Medicare covers surgery for carpal tunnel syndrome (CTS) if it is medically necessary. The surgery usually involves out-of-pocket costs, but some programs may help pay these expenses.
After a person receives a diagnosis of carpal tunnel syndrome (CTS), doctors may first prescribe nonsurgical treatments, such as wearing a brace or taking medications to reduce inflammation. When these measures do not reduce symptoms, doctors generally advise surgery.
Read on to learn more about Medicare coverage for CTS surgery and the costs. This article also identifies programs that may help with the costs and provides information about what CTS surgery involves.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Each part of Medicare offers coverage in specific areas.
Original Medicare
- surgery for CTS in outpatient settings
- doctor visits
- diagnostic tests
- some nonsurgical treatments, such as cortisone injections or braces
Medicare Advantage
Medicare Advantage, or Medicare Part C, is the alternative to Original Medicare. It must offer at least the same basic benefits of Part A and Part B, including coverage of CTS surgery.
Many Part C plans also provide prescription drug benefits, which would include doctor-prescribed medications for inflammation.
Learn more about Medicare coverage for prescription medications.
Part D
Although Original Medicare does not offer prescription drug coverage, a person may enroll in a Part D plan. Each plan has a formulary of drugs that generally includes medications for CTS.
The out-of-pocket costs for each Medicare part are subject to annual change.
Part A
If a person undergoes CTS surgery in a hospital as an inpatient, the costs in 2024 include a $1,632 deductible for each benefit period and $0 coinsurance for days 1 to 60.
Part B
For diagnostic tests or treatment for CTS in an outpatient clinic setting, Part B costs in 2021 include:
- $174.70 monthly premium
- $240 annual deductible
- 20% coinsurance
Part C and Part D
The costs relating to Part C and Part D include:
- deductibles
- copays
- coinsurance
- monthly premiums
These costs vary depending on the plan and the provider. A person can contact their plan provider for more accurate information.
Medicare offers options to help with out-of-pocket costs. These may include:
- Medigap: This Medicare supplement insurance is available to a person enrolled in Original Medicare. The plans pay 50% to 100% of Part A and Part B costs, though they do have a monthly premium.
- Extra Help: This program assists with paying Part D costs for people with limited income and resources. It helps with about $5,900 of medication expenses per year.
- Medicaid: Medicaid is a state-federal program that helps people with a low income and few resources pay some healthcare costs.
- Medicare Savings Program (MSP): The MSP helps a person with limited income and resources pay deductibles, coinsurance, and premiums.
When nonsurgical treatments do not reduce pain and numbness of CTS, a doctor may recommend surgery to prevent permanent damage.
Carpal tunnel surgery involves cutting the ligament forming part of the carpal tunnel, increasing the size of the passageway, and relieving pressure on the median nerve.
Two types of carpal tunnel release surgery exist.
In open carpal tunnel release, a surgeon makes a small incision in a person’s palm to cut the ligament. In endoscopic carpal tunnel release, a surgeon makes one or two smaller incisions and uses a tiny camera to see inside the wrist.
A person usually undergoes the surgery on an outpatient basis. A surgeon may choose to use either general anesthesia, which puts someone to sleep, or local anesthesia, which numbs the hand and arm.
Most people who undergo surgery experience an improvement in symptoms, though this may take a number of days or weeks. It can take several months to recover from surgery.
Original Medicare (Part A and Part B) and Medicare Advantage (Part C) plans cover surgery for CTS. They may also cover doctor visits, lab tests for diagnosis, and nonsurgical treatments.
A person with Original Medicare may receive prescription drug coverage with a Part D plan, while someone with Medicare Advantage may receive coverage with a plan that includes drug benefits.