Medicare Coverage Options for Robotic Surgery

In this article...
  • Robotic surgery is an advanced surgical procedure that may be covered by Medicare if deemed medically necessary. Find out more about Medicare coverage for robotic surgery.

Robotic surgery is a practice in which robotic arms and hand-held robotic devices are utilized for added precision and control during complex procedures. During a robotic surgery procedure, the surgeon controls the robotic device via a computer console that projects 3-D images of the surgical site. Robotic surgery is sometimes preferred over traditional surgery, as the procedures tend to be less invasive and often allow for shorter hospital stays and faster recovery times. 

Does Medicare Cover Robotic Surgery?

Medicare typically covers outpatient robotic surgery procedures under Medicare Part B and inpatient procedures (following admission to a hospital) under Medicare Part A. In general, all robotic surgery procedures must be performed in Medicare-approved facilities, and the surgeries must be deemed medically necessary. 

Medicare Advantage plans must provide coverage for the same procedures covered by Medicare Parts A and B, but Medicare Advantage may not offer the same amount of coverage. For example, Medicare Part B generally covers 80% of an approved outpatient robotic surgical procedure. But Medicare Advantage plans may require recipients to pay a bigger or smaller portion of the overall costs, depending on the details of the plan. 

Medicare supplement insurance may help recipients fill in any financial gaps for robotic surgery procedures not covered by Part A, Part B or Medicare Advantage. Medicare supplements are required to provide coverage for anything covered by Original Medicare. While specific supplemental plan coverage can vary, they may allow for significantly lower or zero out-of-pocket costs. 

Does Medicare Cover Robotic Knee Replacement Surgery?

If a physician or surgeon determines that robotic knee replacement surgery is medically necessary, it may be covered under Medicare Part B for outpatient procedures and Part A for inpatient procedures. However, the surgery must be performed in a Medicare-approved facility. Not all facilities are certified and/or technologically equipped to perform robotic knee replacement surgeries, so it's important for individuals to discuss their options with their providers. 

Does Robotic Surgery Cost More Than Traditional Surgery?

In general, robotic surgical procedures cost more than open surgery and laparoscopic surgery procedures due to the advanced technology and equipment used. However, the overall cost of any surgical procedure will depend on several factors that include the specific type of surgery performed, insurance coverage, surgical facility location, and whether the procedure is inpatient or outpatient. 

What Are Some Common Types of Robotic Surgery?

In addition to robotic knee replacement surgery, some common types of robotic surgery include:

  • Herniated disc repair 
  • Removal of bone spurs
  • Bone grafting
  • Cancer surgery (removal of diseased tissue from blood vessels and organs)
  • Hysterectomy
  • Kidney transplant
  • Kidney removal (full or partial)
  • Hip replacement 
  • Coronary artery bypass

What Are Some Disadvantages of Robotic Surgery?

While robotic surgery offers many benefits, there are some potential disadvantages to the procedures that should be considered when determining treatment plans. Robotic surgeries tend to be more time-consuming than traditional surgeries due to the use of robotic arms and the detailed precision required for each procedure. If complications arise during a robotic procedure, a surgeon may be required to start over with a traditional, open procedure.

While uncommon, robotic arms and computer equipment may malfunction during surgical procedures, which can lead to delays. In some cases, robotic surgery has been associated with nerve compression and nerve damage, which may result in long-term effects. 

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