found

How many epidurals Will Medicare pay for?

How many epidural steroid injections will Medicare cover per year? Medicare will cover epidural steroid injections as long as they're necessary. But, most orthopedic surgeons suggest no more than three shots annually. Yet, if an injection doesn't help a problem for a sustainable period, it likely won't be effective.

Does Medicare pay for spinal decompression?

Medicare covers chiropractic manipulation of the spine to help a person manage back pain, provided they have active back pain. The program only funds chiropractic care that corrects an existing problem and does not cover spinal manipulations as maintenance or preventive services.

What is the success rate of disc replacement surgery 2020?

The authors reported a clinical success rate as defined by the FDA (≥ 15-point improvement in ODI, freedom from device failure or serious device-related adverse events, maintenance/improvement in neurological status) of 87.5% and a return to work rate of 75.9%.

How serious is disc replacement surgery?

Lumbar disk replacement is generally seen as an alternative to the more common spinal fusion surgery. Fusion permanently joins 2 vertebrae together. Lumbar disk replacement is a major surgery that requires general anesthesia and a hospital stay.

How long does a disc replacement last?

In more than 90% of patients, an artificial disc replacement will last at least 10 years and likely for the rest of your life. Simulated wear studies indicate artificial discs could last a minimum of 40 years and perhaps up to 100 years.

Does Medicare cover cervical fusion?

Medicare does not have a National Coverage Determination (NCD) for cervical spinal fusion. Local Coverage Determinations (LCDs)/Local Coverage Articles (LCAs) do not exist at this time. For coverage guidelines, refer to the UnitedHealthcare Commercial Medical Policy title Surgical Treatment for Spine Pain.

Does Medicare cover neck surgery?

Medicare may cover medically necessary treatment to treat neck and back pain, such as: Surgery.

Does Medicare pay for rehab after back surgery?

Medicare Part A covers medically necessary inpatient rehab (rehabilitation) care, which can help when you're recovering from serious injuries, surgery or an illness.

When should you have disc surgery?

Your doctor might recommend surgery as an option for your herniated disc if: Your symptoms have lasted at least 6 weeks and make it hard to do your normal activities, and other treatments haven't helped. You need to get better quickly because of your job or to get back to your other activities as soon as possible.

What is the success rate of disc replacement surgery?

As the bone grows, it fuses the vertebrae together, thus, eliminating the motion at a specific level. Success rates with fusions performed for degenerative disc disease range in the literature between 65 and 93%. It has become the standard of care for discogenic pain and is often very effective in relieving pain.

Is disc replacement better than fusion?

Lumbar disc replacement, a similar procedure that replaces the discs in the lower back, also has a faster recovery time than fusion. A study published in Global Spine Journal found that disc replacement patients were able to return to work significantly faster than fusion patients.

Is disc replacement surgery painful?

There is usually some pain and discomfort in the days and weeks following cervical artificial disc replacement (ADR) surgery. Most commonly, the recovering patient has some pain and soreness at the incision site at the front of the neck. Other symptoms may also be present, such as trouble with swallowing or speaking.

Can you live without a disc in your back?

Your spine is made up of your vertebrae as well as your spinal cord and associated nerves. It's vital to your overall health and functioning, and you can't live without it.

Why you should avoid back surgery?

If things go south, some of the potential complications of back surgery can include an adverse reaction to anesthesia, bleeding, infection, deadly blood clots that can circulate to the heart or lungs, heart attack, stroke, and nerve damage.

How many artificial discs can you have?

Ideally, only one level of the spine is replaced, but up to three levels have been done. The same patients whom we would have fused in the past are receiving artificial discs. Of course, not all patients are suitable for this technology, and assessment by a skilled spinal surgeon is essential.

How long is recovery from lumbar disc replacement surgery?

Recovery from lumbar artificial disc replacement generally lasts 3 months while the spine adjusts to the implanted device and the body recovers from surgery. Recovery times can vary between patients.

Are nerve blocks covered by Medicare?

Medicare does not have a National Coverage Determination (NCD) for paravertebral facet joint/nerve blocks: diagnostic and therapeutic.

Does Medicare cover minimally invasive spine surgery?

A: Minimally Invasive Spine Surgery is covered by Medicare if the surgeon and the facility where the surgery is performed are both in network with Medicare. You can expect to contribute to part of the costs as you would with most surgical procedures covered by Medicare.

Does Medicare cover MRI of spine?

Magnetic resonance imaging (MRI) is a non-invasive imaging technique used in diagnosing certain conditions as well as medical research. MRI scans are covered by Medicare. Medicare plans cover 80% of MRI costs, with beneficiaries expected to pay the remaining 20% unless their yearly deductible has already been met.

What should I not tell my pain management doctor?

Don'ts: Things Pain Patients Wish Doctors Would Avoid
  • Don't label patients. ...
  • Don't tell patients the pain is 'in our heads. ...
  • Don't tell us to just 'live with the pain.