Does Medicare Cover Bunion Surgery (Lapiplasty)?

Medicare covers Lapiplasty and other bunionectomy procedures, when medically necessary, typically in an outpatient setting. Prior to surgical treatment, your doctor is likely to give you a prescription for bunion inserts, pads, or toe spacers.

What Are Bunions?

A bunion is an abnormal bony protrusion on the base of your big toe joint caused by a displaced joint. This will shift the big toe and cause it to drift toward your second toe, which exacerbates the already miserable condition. This will cause painful swelling, nerve damage, and affect your mobility. Bunions can form due to:¹mayoclinic.org, “Bunions“, Accessed November 10, 2021

• Wearing tight and improperly fitted shoes.
• The natural shape of the foot.
• A foot deformity.
• Medical conditions such as arthritis and diabetes

What Is Bunion Surgery?

Bunion surgery is just a minor invasive procedure to get rid of the bunion. The surgeon will numb the afflicted area for the procedure, remove any protruding bone and tissue, and realign the toe. They will even give you some sedatives so you can relax and read a book while the surgeon works. While a full recovery will take a few weeks, most patients will walk out of the clinic after bunion surgery.²healthpartners.com, “What is bunion removal surgery“, Accessed November 10, 2021

How Does Medicare Cover Bunion Surgery?

Medicare will cover bunion removal if a podiatrist, a doctor that specializes in foot care, finds it medically necessary and non-surgical treatments did not do anything for your foot. Most bunion surgeries are performed in an outpatient surgical center, which is covered by Medicare Part B.³Medicare.gov, “Foot care“, Accessed November 10, 2021

If a doctor deems bunion surgery as medically necessary during a beneficiary’s inpatient hospital stay, skilled nursing facility stay, home healthcare visit, or hospice care, it would instead be covered by Medicare Part A.³Medicare.gov, “Foot care“, Accessed November 10, 2021

Foot Care Services

Medicare covers podiatry services for all your severe foot conditions, including bunions, hammer-toes, and heel spurs. However, Medicare won’t cover minor foot care such as the removal of calluses and corns, nail maintenance, or foot cleaning. That is the realm of pedicure salons.⁴Medicare.gov, “Therapeutic shoes & inserts“, Accessed November 10, 2021

Foot exams and services are covered if needed as part of a treatment for a chronic condition, such as diabetes. This includes custom-molded shoes and inserts for those with severe diabetic foot disease and orthopedic shoes if you have a leg brace.⁴Medicare.gov, “Therapeutic shoes & inserts“, Accessed November 10, 2021

How Much Does Bunion Surgery Cost?

The cost of bunion surgery can range from $3,500 to $12,000, depending on the area and the type of surgical technique(s) that are used²healthpartners.com, “What is bunion removal surgery“, Accessed November 10, 2021. If the bunion surgery was performed as an outpatient procedure, Medicare Part B will pay 80 percent of all approved costs once the beneficiary has paid their annual Part B deductible. If the surgeon, anesthesiologist, or the surgical center charge Part B Excess Charges, the beneficiary is responsible for paying these costs.

In the rare situation that your bunion surgery is performed as an inpatient procedure, the hospital costs are covered by Medicare Part A, which has a benefit period deductible. Hospital services related to inpatient surgery include things like daily room and board, laboratory services, diagnostic tests, surgical equipment and supplies, anesthesia, and the services of nurses, and other health professionals. The price can really add up when it comes to hospitals, so you’re much better off financially just getting the procedure done at an outpatient facility.

Post-Surgery Medication Costs

When post-surgery medication is required it will generally be covered by a beneficiary’s Medicare Part D plan. Depending on the Part D plan, members may pay an annual deductible, before the plan begins paying its share, as well as a copayment.⁵Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 10, 2021

Medicare Advantage

Since Medicare Advantage plans are required to cover the same services as Medicare Part A and Part B, it will also cover your bunion surgery. However, your out-of-pocket costs with a Medicare Advantage plan may be different than those with Original Medicare, depending on the plan provider. You may also be restricted to using in-network providers for all your services, supplies, and durable medical equipment.⁶Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 10, 2021

Medigap

People with Original Medicare can purchase additional insurance, called Medigap, to help cover their Medicare Part A and Part B out-of-pocket costs.  Medicare supplement insurance, as it is also known, is available through private insurance companies. A Medigap policy will cover some or all of the out-of-pocket costs from bunion surgeries covered by Part A and Part B. These costs include:⁷Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 10, 2021

• Deductibles
• Coinsurance
• Copayments

Summary

If you have a bunion and it is causing you pain, put on some comfy shoes and go consult with your doctor about surgical options. Bunion surgery could be the logical next step to relieve your foot pain. If you meet the eligibility conditions, and your doctor orders the procedure, Medicare will pay its share.

Citations

• 1
  mayoclinic.org, “Bunions“, Accessed November 10, 2021
• 2
  healthpartners.com, “What is bunion removal surgery“, Accessed November 10, 2021
• 3
  Medicare.gov, “Foot care“, Accessed November 10, 2021
• 4
  Medicare.gov, “Therapeutic shoes & inserts“, Accessed November 10, 2021
• 5
  Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 10, 2021
• 6
  Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 10, 2021
• 7
  Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 10, 2021