A 20-year Analysis of Medicare Reimbursement for Abdominal Wall Reconstruction (2000–2020)

Abstract

PURPOSE: Lack of financial data regarding procedural reimbursement trends in abdominal wall reconstruction was identified. Analysis of such trends is important to understand the sustainability of current reimbursement models and to ensure adequate reimbursement for reconstructive surgeries moving forward. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for 30 abdominal wall reconstruction surgical procedures over a 20-year period (2000–2020). METHODS: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was utilized for each of the 30 included current Procedural Terminology (CPT) codes, and reimbursement data were extracted. The list of CPT codes was compiled prior to data collection in order to ensure a representative and comprehensive analysis of commonly utilized procedural codes. Monetary data were adjusted for inflation to 2020 US dollars utilizing changes to the United States consumer price index. The R-squared, average annual percent change and average total percentage change in reimbursement were calculated based on these adjusted trends for all included procedures. RESULTS: After adjusting for inflation, the average reimbursement for all procedures decreased by 17.8% from 2000 to 2020. The greatest mean decrease was observed for CPT code 49568 (the implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection, −34.4%). The only procedure with an increased adjusted reimbursement rate throughout the study period was CPT code 20680 (+3.9%). From 2000 to 2020, the adjusted reimbursement rate for all included procedures decreased by an average of 0.88% each year, with an average R2 value of 0.80, indicating a stable decline throughout the study period. CONCLUSIONS: After adjusting for inflation, there has been a steady decline in Medicare reimbursement for the included procedures from 2000 to 2020. Increased awareness of these trends by surgeons, hospitals, and policy makers is necessary to assure continued access to optimal abdominal reconstruction care in the United States.