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HomeHealthDoes Medicare Cover Robotic Knee Surgery

Does Medicare Cover Robotic Knee Surgery

Learn More About The Best Options For Treating Knee Pain

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If you are living with mid to late-stage osteoarthritis of the knee, Mako Robotic-Arm Assisted Surgery may be an option for you. During Mako assisted surgery, your orthopedic surgeon will use a robotic-arm assisted procedure that includes real-time information and images of your knee, allowing for more precise placement of the knee implant.

Will Medicare Cover Robotic Surgery

When your doctor decides that surgery is medically necessary for you, Medicare may cover the procedure. Medicare Part A may cover surgery while youâre a hospital inpatient, and Medicare Part B may cover outpatient surgery. Coinsurance or deductibles may apply.

What about robotic surgery? If the procedure is medically necessary, Medicare may cover robotic surgery. You may want to discuss the procedure with your doctor so youâll understand what type of surgery it is, whether itâs robotic surgery or not, exactly why you need the surgery, and other concerns. You can also call Medicare at the number below this article to ask about Medicare coverage of your surgery.

Other Steps To Prepare For Knee Surgery

Knee surgery can have a long recovery period, so here are some other helpful steps to prepare for your knee replacement.

1. Improve your health. Stop smoking if you currently do, eat healthy, and if youre overweight, consider working with your doctor and a nutritionist to shed a few pounds before surgery.

2. Take the time to find the right surgeon. Who does your surgery and where can impact your procedures outcome, your recovery time and your total costs. Research and choose your surgeon carefully.

3. Make a recovery plan. Plan ahead for your recovery routine exercise, physical therapy, home assistance, adaptions to getting around at home or outside once you know what kind of procedure you are getting. And take it slow. Its better to have a healthy, long recovery instead of accidently causing damage by trying to fast-forward things back to pre-surgery normal.

Usually with knee surgery you have time to consider your options and prepare yourself mentally, physically and financially for the procedure. Think of it this way: How much effort do you put in when you are buying a TV or computer or car? Shouldnt you be doing at least as much for something as important as surgery? Talk with your Medicare plan provider and plan your knee surgery carefully.

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What Other Medicare Benefits Are Available For Knee Surgery Cost

A Medicare Supplement plan pays some or all of your out-of-pocket knee replacement costs under Part A and Part B, except for your premiums. Depending on the plan you choose, your Medicare Supplement Plan may cover your Part A and Part B deductibles and coinsurance amounts. Keep in mind, however, that Medicare Supplement Plans generally do not cover any out-of-pocket costs associated with prescription drugs not covered by Medicare.

Medicare Part D is how Medicare beneficiaries get prescription drug coverage. Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans are offered by private insurance companies, which means that plan benefits, deductibles, and cost-sharing structures may vary widely from plan to plan. Each plan may treat knee replacement cost and associated expenses a bit differently. Read your plan documents carefully before your procedure to help you estimate your out-of-pocket knee surgery cost.

If you are covered by a Medicare Part D Prescription Drug Plan, either as a complement to Original Medicare or as part of a Medicare Advantage plan, the medications you take at home are generally covered. You may have a deductible, copayment, or coinsurance amount for these medications.

Do you want to find a Medicare plan that can cover you if you have knee replacement? Just enter your zip code on this page to begin searching.

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How Does Medicare Cover Knee Replacements

Does Medicare Cover Robotic Knee Replacement

Getting a knee replaced requires surgery. And since Medicare only covers surgical procedures that are deemed medically necessary, your knee replacement surgery must be deemed medically necessary by your doctor for Medicare to cover it.

Which part of Medicare actually covers your surgery depends on what kind of surgery you get. If your knee surgery is in an inpatient procedure, Medicare Part A will provide coverage. If you get outpatient surgery, Medicare Part B would provide coverage. If you have a Medicare Advantage plan, your coverage may be different as well. Talk with your plan provider for specifics.2

Your costs will vary based on the type of procedure you need and your Medicare coverage. If Medicare covers your surgery, you still likely will have costs including a deductible and coinsurance.

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Other Costs That May Be Associated With Medicare Coverage Of Knee Replacement Surgery

Another possible cost you might want to plan for is that of any prescription medications your doctor might prescribe, such as painkillers, anticoagulants, or antibiotics. Medicare Part A may cover prescription drugs you receive as part of your inpatient treatment, while Medicare Part B may cover certain prescription drugs administered to you as an outpatient. But Original Medicare typically doesnt cover medications you take at home.

A stand-alone Medicare Part D Prescription Drug Plan may help cover your prescription drugs, although not every prescription drug is covered under every plan. Offered by private, Medicare-approved insurance companies, Medicare Prescription Drug Plans maintain their own formularies . If youre thinking about enrolling in a Medicare plan that includes this coverage, you might want to check the plans formulary before you enroll to make sure your prescriptions are covered. A plans formulary may change at any time. You will receive notice from your plan when necessary.

