Medicare coverage for arthroscopy

Medicare Coverage for Arthroscopy: What You Need to Know

A minimally invasive surgical technique called an arthroscopy is used to identify and treat joint issues. Through a tiny incision, a tiny camera known as an arthroscope is inserted into the joint. This allows the surgeon to see inside the joint and perform various procedures to repair or remove damaged tissue.

Understanding Arthroscopy

Arthroscopy is commonly used to treat conditions such as torn cartilage, torn ligaments, and inflamed joint lining. It is often performed on the knee, shoulder, hip, wrist, or ankle. The procedure is usually done on an outpatient basis, meaning you can go home the same day.

How Arthroscopy Works

During arthroscopy, the surgeon makes a small incision near the joint and inserts the arthroscope. The camera on the arthroscope sends images to a video screen, allowing the surgeon to see the inside of the joint. Surgical instruments are then inserted through other small incisions to perform the necessary repairs or removals.

Medicare Coverage for Arthroscopy

Medicare typically covers arthroscopy when it is considered medically necessary. This means that the procedure is needed to diagnose or treat a medical condition and is expected to improve your health. Medicare Part B covers arthroscopy performed in an outpatient setting, such as a doctor’s office or ambulatory surgical center.

Coverage Details

Medicare Part B covers 80% of the Medicare-approved amount for arthroscopy, after you have met your deductible. You are responsible for the remaining 20% coinsurance. If you have a Medicare Supplement Insurance (Medigap) plan, it may help cover some or all of this coinsurance.

Eligibility and Costs

To be eligible for Medicare coverage for arthroscopy, you must meet certain criteria. Your doctor must determine that the procedure is medically necessary and submit a claim to Medicare. You may also need to get prior authorization from Medicare for the procedure.

Cost Considerations

The cost of arthroscopy can vary depending on factors such as the location of the procedure and the specific details of your coverage. It’s important to check with Medicare and your healthcare provider to understand your out-of-pocket costs before undergoing the procedure.

Medicare coverage for arthroscopy


Arthroscopy is a valuable tool in diagnosing and treating joint problems. With Medicare coverage, eligible beneficiaries can access this important procedure to improve their joint health and quality of life. Understanding the details of Medicare coverage for arthroscopy can help you make informed decisions about your healthcare.

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  • Does Medicare cover arthroscopy for all joints?
    • Medicare typically covers arthroscopy for the knee, shoulder, hip, wrist, and ankle, among other joints. Coverage may vary depending on the specific circumstances and medical necessity.
  • Are there any age restrictions for Medicare coverage of arthroscopy?
    • Medicare coverage for arthroscopy is not based on age but rather on medical necessity. If your doctor determines that arthroscopy is medically necessary, Medicare may cover the procedure regardless of your age.
  • Can I choose any doctor to perform my arthroscopy?
    • Medicare coverage for arthroscopy is generally available when the procedure is performed by a healthcare provider who accepts Medicare assignment. It’s important to check with your doctor and Medicare to ensure coverage before the procedure.
  • Will Medicare cover all costs associated with arthroscopy?
    • Medicare typically covers 80% of the Medicare-approved amount for arthroscopy, after you have met your deductible. You are responsible for the remaining 20% coinsurance, unless you have a Medigap plan or other supplemental coverage.
  • What should I do if I have questions about Medicare coverage for arthroscopy?
    • If you have questions about Medicare coverage for arthroscopy, it’s best to contact Medicare directly or speak with a healthcare provider who can help explain your coverage options.