Needle Aponeurotomy: Medicare Coverage for Dupuytren’s Disease
- Medicare may cover needle aponeurotomy to treat Dupuytren’s contracture, but only if your doctor decides it’s medically necessary. Medicare may also cover collagenase injections like Xiaflex, but you should learn what to ask your doctor before seeking treatment.
Needle aponeurotomy is a treatment for contracture caused by Dupuytren’s disease. Dupuytren’s contracture is a thickening of tissue under the skin of a person’s palm that causes the fingers to bend inwards toward the palm without being able to straighten.
Medicare may cover needle aponeurotomy to treat Dupuytren’s contracture, but only if your doctor deems it medically necessary for your health and quality of life. If your doctor similarly documents that collagenase injections such as Xiaflex are necessary treatment, Medicare may cover the collagenase injections.
Needle aponeurotomy involves inserting a needle into the skin to puncture and break up the tissue that’s causing a finger to contract. Contractures can reoccur, and the procedure can be repeated.
Do Medicare and Private Insurance Plans Cover Needle Aponeurotomy?
Needle aponeurotomy is performed on an outpatient basis. This means that Medicare Part B may cover your outpatient surgery as long as it is considered medically necessary and meets other criteria for coverage. The same coverage rules apply for fasciectomy, another type of surgical treatment sometimes used to treat Dupuytren’s disease.
If Needle aponeurotomy is covered by Part B, then law requires it to be covered by Medicare Advantage plans as well. Medicare Advantage plans are sold by private insurance companies and offer all of the same basic benefits as Part A and Part B of Medicare. Many Medicare Advantage plans also offer additional benefits for things that Original Medicare doesn’t cover, such as dental, vision, prescription drug coverage and more.
It’s recommended for Medicare beneficiaries to discuss Medicare coverage with the health care provider who is performing the procedure prior to any appointments, as Medicare coverage typically depends on whether or not a provider or facility participates in Medicare and whether they determine your procedure is billable to Medicare.
How Much Does Needle Aponeurotomy Cost With Medicare?
Medicare Part B is optional and comes with a standard monthly premium of $148.50 per month in 2021. Beneficiaries are also typically responsible for a coinsurance payment of 20% of the Medicare-approved amount for services after meeting the annual deductible, which is $203 for the year in 2021.
Research published in 2019 showed that the average cost for needle aponeurotomy were $624 per finger.
Medicare May Cover Collagenase Injections and Other Treatments
Needle aponeurotomy, or needling, is not the only treatment for contractures.
Enzymes can be injected into the palm which soften the tissue, allowing a doctor to manipulate the hand in order to straighten the fingers. Clostridium histolyticum (Xiaflex) is an FDA-approved enzyme used for this purpose.
Because it is administered by a doctor in an outpatient setting, Xiaflex may be covered by Medicare Part B and Medicare Advantage plans when certain criteria is met.
Advanced, unresponsive or progressing cases of Dupuytren’s disease may be treated with open surgery. In surgery, the hardened tissue will be removed from the hand and replaced with a skin graft. Physical therapy is used to restore functionality in the hand.
Surgery for finger contractures is covered by Medicare as long as certain criteria is met. Medicare Part B and Medicare Advantage plans may also cover physical therapy to rehabilitate your hand.
Diagnosing Dupuytren’s Disease
Dupuytren’s disease diagnosis can typically be done simply by examining the hand and fingers, and invasive tests are rarely necessary. Your doctor may ask you to place your hand on a tabletop to see if you can fully flatten your fingers.
Don’t hesitate to call Medicare at 1-800-MEDICARE (1-800-633-4227) to inquire about needle aponeurotomy coverage or other treatments for contractures caused by Dupuytren’s disease.
If you are enrolled in a Medicare Advantage plan, contact your plan carrier directly to find out if your plan covers needle aponeurotomy or other treatments.