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.
If you’re staring at a confusing bill right now, our free bill screener tells you what’s missing before you pay for anything.
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:
Appendix surgery is usually an emergency - and the ER visit, scans, surgeon, and anesthesia each bill separately.
Your personalized cost report includes:
- ✓ Why an appendectomy becomes up to five separate bills, and which to check first
- ✓ How the ER visit and CT scan are billed apart from the surgery
- ✓ The surgeon or anesthesia bill that can be out-of-network even at an in-network hospital
- ✓ What "observation" vs. "admitted" means for your hospital bill
- ✓ A real patient billing breakdown, line by line
Free for patients - takes 30 seconds to get.
We'll send a sign-in link to your email - click it to get your guide. No account required, no spam.
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 →
Find Appendectomy providers near you
Hospitals, surgery centers, and imaging centers in your area. Enter your ZIP to see which are closest - and which are typically cheaper.
See providers near you
Enter your ZIP to find appendectomy facilities and see which tend to cost less.
We'll also send you the free Appendectomy cost toolkit.
Related Articles
Interested in understanding healthcare costs and managing your medical expenses?
- Deductible vs Out-of-Pocket MaximumLearn how insurance cost-sharing works and what you actually pay
- Cost ExplorerBrowse procedures and compare prices across the country
- CT Scan Cost GuideFind detailed CT scan pricing for your state
- MRI Cost GuideCompare MRI pricing and understand imaging costs
- X-Ray Cost GuideCompare X-ray pricing across states - one of the most affordable imaging procedures
- Colonoscopy Cost GuideUnderstand colonoscopy pricing and your out-of-pocket costs by insurance type
- New GuidesExplore our latest healthcare guides on costs, insurance, and medical billing
About the Author
John Caruso, FSA, MAAA
Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.
Connect on LinkedIn →Ready to take control of your healthcare costs?
Use the free cost estimator → · Get your bill screened for free → · See the family plan →