Stenosing Tenosynovitis, commonly known as trigger finger, is a medical condition where the flexor tendon in the finger or thumb becomes inflamed, causing it to catch or lock as it attempts to glide through a narrow sheath or pulley system. When this painful locking sensation occurs, and conservative treatments like steroid injections or splinting have not resolved the issue, surgical intervention is often recommended. For individuals with Medicare, this medically necessary procedure is generally covered, though the specific coverage details depend on the setting of the surgery and the particular Medicare plan.
Coverage for Outpatient Surgery Under Medicare Part B
The vast majority of trigger finger release procedures are performed in an outpatient setting, meaning they are covered under Medicare Part B, which addresses medical services and supplies. This coverage includes the professional fees for the surgeon and the anesthesiologist, as well as the facility costs if the procedure is performed in a hospital outpatient department or an Ambulatory Surgical Center (ASC). Coverage is contingent upon the procedure being deemed medically necessary by a physician, which typically means that less invasive treatments, such as corticosteroid injections, have been exhausted and failed to provide lasting relief. Once the medical necessity criteria are met, Original Medicare pays its portion of the approved amount for all covered services.
Inpatient Care and Facility Costs Under Medicare Part A
While trigger finger surgery is almost always an outpatient procedure, there are rare circumstances where a patient might require a formal inpatient hospital admission, which shifts the facility coverage to Medicare Part A. Part A covers the costs associated with the hospital stay itself, such as the semi-private room, meals, nursing care, and use of hospital equipment. This scenario is reserved for patients who have complex medical needs or a high risk of complications requiring close monitoring after the procedure. A formal inpatient admission is different from being under observation status in a hospital, and the physician must specifically admit the patient for Part A coverage to apply. Even when the facility costs fall under Part A, the surgeon’s professional services and other physician-related care are still covered separately under Part B.
Calculating Your Out-of-Pocket Expenses
Even with Medicare coverage, beneficiaries are responsible for certain out-of-pocket costs, which vary depending on the part of Medicare utilized.
For the common outpatient surgery under Part B, the beneficiary must first satisfy the annual Part B deductible, which is \\(257 in 2025. After the deductible is met, the patient is responsible for a 20% coinsurance of the Medicare-approved amount for the surgeon’s fee, anesthesia, and the facility charge.
If the procedure requires an inpatient stay under Part A, the beneficiary is responsible for the Part A deductible, which is \\)1,676 per benefit period in 2025. This deductible covers the patient’s share of costs for the first 60 days of a covered inpatient stay. The 20% coinsurance for the physician’s services still applies under Part B, even if the facility portion is covered by Part A.
Many beneficiaries utilize supplemental insurance to help manage these costs. A Medigap policy works alongside Original Medicare (Parts A and B) and often covers the 20% Part B coinsurance and may cover the deductibles. Alternatively, a Medicare Advantage Plan (Part C) replaces Original Medicare and has its own set of cost-sharing rules, but these plans feature a maximum out-of-pocket limit.