How much does a spinal fusion cost in 2021? | finder.com

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How much does a spinal fusion cost?

Compare payment options and costs for a spinal fusion

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If you're a candidate for a spinal fusion, costs vary significantly based on your insurance, where you live and the hospital or doctor you choose. Each procedure is assigned standardized, 5-digit CPT codes that hospitals and insurance companies use for billing purposes. Use the CPT code to compare prices for a spinal fusion before scheduling your appointment.

Average cost for a spinal fusion

If you have health insurance and use an in-network doctor, you can expect to pay $53,577 for a spinal fusion on average. If you don't have insurance or you choose an out-of-network doctor, the cost increases to $157,026.

Average costs are based on the primary cost of a spinal fusion in the 90201 ZIP code and don't factor in insurance costs like copays or deductibles, or additional fees often charged by doctors or hospitals — like medical supplies, facility fees and support services.

CPT code Procedure ZIP used Description In-network costs Out-of-network costs
22558 Spinal fusion 90201 Spinal fusion except cervical without major comorbid conditions or complications $53,577 $157,026

Related costs for a spinal fusion

CPT code Primary procedure Description In-network costs Out-of-network costs
20930 Medical Procedure Fragmented donor bone graft or placement of material to promote bone growth for spine surgery $1,253 $3,113
22585 Medical Procedure Fusion of spine bones with removal of disc, anterior approach $2,060 $15,000
22845 Medical Procedure Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments $8,052 $21,500
72100 Radiology X-ray of lower and sacral spine, 2 or 3 views $26 $64
76000 Radiology Imagining guidance for procedure, up to 1 hour $35 $600
95861 Other Neddle measurement and recording of electrical activity of muscle of arm(s) or leg(s), 2 extremities $1,141 $2,500
95870 Other Neddle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study $265 $580
95937 Other Testing with stimulation for assessment of function at muscle-nerve junction $219 $510
95938 Other Insertion of needles and skin electrodes for measurements and recording of stimulated sites in the arms and legs $1,634 $3,800
95939 Other Insertion of neddles and skin electrodes for measurements and recording of stimulated sites in the arms and legs (brain motor stimulation) $8,598 $20,000
95941 Other Continuous monitoring of nervous system during operation, per hour $330 $925
95955 Other Measurement of electrical activity (EEG) outside the brain during surgery $2,401 $4,865
00670 Anesthesia Anesthesia for procedure on spine and spinal cord $3,951 $9,860
Total related costs $29,965 $83,317

Does health insurance cover a spinal fusion?

Most health insurance policies cover a spinal fusion if it's medically necessary and you've met your deductible and any coinsurance or copays specified in your policy. If you don't have health insurance, you may need to pay the full cost of a spinal fusion out of pocket. The exact amount your insurance pays for a spinal fusion comes down to your plan and the doctor or healthcare facility you're going to. For the most accurate idea of how much you'll pay out of pocket, contact your insurance company before booking a spinal fusion.

Does Medicare cover a spinal fusion?

It depends on your Medicare plan, but generally Medicare covers procedures like a spinal fusion that are considered medically necessary by your doctor.

  • Medicare Part A (Hospital Insurance) covers inpatient care in a hospital or skilled nursing facility following a hospital stay, so it typically won't cover a spinal fusion.
  • Medicare Part B (Medical Insurance) pays for emergency, urgent and outpatient care and some preventative services, which means Medicare likely covers a spinal fusion — but you'll be charged a 20% coinsurance.
  • Medicare Part C (Medicare Advantage) is a comprehensive plan that combines Part A, Part B and often Part D and should pay for a portion of a spinal fusion minus any deductible, copay or coinsurance.
  • Medicare Part D (Prescription Drugs) won't cover a spinal fusion, but it may help to pay for any medication you need as part of your recovery.

What affects the cost of a spinal fusion?

The price you'll pay for a spinal fusion varies based on factors like:

  • Your health insurance plan. Your coinsurance, copay and how much of your deductible you've met affects the amount you pay for a spinal fusion out of pocket, does as whether your doctor or anyone else involved is outside your network.
  • Your location. Where you live dictates which doctors or healthcare facilities you have access to for a spinal fusion. Urban areas are more competitive, which can drive down costs for a spinal fusion compared to rural areas.
  • Your doctor. Your doctor's experience and expertise affects how much they charge for a spinal fusion. And the cost may increase if complications arise during a spinal fusion and your doctor has to call in other medical professionals.
  • Additional fees. Your healthcare provider may charge associated fees that increase the overall cost of a spinal fusion.

How to cut your costs for a spinal fusion

In the leadup to a spinal fusion, confirm your copay, coinsurance and deductible with your insurer so you know how much you'll pay out of pocket.

  • Dip into your HSA, FSA or HRA. These tax-advantaged accounts can help you to cover out-of-pocket costs for a spinal fusion.
  • Ask about financial aid. If you can't afford to pay the average cost of $53,577 with or without insurance, most hospitals and clinics offer financial aid programs that include discounts or interest-free payment plans.
  • Explore outpatient centers. Outpatient facilities tend to charge less for medical procedures like a spinal fusion, though they're not an option for everyone.
  • Consider medical loans. A medical loan could help pay for anything your health insurance doesn't cover for a spinal fusion, like copays or coinsurance.
  • Compare doctors and hospitals. Lower the price of medical services by comparing in-network hospitals before you schedule a spinal fusion. The Centers for Medicare and Medicaid Services require hospitals and clinics to publish online price lists for common procedures, which may include costs for a spinal fusion.

Bottom line

The price of a spinal fusion is a major consideration for treatment whether you have health insurance or not. The amount you'll pay for a spinal fusion can vary between doctors, hospitals, locations and insurance plans, which is why it's worth comparing hospital prices.

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