Question 1

Does Medicare cover lumbar laminectomy for spinal stenosis?

Accepted Answer

Yes. Medicare Part B covers lumbar laminectomy (CPT 63047) when medically necessary for symptomatic spinal stenosis that has not responded to conservative treatment. Imaging (MRI or CT) confirming stenosis and documentation of failed non-surgical treatment (physical therapy, injections) is typically required before Medicare will approve the surgery. The procedure is covered either inpatient (Part A) or outpatient (Part B) depending on clinical complexity.

Question 2

Is laminectomy inpatient or outpatient with Medicare?

Accepted Answer

Lumbar laminectomy can be performed either as an inpatient admission or as an outpatient procedure (HOPD or ASC). The setting depends on your health status, the extent of surgery, and your surgeon's judgment. Outpatient laminectomy has become more common in recent years for appropriate candidates. Outpatient costs (20% Part B coinsurance) may be higher or lower than inpatient (Part A deductible $1,736) depending on total charges and length of stay.

Question 3

What does Medicare pay for lumbar laminectomy?

Accepted Answer

For 2026, the Medicare-approved surgeon fee for lumbar laminectomy (CPT 63047) is approximately $658 nationally. Medicare pays 80% ($526); you owe 20% ($132). The HOPD facility fee is approximately $6,500 (your 20% share: $1,300). The ASC facility fee is approximately $4,200 (your 20% share: $840). If admitted inpatient, the DRG 518 Medicare payment is $14,109 to the hospital; you pay the $1,736 Part A deductible. Medigap Plan G covers your 20% coinsurance in full.

Question 4

Why does this calculator show a different amount than Medicare.gov's cost estimate?

Accepted Answer

This calculator may show a higher number than Medicare.gov's "Patient Pays (average)" for several reasons: (1) Deductible timing — this calculator applies the $283 Part B annual deductible if it has not yet been met; Medicare.gov's average assumes many patients have already satisfied theirs. (2) Anesthesia — Medicare.gov's estimate covers the facility fee and surgeon only; anesthesia is billed separately and is included in this calculator. (3) Location adjustment — surgeon fees are adjusted by your region's Geographic Practice Cost Index (GPCI); in high-cost cities like Seattle or New York, surgeon fees run 30–50% above the national rate. Facility fees (HOPD and ASC) are nationally fixed by CMS and should match Medicare.gov exactly. (4) Patient mix — Medicare.gov's "Patient Pays" average includes Medigap enrollees who pay $0 coinsurance, which pulls the reported average below what uninsured Original Medicare patients typically pay.

Cost Component	Medicare-Approved Amount	Your Share (20%)
Surgeon Fee — Lumbar Laminectomy (CPT 63047)	$1,065	$213
Hospital Outpatient (HOPD) Facility Fee	$7,413	$1,483
Ambulatory Surgery Center (ASC) Facility Fee	$3,695	$739
Inpatient Hospital (DRG 519) — Medicare Pays	$14,555	$1,736 Part A deductible
Anesthesia (estimated)	$600–$1,100	20% of approved

Medicare Lumbar Laminectomy Cost 2026 | Out-of-Pocket Estimator

2026 Medicare Cost Summary — Lumbar Laminectomy (CPT 63047)

What Medicare Pays

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