Will Medicare cover shoulder surgery?

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Medicare covers rotator reconstruction.

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If you have a rotator cuff injury, the best way to determine if Medicare will pay for surgery is for your orthopaedic physician's staff to check with Medicare directly. The staff will have the codes for the diagnosis as well as for the surgery, and that would likely influence what Medicare will or will not cover.

I do know that some doctors have told people my age that Medicare won't pay for surgery unless the patient has PT first, before any surgery. I suppose Medicare's position is that if PT can cure it, funds will be saved by avoiding surgery. But PT can't repair the tears in a rotator cuff.

I was cautioned by a hospital professional not to wait until I was much older as Medicare shies away from paying for rotator cuff surgery for "older" people, although no specifics were given on how young vs. how old.

If your physician doesn't feel that surgery is necessary, see another ortho surgeon. I mention this because when I tore mine, the ortho doctor said every time I saw him that he has other "older" patients (I was only in my mid 60's at the time!) who learn to live with the rotator cuff tears.

Obviously he didn't remain as my surgeon and I went elsewhere. I have also noticed other signs of discrimination against older people with other doctors affiliated at that hospital. Left them all by the wayside and went elsewhere.
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