Does Medicare cover outpatient surgery?

What outpatient surgery does Medicare cover?

Medicare Part B covers approved outpatient services and supplies, which can include X-rays, casts, stitches and outpatient surgeries. Medicare covers many medically necessary inpatient and outpatient surgical procedures, and Part B's covered outpatient hospital services include services in an outpatient clinic, including same-day surgery.

If you're an outpatient, you may have a choice between an ambulatory surgical center and a hospital outpatient department. Ambulatory surgical centers are outpatient facilities that perform surgical procedures, and in most cases they release patients within 24 hours.

What do I pay for outpatient surgery at a hospital?

After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for doctor or other health care provider services, and you generally also pay a copayment for each service you get in a hospital outpatient setting. In most cases, the copayment can't be more than the Part A hospital stay deductible ($1,736 in 2026) for each service. At a critical access hospital, your copayment may be higher and may exceed the Part A deductible.

Costly surgical procedures called comprehensive services, like total knee replacements, are an exception: for these, you pay 20% for the entire episode of care, including any drugs, laboratory tests and other services. You may pay more for outpatient services in a hospital outpatient setting than you'd pay for the same care in a doctor's office that's independent from the outpatient department.

What do I pay at an ambulatory surgical center?

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount to both the ambulatory surgical center and the doctors who treat you. You pay all facility fees for procedures Medicare doesn't cover.

You pay nothing for certain preventive services, like a screening colonoscopy, if your doctor or other health care provider accepts assignment, but you may have other costs. For example, if your doctor removes a polyp during a screening colonoscopy, you may have to pay 15% of the Medicare-approved amount. See how Medicare covers colonoscopies.

Does Medicare cover anesthesia for outpatient surgery?

Yes. Medicare Part B covers anesthesia services you get as an outpatient in a hospital or as a patient in a freestanding ambulatory surgical center. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for anesthesia services from a doctor or certified registered nurse anesthetist. The anesthesia service must be associated with the underlying medical or surgical service, and you may have to pay an additional copayment to the facility.

What if the hospital keeps me overnight after outpatient surgery?

You can still be an outpatient. If you go to a hospital for outpatient surgery and it keeps you overnight, for example for high blood pressure, but your doctor doesn't write an order to admit you as an inpatient, Part A pays nothing and Part B covers your doctor services and hospital outpatient services, like the surgery, lab tests or intravenous medicines. Ask the doctor or hospital about your status, because it affects what you pay. See how Medicare covers observation stays.

How can I estimate what I'll pay before outpatient surgery?

It's hard to know exact costs in advance, but you can estimate them. Medicare.gov suggests these steps:

• Ask the doctor, hospital or facility how much you'll have to pay for the surgery and any care afterward.
• Find out whether you're an inpatient or an outpatient, because what you pay may be different.
• Check with any other insurance you have, like employer coverage, Medicaid or a Medigap (Medicare Supplement Insurance) policy, and contact your plan if you belong to a Medicare health plan.
• Log into your secure Medicare account, or look at your last Medicare Summary Notice, to see whether you've met your deductibles.