A stapedectomy is a surgical procedure designed to treat conductive hearing loss, most commonly caused by otosclerosis. Otosclerosis involves abnormal bone growth that immobilizes the stapes, the tiny, stirrup-shaped bone in the middle ear. During the procedure, the surgeon removes the fixed stapes and replaces it with a prosthetic device, allowing sound waves to transmit effectively. Medicare covers stapedectomy surgery, provided the procedure is determined to be medically necessary to correct a diagnosed hearing impairment.
Coverage for Physician Services and Outpatient Care
Original Medicare Part B provides coverage for costs associated with a stapedectomy, as the procedure is typically performed on an outpatient basis. Part B covers the physician’s services, including the surgeon’s fee, necessary diagnostic tests, supplies, and the facility fee. Approved settings include an ambulatory surgical center (ASC) or a hospital outpatient department.
To qualify for coverage, a physician must deem the stapedectomy medically necessary to treat hearing loss from otosclerosis or a similar condition. After the annual Part B deductible is met, Medicare pays 80% of the Medicare-approved amount for the procedure (CPT code 69660). The remaining 20% coinsurance is the patient’s responsibility and applies to both the surgeon’s services and the facility fee. Patient payments under Original Medicare can range from approximately $762 at an ASC to about $1,362 at a hospital outpatient department.
Coverage for Inpatient Hospital Stays
If the patient’s health status or surgical complexity requires a formal hospital admission, Original Medicare Part A becomes the primary payer for facility charges. Part A covers costs associated with an inpatient stay, such as the room, meals, general nursing care, and other hospital services. An official inpatient admission is triggered when the physician orders a length of stay that crosses two midnights to receive necessary hospital services.
Financial responsibility under Part A is structured around a deductible that applies per benefit period, which was $1,676 in 2025. Once this deductible is satisfied, Part A covers the full cost of the first 60 days of the inpatient stay. Even during an inpatient stay covered by Part A, the surgeon’s fees and other physician services are still billed under the rules of Part B. This means the patient may still owe the Part B coinsurance for the surgical component, in addition to any Part A deductible obligations.
Navigating Medicare Advantage Plans
For individuals enrolled in a Medicare Advantage (MA) Plan, the stapedectomy is covered because these private plans must provide the same benefits as Original Medicare. However, the process for accessing care and the out-of-pocket costs differ significantly from the standard Part A and Part B structure. MA plans, which include Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), frequently require prior authorization before scheduling the surgery.
Prior authorization means the plan must pre-approve the procedure based on medical necessity criteria, or the plan may refuse to cover the costs. Most MA plans operate with specific provider networks, requiring the patient to select an in-network surgeon and facility to avoid higher costs or claim denial. The cost-sharing structure also varies, often replacing the 20% Part B coinsurance with fixed copayments or different coinsurance percentages. Beneficiaries must review their plan’s Evidence of Coverage document to understand the specific rules and financial responsibilities.
Patient Costs and Out-of-Pocket Expenses
The patient’s financial responsibility for a stapedectomy depends heavily on the type of Medicare coverage they possess. Under Original Medicare, the primary out-of-pocket expenses are the annual Part B deductible and the 20% coinsurance applied to the surgical and facility charges. If the procedure leads to a formal inpatient stay, the Part A deductible for that benefit period would also apply.
Many beneficiaries with Original Medicare enroll in a Medigap policy to mitigate these costs. Medigap plans are designed to cover the deductibles, copayments, and coinsurance amounts left unpaid by Original Medicare, often reducing the patient’s financial responsibility to near zero. Medicare Advantage plans replace the Part A and Part B cost-sharing with their own structure of copayments and coinsurance. These plans must include an annual out-of-pocket maximum, which provides a financial safety net once reached.