Original Medicare (Parts A & B): Ambulatory Surgical Centers
Many surgeries today are performed in ambulatory surgical centers or outpatient hospital facilities and do not require a hospital stay.
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How To Receive
Details on how to apply
Obtain a provider order for the outpatient procedure.
Schedule the procedure at an ambulatory surgery center that accepts Medicare.
The ordering provider will likely have a preferred outpatient facility.
Attend the appointment and complete the procedure.
Follow through with any post-op recommendations or referrals.
For more information on Medicare benefits and coverage, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Benefits Website. TTY users, call 1-877-486-2048.
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Outpatient surgery is also referred to as "same-day" surgery and "ambulatory" surgery.
Many surgeries today can be performed on an outpatient basis and do not require admission to the hospital. Examples include but are not limited to, knee and hip arthroplasty/replacement, removal of non-malignant growths, cataract surgery, and laparoscopies.
When having surgery in a hospital facility, however, check with the provider about the expected inpatient or outpatient status following the surgery. Unless the provider writes an order for inpatient admission to the hospital, the status will be outpatient, and payment of cost-sharing amounts for outpatient surgery is required. Even with an overnight hospital stay, it may still be considered outpatient.
Medicare covers the facility service fees related to approved surgical procedures provided in an ambulatory surgical center (an outpatient facility where surgical procedures are performed, and the patient is expected to be released within 24 hours). Except for certain preventive services, the member pays 20% of the Medicare-ap[proved amount to both the ambulatory surgical center and the provider who treats them. The Part B deductible applies. The member pays all of the facility service fees for procedures Medicare doesn't cover in ambulatory surgical centers.
To get cost estimates for ambulatory surgical center outpatient procedures, click here.
Bariatric surgery
Medicare covers some bariatric surgical procedures, like gastric bypass surgery and laparoscopic banding surgery, when certain conditions are met related to morbid obesity. For information on coverage click here.
Second surgical opinions
Medicare covers a second surgical opinion in some cases for medically necessary surgery that isn't an emergency. In some cases, Medicare even covers third surgical opinions.
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