If you have other questions about Medicare coverage, or would like to learn more about your Medicare plan options that may give you more benefits, we would be happy to help. You can use the links below to request a phone call or an email containing personalized information. Of course, you can also shop Medicare plans in your area on your own by clicking the Find Plans button on this page.

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What Are The Additional Things That A Surgeon Has To Do With A Robotic Hip Replacement

The surgeon has to do the following things additional for robotic hip replacement surgery:

  • Preoperatively, the surgeon has to plan the surgery from the CT scan that is performed on the patient.
  • The surgeon has to look at logistics at the hospital if there are other surgeons using the robot for any surgery so that there is no conflict in operating time.
  • The surgeon has to make incision in the pelvis and place pins for registering the anatomy of the pelvis with the robot and to match it with the preoperative CT scan.
  • The surgeon has to do registration of the femur and the cup for the robot to recognize the 3 dimensional anatomy.
  • After the surgical exposure is made, the surgeon has to place pins inside the pelvis and inside the femur for helping the robot understand that the hip geometry.
  • EKG lead has to be placed over the knee before the surgery for helping the robot understand the limb length.
  • The pins have to be removed at the end of the procedure.
  • The markers from inside the hip need to be removed.
  • The wound at the location of the pins in the pelvis has to closed after the pins are removed.

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Bundled Payments Focus On Quality

The new CMS bundled payment model will focus on the quality of care more than the quantity.

The CMS will continue to pay surgeons, physical therapists, rehab facilities, and others involved in patient care separately for each service.

However, the CMS will also track the overall cost of patient care provided by hospitals, surgeons, nursing homes, and home health agencies for up to 90 days after the start of care.

If this bundled cost falls under a target price the CMS sets for each hospital, the CMS will pay the hospital a bonus.

However, if patients have complications or end up staying longer in the hospital or rehabilitation facility, hospitals could have to pay back part of that bundled payment to Medicare.

These changes will not affect all hospitals in the country.

Mako For Partial Knee Replacement

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Unlike more invasive procedures, MAKOplasty is usually performed through a four- to six-inch incision over your knee with small incisions in both your femur and tibia . Additionally, preserving your own natural bone and tissue, along with accurate implant positioning, results in a more natural feeling knee.

Because healthy bone is preserved, patients who undergo MAKOplasty partial knee replacement procedures may remain candidates for total knee replacement later in life.

A total knee replacement is sometimes necessary if your surgeon discovers, during surgery, that your knee has more damage than originally seen in the pre-operative X-rays and CT scans. MAKOplasty Partial Knee Resurfacing can:

  • Enable surgeons to precisely resurface only the arthritic portion of the knee
  • Preserve healthy tissue and bone
  • Facilitate optimal implant positioning to result in a more natural feeling knee following surgery
  • Result in a more rapid recovery and shorter hospital stay than traditional total knee replacementAs a knee arthroplasty procedure, Medicare insurers typically cover MAKOplasty check with your private health insurers for details. In some cases, it may be performed in an outpatient setting depending on what your surgeon determines is the right course of treatment for you.

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Medicare And Knee Replacement Surgery Rehab

Does Medicare pay for knee replacement? Medicare Part A covers many inpatient hospital and rehabilitation services you may need after having knee replacement surgery, including a semi-private room, meals and necessary medicine. It can also help with skilled nursing care after the surgery.

There is no Medicare knee replacement age limit. However, in order for Medicare to pay for knee replacement surgery, you must be enrolled in Medicare and meet the Medicare Part A deductible.

In 2021, the Medicare Part A deductible is $1,484 per benefit period. If your doctor suggests services not covered by Medicare during your recovery, you may be responsible for paying some or all of the additional costs. This cost of the procedure itself may incur additional out-of-pocket costs.

Medicare Part B will help pay for outpatient care, like doctor visits. It comes with a $203 annual deductible in 2021. After meeting the deductible, you typically pay 20 percent of the Medicare-approved amount for services.

Additional Knee Replacement Costs

Some additions to your living space can be made to ensure your comfort during recovery. These include toilet seat risers, safety bars, a shower bench, and even a modified first-floor living area to eliminate the need for stairs.

For patients with insurance, physical therapy costs are often covered. Usually patients will have to complete several weeks of physical therapy sessions following a knee replacement. Its always advisable to enter this stage of your recovery with an open mind and a positive attitude: after all, your recovery depends on you, and the mobility that you regain is directly related to the effort you put into your rehab.

Finally, depending on your lifestyle, your knee replacement device may need to be replaced later in life. The lifespan of current knee replacements can range from 10 to 15 years, to even longer. Remember to always notify your doctor if you experience uncharacteristic discomfort or limited mobility, as it these may be indicators of a complication with your knee replacement.

Knee replacement complications can include infection , complications from anesthesia , and other issues.

All material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.

