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Balloon Sinuplasty

Does Medicare Cover Balloon Sinuplasty?

March 7, 2024

5 minutes

Reviewed by Michael Kaplan, MD

Balloon sinuplasty is a minimally invasive procedure that has transformed the lives of countless individuals suffering from chronic sinusitis, especially among those over the age of 65. As this age group searches for relief, one prevailing question arises: does Medicare cover balloon sinuplasty?

The answer is a resounding yes. Medicare recognizes the significance and medical necessity of this procedure for eligible patients. With its growing popularity and proven efficacy, balloon sinuplasty has provided thousands of seniors with a safe and effective alternative to traditional sinus surgery, ensuring their golden years are not tarnished by the discomfort and pain of sinus conditions.

Here’s what you need to know about using Medicare to cover the cost of balloon sinuplasty.

What is balloon sinuplasty?

Balloon sinuplasty in Houston is a minimally invasive procedure most commonly used to treat chronic sinusitis. In this condition, the sinuses become inflamed and swollen, causing difficulty breathing, headaches, and facial pain. The traditional treatment for this condition was endoscopic sinus surgery, which involved removing tissue or bone from the sinuses to clear blockages. 

Balloon sinuplasty, on the other hand, uses a small balloon catheter to gently dilate the sinus openings and restore proper drainage without any tissue or bone removal. This results in less post-operative pain and faster recovery times than traditional surgery.

This low-risk procedure can also be used to treat various other conditions including chronic cough, snoring, sinus headaches, and there is even balloon sinuplasty for allergies

Continue Learning: How long does balloon sinuplasty last?

Is balloon sinuplasty covered by insurance?

Yes, balloon sinuplasty is covered by Medicare, but certain criteria must be met for coverage. Medicare covers the procedure under Part B (medical insurance) for eligible patients with chronic sinusitis who have not responded to other medical treatments. Traditional endoscopic sinus surgery is also covered by Medicare, but the recovery time and potential risks associated with this method make balloon sinuplasty an attractive option.

Medicare will cover 80% of the cost of balloon sinuplasty, meaning that your balloon sinuplasty out-of-pocket cost will be the remaining 20%. However, if you have a Medicare Supplement plan, it may cover some or all of the remaining costs. 

How much does a balloon sinuplasty cost?

The balloon sinus surgery cost typically ranges from $3,000 to $7,000. This price often includes:

  • The use of the medical facility
  • Anesthesia
  • Professional fees for the surgeons and medical staff

Factors that can affect the balloon sinuplasty price include the: 

  • Geographic location of the procedure
  • Complexity of the patient’s condition
  • Whether the procedure is performed in a hospital or an outpatient setting

Furthermore, if additional services or treatments are required during the procedure, such as treatments for other nasal issues discovered during sinuplasty, costs can increase. Because balloon sinuplasty recovery time is shorter than other sinus procedures, patients may also save on post-operative costs.

Balloon sinuplasty price and Medicare

For those covered by Medicare, understanding the relationship between these costs and the coverage is crucial so that you can better predict what you’ll be responsible for paying. As mentioned, Medicare Part B will cover 80% of the procedure’s cost after the deductible is met, provided that the criteria for medical necessity are fulfilled, and it is performed by a Medicare-approved provider. 

Patients should be aware that while Medicare approves the procedure, some sinus balloon surgery costs may still be out-of-pocket. These out-of-pocket expenses could include the Part B deductible, coinsurance, and any charges exceeding the amount that Medicare approves for the service.

Patients need to consult with their healthcare provider and insurance to gain a clear understanding of their coverage options and potential financial responsibilities.

How do you qualify for balloon sinuplasty?

To qualify for balloon sinuplasty coverage under Medicare, you must meet certain criteria as outlined above. In addition, your medical provider will also assess certain factors to determine if you are a suitable candidate for the procedure, including:

  • The length and severity of your sinus condition
  • Any underlying health issues that may affect recovery or increase risks
  • Medications and supplements you are taking that may interfere with the procedure
  • Any previous sinus surgeries or treatments

It is essential to have a thorough discussion with your physician to determine if balloon sinuplasty is the right option for you. They will also be able to provide additional information on costs, Medicare coverage, and any other concerns you may have.

Kaplan Sinus Relief is proud to offer balloon sinuplasty for Medicare patients in Houston!

In summary, for those pondering, “Does Medicare cover balloon sinuplasty?”, the answer is yes. Medicare coverage is available under Part B for qualified patients, covering 80% of the procedure’s cost. With favorable recovery times and less postoperative discomfort compared to traditional surgery, balloon sinuplasty is an excellent option for those who meet the Medicare eligibility criteria. 

For residents of Houston seeking relief from sinus issues, Kaplan Sinus Relief proudly extends its expertise in balloon sinuplasty, accompanied by Medicare assistance, to ensure that you receive the care you need without the financial burden.

Schedule an appointment with us today to learn more! At your first appointment, our founding physician and pioneer of the balloon sinuplasty procedure, Dr. Michael Kaplan, can walk you through everything you need to know about the costs before and after balloon sinus surgery.

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