Kidney stones can be small, but they can cause major pain. They are hard deposits made from minerals and salts that form in the kidneys or urinary tract.
Medicare may help cover kidney stone diagnosis, treatment, follow-up care, and medications when services are medically necessary. Coverage depends on where care happens, what treatment is needed, and whether you have Original Medicare or Medicare Advantage.
In this article
Symptoms
Prevention
Diagnosis
Treatment
Recovery
Medications
Common Questions
What Are Kidney Stones?
Kidney stones are hard, pebble-like deposits that can form when minerals build up in the urine. A stone may stay in the kidney, move into the ureter, pass into the bladder, or leave the body in urine.^1
What this means for you: A small stone may pass on its own. A larger stone, or one that blocks urine flow, may need urgent treatment.
Types of Kidney Stones
Common types include:
Calcium oxalate stones
Calcium phosphate stones
Uric acid stones
Struvite stones, often linked to urinary tract infections
Cystine stones, caused by a rare inherited condition
Common Symptoms and Warning Signs
Kidney stone pain often starts in the side or back, below the ribs. The pain may move toward the lower abdomen or groin.
Common symptoms include:
Sharp pain in the side, back, belly, or groin
Pain that comes in waves
Blood in the urine
Burning when urinating
Frequent or urgent urination
Nausea or vomiting
Cloudy or foul-smelling urine
Watch for: Fever, chills, severe vomiting, trouble urinating, confusion, or pain that cannot be controlled. These symptoms may mean the stone is causing an infection, blockage, or another urgent problem.
Why Kidney Stones Matter
Kidney stones are common. The National Institute of Diabetes and Digestive and Kidney Diseases reports that about 11% of men and 6% of women in the United States have kidney stones at least once during their lifetime.^1
Kidney stones can also come back. That is why follow-up matters. The goal is not only to treat the current stone, but also to lower the chance of another one.
Causes and Risk Factors
Kidney stones can form when urine has too many stone-forming minerals, too little fluid, or too few substances that help prevent crystals from sticking together.
Risk factors include:
Dehydration or low fluid intake
Personal or family history of stones
High-sodium diet
High animal-protein intake
Obesity
Gout
Diabetes
High blood pressure
Recurrent urinary tract infections
Certain digestive diseases or surgeries
Some medications or supplements
People often do not realize: Cutting out calcium is not always the answer. For some people, getting normal dietary calcium with meals may help lower stone risk. Ask your doctor before changing calcium supplements.
Prevention and Screening
There is no routine Medicare preventive screening test for kidney stones in people without symptoms.
Prevention focuses on:
Drinking enough fluids, if medically safe
Lowering sodium
Adjusting animal protein if needed
Reviewing calcium and oxalate intake
Analyzing a passed or removed stone
Using 24-hour urine testing for some people with repeat stones
Kidney stone prevention is not one-size-fits-all. The best plan depends on the type of stone, urine test results, diet, medications, and other health conditions.
How Kidney Stones Are Diagnosed
Diagnosis may include a symptom review, physical exam, urine test, blood tests, and imaging. Imaging may include a CT scan, ultrasound, or X-ray.^1
Doctors may also test a stone after it passes or is removed. This can help identify the stone type and guide prevention.
What this means for you: If you can safely save a passed stone, ask your doctor whether it should be analyzed.
How Medicare May Cover Diagnosis
Medicare Part B may cover medically necessary outpatient doctor visits, urgent care, emergency department physician services, lab tests, urinalysis, urine culture, blood tests, CT scans, ultrasounds, and X-rays.
If testing happens in a hospital outpatient setting, it is generally covered under Part B when medically necessary.^2
If you are formally admitted as an inpatient, Medicare Part A generally covers medically necessary inpatient hospital care, subject to Part A rules and costs.^3
What to watch for: Observation status is usually outpatient care under Part B, even if you stay in the hospital overnight.
Treatment Options
Treatment depends on the stone’s size, location, symptoms, infection risk, kidney function, and whether the stone is likely to pass.
Treatment may include:
Pain medicine
Anti-nausea medicine
Fluids, if medically appropriate
Medication to help some stones pass
Antibiotics if infection is present
A procedure to break up or remove the stone
Common procedures include shock wave lithotripsy, ureteroscopy with laser lithotripsy, ureteral stent placement, and percutaneous nephrolithotomy for larger or more complex stones.
Kidney stone treatment depends on the stone’s size, location, symptoms, and infection risk. Some stones may pass with medication and monitoring, while others may need a procedure.
How Medicare May Cover Treatment
Medicare may cover medically necessary kidney stone treatment when it is reasonable and necessary for your condition.
