An Analysis of Procedural Medicare Reimbursement Rates in Craniofacial Plastic Surgery: 2000–2019

Abstract

PURPOSE: An understanding of financial trends is important to advance agreeable reimbursement models in craniofacial surgery. This study aimed to evaluate trends in Medicare reimbursement rates for commonly billed craniofacial surgery procedures from 2000 to 2019. METHODS: Commonly billed craniofacial surgery procedures were identified by a pediatric craniofacial surgeon and referenced with The Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File. Reimbursement data were extracted from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services for each Current Procedural Terminology code. Monetary data was adjusted for inflation to 2019 US dollars utilizing changes to the United States consumer price index. The average annual and total percentage changes in reimbursement were calculated based on these adjusted trends. RESULTS: The average adjusted reimbursement for all procedures decreased by 14.17% from 2000 to 2019. The greatest mean decrease was observed in repair of oronasal fistula (−21.95%). The only procedure with an increased adjusted reimbursement rate was palatoplasty with attachment of pharyngeal flap (+2.62%). From 2000 to 2019, the adjusted reimbursement rate for all procedures decreased by an average of 0.71% annually. CONCLUSION: This is the first study evaluating trends in procedural Medicare reimbursement in craniofacial surgery. When adjusted for inflation, Medicare reimbursement for the included procedures has steadily decreased from 2000 to 2019. Increased consideration of these trends will be important for US policy-makers, hospitals, and surgeons to assure continued access to meaningful craniofacial surgery.