Is Supraspinatous Tendon Tear Surgery Covered Under Ayushman Bharat?

Hello,

Yes, treatment for a supraspinatus muscle/tendon tear is covered under Ayushman Bharat PM-JAY. Whether surgery is needed depends on the size and type of tear, pain, shoulder strength, age, activity level and MRI findings. A 10 mm tear does not automatically mean that surgery is required.

If surgery is approved under the applicable PM-JAY package and the patient is eligible, treatment at an empanelled private hospital can be cashless. The exact amount you would have to pay may therefore be ₹0 for the covered package, but any non-covered services or items would need to be confirmed with the hospital.

How to check Ayushman Empanelled Hospital?

1. Open the official PM-JAY Hospital Search portal.

2. Select your State.

3. Select your District.

4. Select Government or Private Hospital.

5. Select Orthopaedics, if available.

6. Search for the exact hospital name.

7. Enter the captcha, if shown.

8. Click Search.

9. Check that the hospital has active PM-JAY empanelment and the required shoulder/orthopaedic treatment package.

10. Visit the hospital's Ayushman Mitra/PM-JAY desk with the MRI report and orthopaedic doctor's treatment advice. Ask them to confirm whether the required surgery is covered and whether pre-authorisation is needed.

You can also check the district-wise PM-JAY empanelled hospital list.

Documents to carry

• Ayushman Card

• Aadhaar Card or valid ID proof

• MRI shoulder report and images, if available

• Orthopaedic doctor's prescription/treatment advice

• Previous prescriptions and medical records

• Blood/other test reports, if available

• Admission/discharge papers, if applicable

• Referral document, if required

Wishing you and your family good health always.
Warm regards,
Team HexaHealth