Surgical procedures differ in terms of complexity and technology used, but most require some type of surgical tray. A surgical tray is simply a sterilized container or metal tray that houses various instruments that are commonly used in procedures. A surgical tray may come pre-packaged with sterilized tools, but additional tools may be assembled depending on the expected need during a procedure. Although it can be easy to dismiss small items like surgical trays when it comes to cost considerations of procedures, these items will need to be accounted for in billing, even when a surgical patient has Medicare coverage.
The way that Medicare pays for surgical trays is by bundling them with different procedures. This helps to keep the program working more efficiently as it is expected that surgical trays will be utilized for surgical procedures, meaning no separate billing is required. If surgical trays are used outside of normal procedure expectations, a provider would likely need to bill Medicare separately for the tray and any additional supplies needed for the tray using an invoice detailing the additional tools utilized. Because the initial tray and supplies are bundled with the procedure, Medicare may require additional details about the reason behind the additional tray in order to process and approve the separate claim.
Will Medicare Pay for Surgical Trays?
Because Medicare insurance coverage may be affected by the setting of your procedure, it’s important to point out that surgical tray and procedure coverage may be based on when, where and how a procedure is conducted. Medicare Part A may cover inpatient stays and associated care in a hospital, skilled nursing facility, or home health services. If a surgical procedure is ordered that is directly associated with the cause of being in a skilled nursing facility, Medicare Part A would likely help cover the costs.
Medicare Part B may cover medically necessary services and supplies, including outpatient procedures, such as cataract surgery, bunion removal, or gastric bypass. Other situations involving outpatient surgery may include dermatological excision or various biopsy procedures. Once again, if these types of surgical procedures are ordered by a physician to be completed in an outpatient setting, they will likely be billed under Medicare Part B.
Does Medicare Part D Affect Surgical Tray Costs?
Medicare insurance coverage under Part D exists to provide a benefit for those who are prescribed medications that can be picked up at a retail pharmacy. As a result, Medicare Part D does not cover anything involving surgical trays or tools. Medicare coverage under Part D should, however, provide cost savings for medications that may be prescribed to aid in recovery after a surgical procedure. These medications may include things like antibiotics and pain management drugs. It should also be noted that drugs requiring infusion technology likely won’t be covered under Part D because they can’t be purchased at a traditional pharmacy. In these cases, treatments with such medications will be billed under Medicare Part B for outpatient services or Part A when administered during an inpatient hospital stay.
Does Medicare Advantage Provide Additional Benefits?
Medicare Advantage plan are required to cover at least the same benefits as Original Medicare Part A and Part B, but many provide additional benefits to recipients. In most cases, the patient will not see additional benefits for surgical trays or instruments used. As with Original Medicare, a Medicare Advantage plan will offer coverage of surgical trays as benefits that are bundled into the billing for the procedure as a whole.
If a mistake is made and a new surgical tray needs to be provided by the surgical team, this will likely not affect the patient’s financial responsibility. If a procedure needs additional surgical trays or instruments as the result of a complication, a separate billing code will be used by the healthcare provider when billing Medicare to have the additional bundled tray included in the final amount.