Does Medicare Pay For Hemorrhoid Surgery?

Does Medicare Pay For Hemorrhoid Surgery?

Medicare does not cover cosmetic procedures, including hemorrhoid surgery. Medicare does cover hemorrhoid surgery when a person has an anal fissure or when they have bleeding that is not controlled with other treatments.

Medicare may cover hemorrhoid surgery in the following instances:

Anal fissure

Hemorrhoids are not related to the anal fissure. In other words, a person does not need to have hemorrhoids to have an anal fissure. An anal fissure may occur in the absence of the presence of hemorrhoids.

However, hemorrhoids may worsen an anal fissure, making it more difficult to heal.

Anal fissures are tears in the lining of the anus that cause bleeding. They are usually caused by straining during a bowel movement or from passing a hard stool. Anal fissures are very painful.

Risk factors for developing an anal fissure include:

Less common risk factors for an anal fissure include:

Surgery to correct an anal fissure may include the injection of collagen into the anal canal to heal a torn muscle or a surgical procedure to repair the torn muscle.

Anal fissures are most commonly treated with fiber supplementation, stool softeners, and gentle bowel training. However, these treatments do not always work. In such instances, a person may be referred to a surgeon for treatment.

Anal fissure treatment that is not covered by Medicare may include:

Another surgical procedure for a recurring anal fissure is to remove a small portion of skin from the anus. This procedure is called a sphincterotomy or a sphincteroplasty.

Hemorrhoids

Hemorrhoids are swollen veins in the lower rectum and anus. These swollen veins may be in the internal sphincter of the anus, the surrounding tissue of the anus, or the anal canal. They are also called piles.

The following are the most common types of hemorrhoids:

Internal hemorrhoids: These clots are located entirely inside the anal canal.

These clots are located entirely inside the anal canal. External hemorrhoids: These clots are located outside the anal canal.

These clots are located outside the anal canal. Thrombosed external hemorrhoids: This is a hemorrhoid that has become engorged with blood. A person may have experience painless bleeding from a thrombosed external hemorrhoid.

This is a hemorrhoid that has become engorged with blood. A person may have experience painless bleeding from a thrombosed external hemorrhoid. Prolapsed external hemorrhoids: These hemorrhoids have become queued outside of the anus, but still attached to the anus.

A person may have all of the above types of hemorrhoids.

Risk factors for hemorrhoids include:

Genetic factors

Pregnancy

Sitting for long periods of time, such as on a long car ride or airplane

Constipation

Chronic diarrhea

Chronic coughing

Heavy lifting

Anal intercourse

Excessive weight loss

Lack of physical activity

These risk factors may not be present for all people who develop hemorrhoids.

A person may experience the following symptoms of hemorrhoids:

Bleeding

Itching

Painful bowel movements

Thick, lumpy stools

Dizziness

If the pain is severe, it may be a symptom of a thrombosed external hemorrhoid or a prolapsed external hemorrhoid.

Other symptoms may include the following:

Fecal incontinence

If a person has a persistent but mild case of an anal fissure or a mild case of hemorrhoids, they may be able to manage the condition with fiber supplements, stool softeners, and gentle bowel training.

However, if the person's symptoms are severe or if they have a repeated problem, they may be referred to a surgeon for treatment.

Hemorrhoid surgery may be covered by Medicare in the following instances:

Hemorrhoids that are bleeding

There are two types of surgical procedures for a hemorrhoid that is bleeding:

Doppler sclerotherapy

Ligation

In Doppler sclerotherapy, a vein that is bleeding is injected with a material to shrink it. This is called sclerotherapy. The material used is called a sclerosing agent.

In ligation, the hemorrhoid is tied off. This is also called a hemorrhoidectomy. Once a hemorrhoid is tied off or removed, it will not come back.

Hemorrhoids that are causing bleeding or pain

There are three types of surgical procedures for a hemorrhoid that is causing pain or bleeding:

Stapling

Resection

Coagulation

In stapling, the hemorrhoid may be removed or a small opening may be made in the hemorrhoid to allow the blood to drain.

In resection, the hemorrhoid tissue is cut out.

In coagulation, the hemorrhoid tissue is burned with a laser or an electric needle.

Hemorrhoids that are causing pain or bleeding are also called thrombosed external hemorrhoids.

Hemorrhoids that are causing bleeding or pain may be treated with one of these surgical procedures:

How much does hemorrhoid surgery cost?

The average cost of hemorrhoid surgery in the United States is $4,007 per hemorrhoid. The cost can vary depending on the surgeon, the length of the operation, and the type of anesthesia used.

Medicare may cover hemorrhoid surgery in the

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