Medicare covers diagnostic tests and medically necessary treatment for carpal tunnel syndrome (CTS), including surgery. The tests, treatments, and surgery for CTS involve out-of-pocket Medicare costs. Some programs may help pay such expenses.
After a person receives a diagnosis of 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.
This article discusses CTS, covering its symptoms, diagnosis, and possible treatments, including surgery. It also looks at Medicare coverage and costs and identifies programs that may help with the costs.
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.
The wrist bones and a ligament form a narrow passageway called the carpal tunnel. The median nerve, which is the major nerve to the hand, goes through this passageway, as well as nine tendons that attach to finger muscles.
If swollen tissues squeeze the median nerve, this results in the slower transmission of the nerve impulses that provide muscle function and feeling in the hand, causing CTS.
According to an article in American Family Physician, CTS affects approximately 3% of adults in the United States and is more common in females than in males.
CTS produces several symptoms, including:
- loss of function
- loss of feeling
- pins and needles sensation
- burning that may extend up the forearm
The condition can affect one or both hands. Some people may find that the symptoms are worse at night, while others will notice them more during the day when they engage in activities involving repetitive hand movements.
When CTS begins, the symptoms may be mild and periodic. However, the condition can progress, resulting in permanent muscle and nerve damage.
The diagnosis starts with a physical exam to check for reduced feeling in the hand and gauge finger muscle strength. The doctor might also ask the person to hold the wrist at a 90-degree angle to see whether doing so for a certain period produces symptoms.
If the physical exam suggests that the person may have CTS, the doctor will carry out a nerve conduction test to determine the condition’s severity.
The first part of this test sends a small electrical impulse through the median nerve to measure how long it takes to go through the carpal tunnel and reach the hand. The results show the degree of nerve damage.
The second part of the test uses electromyography, which involves the placement of needles to measure electrical impulses in the affected muscles at rest and during use. It shows how well the innervated muscles are functioning.
Early diagnosis and treatment of CTS may relieve symptoms without surgery. The treatment of mild symptoms can include the following:
- Wearing braces or splints on the wrist: At night, this treatment prevents the wrist joint from bending and thereby putting pressure on the carpal tunnel during sleep. During the day, braces or splints help protect the wrist while a person performs repetitive activities.
- Making activity changes: Some changes, such as altering how a person works at a desk, may prevent symptoms that happen when the wrist is in a fixed position for a long period.
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen and naproxen may lower inflammation and reduce pain.
- Receiving steroid injections: The injection of a drug such as cortisone into the carpal tunnel can relieve symptoms, although the benefit may be temporary.
- Doing nerve flossing exercises: These exercises may help the median nerve move more freely within the small space of the carpal tunnel.
When nonsurgical treatments do not reduce pain and numbness, a doctor may recommend surgery to prevent permanent damage. The surgical procedure cuts the ligament forming part of the carpal tunnel, increasing the size of the passageway and relieving pressure on the median nerve.
A person usually undergoes the surgery on an outpatient basis. A surgeon may choose to use general anesthesia, which puts someone to sleep, or local anesthesia, which merely numbs the hand and arm.
There are two types of carpal tunnel release surgery. Open carpal tunnel release involves a small incision in the palm to cut the ligament, whereas endoscopic carpal tunnel release involves one or two smaller incisions and the use of a tiny camera to see inside the wrist.
The most common complications of carpal tunnel release include infection, bleeding, and nerve injury. Most people who undergo surgery experience an improvement in symptoms, although complete recovery may take up to a year.
Each part of Medicare offers coverage in specific areas.
Original Medicare comprises Part A (hospital insurance) and Part B (medical insurance). Part A covers CTS surgery that involves a hospital stay, while Part B covers:
- doctor visits
- diagnostic tests
- surgery for CTS in certain outpatient settings
- some nonsurgical treatment, such as cortisone injections or braces
Medicare Advantage, or 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.
Many plans also provide prescription drug benefits, which would include doctor-prescribed medications for inflammation.
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.
If a person undergoes CTS surgery in a hospital, the costs in 2021 include a $1,484 deductible for each benefit period and $0 coinsurance for days 1–60.
For diagnostic tests or treatment for CTS in an outpatient clinic setting, Part B costs in 2021 include:
- $148.50 monthly premium
- $203 annual deductible
- 20% coinsurance
Parts C and D
The costs relating to parts C and D include deductibles, copays, coinsurance, and monthly premiums. These costs vary depending on the plan and the provider.
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 50–100% of Part A and Part B costs, although 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 $5,000 of medication expenses per year.
- Medicaid: This state-federal program helps people with a low income and few resources pay some healthcare costs.
- Medicare savings programs: These help a person with limited income and resources pay deductibles, coinsurance, and premiums.
Both original Medicare and Advantage plans cover surgery for CTS. They may also cover doctor visits, lab tests for diagnosis, and nonsurgical treatments.
NSAIDS may be a nonsurgical treatment that doctors recommend before advising surgery. 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.