Does Medicare Cover Radiofrequency Ablation?
- Radiofrequency ablation (RFA) is used to treat various conditions, including chronic pain. Learn how RFA works and the approval criteria for Medicare coverage.
Physicians may recommend radiofrequency ablation as part of their treatment plan for a variety of medical conditions. This low-risk technique may be used to shrink tumors, restore a normal heart rhythm or treat varicose veins; however, it’s most often used to help individuals experiencing chronic pain due to injuries, arthritis or prior surgeries. Does Medicare cover radiofrequency ablation? In many cases, the answer is yes, as long as the procedure is deemed medically necessary. In this article, you’ll learn what’s required for coverage to be approved through Medicare, how radiofrequency ablation works and what it's used for.
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Does Medicare Cover Radiofrequency Ablation?
Medicare covers radiofrequency ablation for a variety of conditions if the procedure is deemed medically necessary by a plan-approved physician. Criteria for approval varies depending on the condition RFA is being used to treat.
For example, the following criteria may need to be met before RFA is approved for coverage when using the technique for pain management:
- Chronic pain is moderate to severe, and is causing a functional deficit
- Pain must be present for three or more months and unresponsive to conventional pain management techniques
- The pain must not be caused by a fracture, infection, tumor or significant deformity
- Pain is assessed using the same disability scale each time, including a baseline
Beneficiaries who receive an RFA procedure during an inpatient hospital stay are covered under Medicare Part A, Original Medicare’s hospitalization component. If the RFA procedure is administered in an outpatient setting such as a doctor’s office, coverage is provided by Medicare Part B. The plan deductible must be met before coverage begins, and beneficiaries are responsible for the coinsurance or copayment, as applicable.
At minimum, Medicare Advantage must provide the same coverage as Original Medicare. However, depending on the terms of a beneficiary's individual coverage, Medicare Advantage enrollees may receive additional benefits that can reduce out-of-pocket expenses.
How Does Radiofrequency Ablation Reduce Pain?
Older adults experiencing pain caused by irritated or damaged nerves may find relief through radiofrequency ablation (RFA). During the procedure, a microelectrode delivers radio waves to the nerve tissue where the pain originates. These radio waves heat up the affected tissue, disabling the nerve’s function so it can’t send a pain signal to the brain. Although results may vary and the effects of the procedure aren’t permanent, many individuals experience modest relief and can return to their normal activities.
How Does Radiofrequency Ablation Shrink Tumors?
In some instances, radiofrequency ablation is used to shrink tumors and other growths in the body. During the procedure, radio waves are directed through a microelectrode into an individual’s soft tissue, heating and destroying the tumor and/or cancer cells. The heat may also close off small blood vessels surrounding the tumor, lessening the risk of bleeding.
How Does Radiofrequency Ablation Restore Normal Heart Rhythms?
To restore normal heart rhythms in patients experiencing atrial fibrillation, a cardiologist threads a thin wire directly to the heart via a vein. Through this wire, radio waves are delivered to the problematic areas, generating heat and destroying a small amount of tissue, which eliminates abnormal heart beats and restores the heart's normal rhythm.
Who Is a Candidate for Radiofrequency Ablation?
Because radiofrequency ablation is minimally invasive and has a low risk of side effects, it's typically considered safe for most individuals. In particular, people experiencing the following medical conditions may benefit from radiofrequency ablation:
- Atrial fibrillation
- Neuropathic pain conditions
- Chronic venous insufficiency
- Whiplash and other orthopedic injuries
- Pain associated with spine surgery
- Chronic pain of the neck, back, hip or pelvic
- Tumors, non-cancerous thyroid nodules and other growths
If you’re on blood thinners or you haven’t responded well to local anesthetic blocks, you may not be a good candidate for RFA.
What You Can Expect During RFA?
Prior to beginning the procedure, the attending physician typically administers intravenous medication intended to relax the individual, and a local anesthetic is used to numb the treatment area. With the help of X-ray or ultrasound imaging, the provider then inserts a thin needle into the treatment area and uses it to place a microelectrode, which delivers radio waves to the affected tissue. Treatment may take between 20 minutes and several hours, depending on the reason for treatment and the size of the target area. You’ll be awake and alert throughout the treatment. After a short recovery period, during which a nurse monitors the individual closely for side effects, most people are released and may go home.
Many individuals experience muscle soreness in and around the injection site for several days. However, most people can expect to return to their normal routine about 24 hours after receiving treatment.
When Does Radiofrequency Start Working?
The results of radiofrequency may vary from person to person and may depend on what the treatment is being used for. If you’re undergoing RFA for pain relief, the full effect may not be felt for up to three weeks following the procedure. Depending on the results and the anticipated outcome, a physician may recommend repeat treatments.
Does Radiofrequency Ablation Cause Side Effects?
Radiofrequency ablation is generally considered a safe alternative to surgery. However, some individuals may experience side effects such as those listed here:
- Skin infections at the injection site
- Muscle soreness or tenderness
- Damage to nerves, muscles or blood vessels near the injection site
- Temporary numbness or tingling
- Bleeding, itching burning or hypersensitivity at the injection site
Reactions are typically mild and temporary. Some individuals may also experience allergic reactions or other adverse reactions to the sedative or numbing agent administered prior to treatment.
Is Radiofrequency Ablation a Permanent Solution for Chronic Pain?
Unfortunately, radiofrequency ablation isn’t a permanent solution for chronic pain. However, it may provide physicians with a low-risk treatment option for managing and reducing pain so an individual can return to their regular activities. RFA may be particularly effective for individuals who haven't responded to pain-relief medications and other common treatments.