Medicare Part B covers Appendectomy at 80% after the Part B deductible. Here's the full cost-sharing breakdown, admission status rules, and Medicare Advantage differences.
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Does Medicare Cover Appendectomy? (2026)
Yes. Medicare covers medically necessary appendectomy: Part A if you're admitted as an inpatient, or Part B if performed as an outpatient procedure. Your cost sharing differs significantly between the two.
Quick answer:
- Inpatient Appendectomy (admitted to hospital): Part A - hospital deductible ($1,676 in 2026), then $0 for days 1–60
- Outpatient Appendectomy (hospital outpatient or ASC): Part B - 80% after $257 Part B deductible
- Prior authorization: Not required under Original Medicare; varies under Medicare Advantage
Part A vs. Part B: The Admission Status Question
Whether your appendectomy is covered under Part A (inpatient) or Part B (outpatient) depends on your admission status - not how many nights you stay:
Part A (inpatient):
- Your physician formally admits you to the hospital as an inpatient
- Part A deductible: $1,676 for days 1–60 (2026), then $0 if you leave by day 60
- Covers facility, nursing care, medications administered during stay
Part B (outpatient - hospital HOPD or ASC):
- Procedure done as outpatient or same-day surgery
- Part B deductible: $257 (2026), then 20% coinsurance
- Surgeon and anesthesiologist also bill under Part B (separate 20% coinsurance claims)
Multiple Claims Under Medicare
| Claim | Coverage under Part B | Your portion |
|---|---|---|
| Facility fee | Part B: 80% after deductible | 20% |
| Surgeon fee | Part B: 80% after deductible | 20% |
| Anesthesia fee | Part B: 80% after deductible | 20% |
| Pathology fee | Part B: 80% after deductible | 20% |
Related Cost Information
Related: Is a Appendectomy covered by insurance? → · Appendectomy billing surprises →
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About the Author
John Caruso, FSA, MAAA
Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.
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