Does Medicare Cover iovera° Treatment? 

Pain treatment can be a complicated thing. Pain affects people differently, and response to therapy can vary from person to person. In some cases, simple physical exercises and the application of a hot or cold pack are enough to alleviate pain when stiff joints or muscles are causing discomfort. In other cases, prescription medications may be necessary to treat pain. In severe cases, surgical intervention may be required in order to correct a medical issue that is leading to pain.

Medical professionals also use treatments like cryotherapy to treat pain. Cryotherapy involves the introduction of very cold temperatures to the body using specialized medical equipment. It is believed that this approach to therapy can alleviate pain by blocking or interrupting pain signals to the brain. Some cryotherapy like iovera° actually destroys damaged nerves using focused cold therapy.

How does iovera° work?

In a process referred to as cryoanalgesia, iovera° works by destroying the axons within nerve cells. Axons are the conductive pathways of nerves that allow sensation to travel through the nervous system, and they are encased in an endoneurium. The purpose of iovera° is to destroy the damaged axons but leave the endoneurium intact. The axons then grow back at a rate of around two millimeters per day, eventually reaching their original location once fully regenerated. This rids the affected area of pain from damaged nerve cells.

Does Medicare cover iovera°?

When it comes to pain management and Original Medicare benefits, treatment for outpatient procedures is covered by Medicare Part B. This part of Medicare provides benefits for doctor visits, surgical procedures, diagnostic testing, imaging, and more.

Original Medicare may cover iovera° treatment under Part B if the procedure is medically necessary as qualified by your doctor. In virtually all cases, Medicare coverage is provided on the basis of medical necessity. This is why cosmetic surgery and elective procedures are not covered. It should be noted that you and your doctor may be required to attempt other medical means of pain treatment before iovera° will be considered for coverage by Medicare.

Medicare Part A and iovera° coverage

If iovera° is administered while you are hospitalized or admitted to a skilled nursing facility, Medicare benefits under Part A would apply toward the cost of treatment instead of Part B. Medicare Part A is the inpatient benefit of the program and is usually available premium-free to Americans 65 and over, or individuals under 65 who qualify due to disability.

Medicare Part A does carry a deductible, even if you receive premium-free access. Additionally, your inpatient care is only covered for 60 days at 100% during each benefit period. You can receive an additional 30 days at a discounted rate and further covered care at a discount if you have lifetime reserve days to use.

Medicare Part D and iovera° coverage

Since iovera° is not a prescription drug purchased at a pharmacy for use at home, Medicare Part D insurance does not apply. You may be prescribed medications to alleviate pain prior to or after receiving iovera° treatment. In these cases, you will need to check your Part D plan’s formulary to see if your prescriptions are covered.

Medicare Advantage and iovera° treatment

Medicare Advantage plans will likely have the same requirements regarding iovera° coverage, meaning your doctor will need to qualify iovera° as a medical necessity. These types of plans follow Original Medicare’s coverage for Part A and Part B benefits, but they sometimes offer additional benefits not found under Original Medicare.

If you’re facing a chronic pain concern, a Medicare Advantage plan may cover iovera° as well as offer you the ability to receive coverage for exercise classes or nutrition counseling designed to address pain concerns. Each Medicare Advantage plan is different, so you’ll want to contact your plan manager for details about the benefits to which you are entitled. You are also encouraged to work with an independent Medicare coverage insurance broker who can impartially shop a range of Medicare Advantage plan providers to help you find the one that best matches your unique healthcare needs.