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Are There Any Disadvantages Of Using The Robot

The surgery using a robot requires additional incision for placement of the pins. The operative time is little longer because of this and because of the registration process.

The patient does require a CT scan before the procedure, which involves some radiation.

There is an additional risk in complication because of placement of pins into the pelvis. The pins if placed incorrectly into the pelvis, can damage the structures inside the abdomen and inside the pelvis.

There is also the risk of breakage of pins that can cause retention of hardware or can necessitate additional exposure to remove the broken hardware .

The surgeon who is in training and is not very familiar with robotic hip replacement may have significantly increased time in the operating room and the patient can be exposed to increased risk of complications that are associated with increased surgical time.

If the surgeon is not cognizant of the anatomy and the location where components should be placed, the components can actually be placed in an incorrect position. In computer assisted navigation and robotics, I always say garbage in and garbage out. It is very important to give the robot accurate information.

How Does Mako Technology Work

Does Medicare Cover Robotic Knee Replacement

Mako Robotic-Arm Assisted Technology provides you with a personalized surgical plan based on your unique anatomy. First, a CT scan of the diseased hip or knee joint is taken. The CT scan is uploaded into the Mako System software, where a 3D model of your hip or knee is created. This 3D model is used to pre-plan and assist your surgeon in performing your hip replacement or knee replacement surgery.

In the operating room, your orthopedic surgeon follows your personalized surgical plan while preparing the bone for the implant. The orthopedic surgeon guides the robotic arm within the pre-defined area and the Mako System helps the surgeon stay within the planned boundaries that were defined when the personalized pre-operative plan was created.

In a laboratory study, Mako Total Knee Technology demonstrated accurate placement of implants to a personalized surgical plan. This study also showed Mako total knee replacement demonstrated soft tissue protection to the ligaments around the knee. Inpatient and laboratory studies on Mako total hip replacement and partial knee replacement, Mako Technology demonstrated accurate placement of implants to a personalized surgical plan.

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Are There Limitations During The Recovery Process

Recovery time can range from two to six weeks, and some physicians may recommend that you work with a physical therapist who can help you maintain or build up your range of motion and strength. Depending on the patients hip strength and mobility, they may want to consider arranging for a family member to help with daily activities and errands or at-home care.

The Surgery Is Not Performed By A Robot

One of the most common misconceptions about robotic knee replacement is that the surgery is done 100% robotically.

Thats simply not the case while the procedure is assisted by a robotic arm, your orthopedic surgeon is still in control. The robotic arms only job is to help the surgeon perform with greater precision.

Technology assists the procedure in other ways, too. Before surgery, a CT scan is used to create a 3D model of the patients knee. This allows surgeons to more accurately place the implant. During the operation, the robotic arm uses data from the 3D model to create a predefined space for the surgeon to work in, preventing them from accidentally damaging the surrounding tissue.

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Is Robotic Prostate Surgery Covered By Medicare

The Centers for Medicare and Medicaid Services doesnt have a policy for the national coverage on radical prostatectomy. Procedures to remove the prostate may be open, laparoscopic, or robot-assisted surgery. Local coverage is a little different.

As it stands, robot surgery for prostate cancer is a service Medicare covers. Additionally, reimbursement for providers is the same as the compensation for traditional prostatectomy.

Will Medicare Advantage Plan Cover Robotic Surgery

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If you have a Medicare Advantage plan, coverage for robotic surgery will mainly mirror Original Medicares coverage . You might pay different cost-sharing amounts, such as deductibles and coinsurance, which vary among plans.

Fill in your zip code in the box on this page to start comparing Medicare Advantage plans today with no obligation to enroll. You can also compare other types of plans.

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How Much Does Medicare Pay For Knee Replacement Surgery

Medicare typically covers a number of surgeries that are considered medically necessary, including knee and other joint replacement surgeries.

How much Medicare will pay for your knee replacement surgery depends on where you receive the procedure.

  • If you get your surgery in a hospital and are admitted as an inpatient, you can expect both Medicare Part A and Part B to contribute. Part A will help pay your hospital costs, and Part B will cover medical costs associated with the procedure.
  • An outpatient procedure will likely be covered under Part B.

Deductibles and coinsurance may apply, whether your surgery is covered under Part A or Part B.

  • Part A requires a deductible of $1,408 per benefit period in 2020. You don’t pay coinsurance for the first 60 days of an inpatient hospital stay during a benefit period.
  • Part B requires an annual deductible of $198 per year in 2020. After you meet your Part B deductible, you usually pay a coinsurance or copay amount that is typically 20% of the Medicare-approved amount.

A Medicare Supplement Insurance plan can help cover some of the out-of-pocket Medicare costs you may face for knee replacement surgery, such as the Part B coinsurance and your Part A deductible.

Medicare Advantage plans which are different from Medicare Supplement plans are required by law to provide all of the same basic benefits as Original Medicare, so a knee replacement surgery with a Medicare Advantage plan would come with identical coverage to the above.

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