Does Medicare Cover Anesthesia?
- Find out if Medicare covers anesthesia, and learn about the amount of coverage provided by Medicare and the out-of-pocket percentages that beneficiaries are responsible for.
Anesthesia prevents individuals from feeling pain when undergoing surgical procedures. The three categories of anesthesia are general, regional and local. General anesthesia is used to put people to sleep during extensive surgery, while local and regional anesthesia works to numb the area in which the procedure is performed, allowing them to stay conscious without feeling pain. In most cases, Medicare does cover anesthesia, but there are some exceptions.
Does Medicare Cover Anesthesia?
Medicare covers anesthesia under most circumstances. Medicare Part A provides coverage for anesthesia administered in hospital settings, and Medicare Part B covers anesthesia administered during outpatient procedures in both hospitals and freestanding ambulatory surgical centers.
Original Medicare recipients are required to pay 20% of the total cost of anesthesia in most cases, and they may be charged additional copays depending on the specifics of their plan. Medicare generally pays 80% of the cost of anesthesia in both inpatient and outpatient settings. For outpatient procedures, recipients are also required to pay Medicare Part B deductible costs.
Individuals with Medicare Advantage plans receive the same coverage as Medicare Part A and Part B, and they may also qualify for additional coverage. However, those with Medicare Advantage may have to choose an anesthesiologist in their plan's specific network to prevent additional charges.
Does Medicare Pay for Anesthesia for Colonoscopies to Screen for Colon Cancer?
In situations where someone must undergo a colonoscopy procedure to screen for colon cancer, Medicare provides full coverage for anesthesia services. However, if polyps or other abnormal tissue is removed during the colonoscopy screening, Medicare recipients are required to pay out-of-pocket for the entire procedure, including anesthesia administration. This is because the removal of tissues and polyps is considered a medical treatment as opposed to a cancer screening.
Anesthesia administration during colonoscopies is only covered by Medicare when the procedure is necessary to check for colon cancer. Anesthesia for colonoscopies utilized to detect other medical issues are not covered under any Medicare plan.
Is Conscious Sedation Covered by Medicare?
Conscious sedation is a medical treatment that combines sedative drugs with pain-blocking anesthetics. Medicare does not typically cover conscious sedation for dental procedures. However, Medicare Part B provides coverage for conscious sedation utilized in procedures such as minor surgery and endoscopic upper GI imaging. Conscious sedation coverage is similar to anesthesia coverage, in which recipients are required to pay 20% of the costs out-of-pocket.
What Is the Average Cost for Anesthesia?
The cost of anesthesia services can vary depending on the specific procedure. On average, costs range between $500 and $3,500, with $500 on the lower side for outpatient local anesthetic and $3,500 on the higher side for general anesthesia.
Does Medicare Cover Any Type of Anesthesia for Dental Work?
In general, Medicare does not pay for dental work or anesthesia administration for dental procedures. However, individuals with Medicare Advantage plans may be eligible for certain types of dental coverage, and Medicare may also cover procedures such as oral surgery if the procedures are medically necessary to improve overall health. If anesthesia is required as part of the oral surgery, it may be covered. To learn more about specific plan coverage, recipients should contact their Medicare plan providers directly.