Orthopaedic surgeons in the United States have recently been facing the challenge of caring for their patients in the face of rising costs and declining reimbursements. While medical practice expenses and professional liability insurance rates have been increasing, the average Medicare reimbursement rates for the twenty-five most frequently performed orthopaedic surgical procedures (Table I) have declined 28% since 1992, after adjustment for inflation with use of the Consumer Price Index1,2. For the last several years, physicians have been subject to what has become a familiar scenario: projected Medicare physician reimbursement decreases are met by last-minute congressional action that either temporarily freezes or marginally increases reimbursement without keeping pace with the inflation rate. None of these congressional stopgap measures revise the formula (the sustained growth rate formula, or SGR) that has mandated, and will continue to mandate, annual decreases in physician reimbursement. Furthermore, since these congressional reimbursement measures escalate Medicare spending beyond the budget mandated by the sustained growth rate formula, the formula will automatically call for even deeper future Medicare budget targets to offset this increased spending. View this table: TABLE I The Twenty-five Most Commonly Performed Inpatient Orthopaedic Surgical Procedures According to the 2005 National Hospital Discharge Survey For the orthopaedic surgeon, Medicare Part B plays an important role as it covers inpatient and outpatient physician services, for example, reimbursement for operations, clinic visits, and consultations. There are three options for physicians under Medicare Part B: participating, nonparticipating, and private contracting (i.e., opting out). These three scenarios are described in this article. We integrate and organize a variety of primary documents and organizational updates that address this topic to present a comprehensive review of the physician participation options3-7. Prior to 1920, the practice of medicine in the United States was quite rudimentary, and therefore the chief …