Medicaid Reimbursement for 20 Commonly Billed Orthopedic Sports Medicine Procedures was 14.9% less than Medicare

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The purpose of this study was to compare Medicaid and Medicare rates for the 20 most commonly billed orthopedic sports medicine procedures. Medicaid reimbursement rates were obtained from state-specific fee schedules. Medicare rates were collected from the Centers for Medicare & Medicaid Services physician fee schedule along with relative value units for each procedure. State rates were compared using averages and dollar differences. Reimbursement rates were adjusted for cost-of-living using the Medicare Wage Index. Variability between states and between procedures was assessed using coefficients of variation. Medicaid mean reimbursement was lower than Medicare for nineteen of the 20 procedures. In total, Medicaid reimbursed surgeons 14.9% less unadjusted and 26.0% less when adjusted for cost-of-living. Variation in Medicare rates between states was constant with a coefficient of variation of 0.06. For Medicaid, the coefficient of variation ranged from 0.27-0.70 for unadjusted data and 0.35-0.69 for adjusted data. On average, Medicaid reimburses less to orthopedic sports medicine specialists than does Medicare with substantial variability between states. Adjustment for cost-of-living increases the percent difference and the variability between states' Medicaid reimbursement rates. IV; Economic Analysis.