CMS has a National Coverage Determination for Treatment of Kidney Stones, NCD 230.1. This national policy covers certain lithotripsy treatments, including extracorporeal shock wave lithotripsy, percutaneous lithotripsy, and transurethral ureteroscopic lithotripsy for kidney or ureter stones.^4
Part B may cover many outpatient kidney stone services, including outpatient surgery, emergency department physician services, imaging, lab work, and follow-up visits.
Part A may apply if you are formally admitted to the hospital for severe pain, infection, blockage, kidney injury, surgery, or complications.
Recovery and Follow-Up
Recovery depends on whether the stone passed naturally or required a procedure.
Follow-up may include:
Confirming the stone passed
Checking kidney function
Reviewing imaging
Removing a stent
Testing the stone
Building a prevention plan
Recovery can be just as important as treatment itself. Preventing another stone may require diet changes, medication review, lab monitoring, and follow-up imaging.
How Medicare May Cover Recovery or Rehab
Part B may cover medically necessary follow-up visits, lab tests, imaging, stent removal, and outpatient urology or nephrology care.
If complications cause weakness or functional decline, Medicare may cover therapy, home health, or skilled nursing facility care when eligibility rules are met. Kidney stones alone do not automatically qualify someone for rehab.
Medications
Kidney stone medications may include pain medicine, anti-nausea medicine, antibiotics, alpha blockers, or prevention medications such as thiazide diuretics, potassium citrate, or allopurinol.
How Medicare May Cover Medications
Outpatient prescriptions are generally covered by Medicare Part D if the drug is on your plan’s formulary and plan rules are met.
Drugs given during an inpatient hospital stay are generally covered under Part A as part of the stay. Some drugs given in an outpatient medical setting may be covered under Part B, depending on the drug and setting.
What to watch for: Part D plans may use prior authorization, step therapy, quantity limits, preferred pharmacies, and drug tiers.
Medicare Part D may cover outpatient prescription medications for kidney stones if the drug is on your plan’s formulary and plan rules are met.
What Medicare May Not Fully Cover
Medicare may not fully cover:
Deductibles, copays, and coinsurance
Non-medically necessary testing
Services that do not meet documentation rules
Out-of-network care under some Medicare Advantage plans
Some medications not on a Part D formulary
Convenience items or non-covered supportive services
Helpful tip: Before a planned procedure, ask where it will be performed: doctor’s office, ambulatory surgical center, hospital outpatient department, or inpatient hospital. The setting can change your cost.
Medicare Advantage Considerations
Medicare Advantage plans must cover Medicare-covered services, but they can use networks, referrals, prior authorization, and plan-specific cost sharing.
For kidney stones, check whether your urologist, hospital, imaging center, lab, surgery center, and pharmacy are in network.
Prior authorization may affect non-emergency imaging, planned procedures, follow-up imaging, and some medications.
Common Questions
What Dissolves Kidney Stones Fast?
Some uric acid stones may be treated with medicine that helps change urine chemistry, but many kidney stones do not dissolve quickly. Treatment depends on the stone type, size, location, and symptoms.
Do not try to force a stone to pass at home if you have fever, chills, vomiting, severe pain, or trouble urinating. Those symptoms need medical attention.
How Do I Tell If My Pain Is a Kidney Stone?
Kidney stone pain often starts in the side or back and may move toward the lower belly or groin. It may come in waves and may be accompanied by nausea, vomiting, blood in the urine, or urinary urgency.
The only way to know for sure is to be evaluated. A doctor may use urine testing, blood testing, and imaging.
Does Medicare Cover Lithotripsy for Kidney Stones?
Medicare may cover medically necessary lithotripsy. CMS NCD 230.1 covers certain lithotripsy treatments for kidney or ureter stones.^4
Does Medicare Cover Kidney Stone Testing?
Medicare Part B may cover medically necessary outpatient testing, including urine tests, blood tests, CT scans, ultrasounds, and X-rays.
What to Do Next
If you think you may have a kidney stone, call your doctor or seek urgent care if symptoms are severe.
Ask these questions:
What type of stone do I have?
Can the stone be analyzed?
Do I need imaging or follow-up testing?
Is this procedure outpatient or inpatient?
Will my Medicare Advantage plan require prior authorization?
Which medications are covered by Part D?
Learn more about Medicare
Key Takeaways
Kidney stones are common, painful, and often treatable.
Medicare may help cover diagnosis, treatment, procedures, follow-up care, and medications when they are medically necessary.
Coverage depends on the service, setting, documentation, and plan rules.
The most important next step is to treat the current stone safely and ask how to prevent another one.
References
This website is for educational purposes only. It isn’t medical advice, legal advice, or financial advice. It also isn’t a promise of coverage or payment. For official Medicare information, visit Medicare.gov. You can also get free, unbiased help from your State Health Insurance Assistance Program (SHIP). For personal medical guidance, talk with your doctor, and review your Medicare plan documents.