Physician Fee Schedule Look-Up Tool Research Articles

Dwindling dollars: The inflation-adjusted decline of Medicare reimbursement in endocrine surgery (2003–2023)

Medicare determines reimbursement rates for medical services, often setting a benchmark that is followed by private insurers. Across various medical specialties, decreases in Medicare reimbursement have been observed. However, the extent of Medicare reimbursement for endocrine surgery remains unexplored. This study investigates the trajectory of reimbursement rates for endocrine surgical procedures. Data spanning 2003 to 2023 were gathered from the Physician Fee Schedule Look-Up Tool for 16 endocrine operations and procedures. Each operation's or procedure's relative value units and conversion factor, which accounts for geographic variation in relative value units, are determined annually by the Centers for Medicare and Medicaid Services. The total annual Medicare reimbursement for each operation or procedure was determined by multiplying procedure-specific relative value units with the conversion factor. Raw yearly percentage changes in reimbursement were computed and compared to changes in the general consumer price index. All data were then corrected for inflation. The compound annual growth rate for each procedure was calculated using inflation-adjusted data. From 2003 to 2023, the mean unadjusted percentage change for all queried procedures was+14.14% (standard deviation 0.28). During this same time, the consumer price index increased by 69.15% (P < .001). After adjusting for inflation, the mean total adjusted percentage change for all queried procedures over the entire study period was -31% (standard deviation 0.17). The adjusted average yearly compound annual growth rate was -1.93% (standard deviation 0.92). Only 1 procedure showed an increase in reimbursement (image-guided fine-needle aspiration,+32%). Inflation-adjusted Medicare reimbursement rates for endocrine surgical procedures have consistently declined. Stakeholders must address these trends to ensure access to quality surgical endocrine care in an evolving health care landscape.

Trends in Medicare Reimbursement for Common Pediatric Orthopedic Procedures: From 2000 to 2022.

Objective We aimed to evaluate trends in government monetary reimbursement (Medicare) for 10 of the most commonly performed pediatric orthopedic procedures from 2000 to 2020. Methods Utilizing the Centers for Medicare and Medicaid Services website, we collected data for 10 of the most commonly performed pediatric orthopedic surgical procedures and their variations. The reimbursement data for each procedure was taken from the Current Procedural Terminology (CPT) code, which was collected from the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services (Baltimore County, MD). The reimbursement values were adjusted for inflation to the 2022 US dollar (USD) using the changes to the Consumer Price Index. The compound annual growth rates (CAGRs) and total percentage changes in reimbursement were calculated for all the procedures and put into relative value units. Results Reimbursement for 20 of the 22 total procedures decreased by 32.65% from 2000 to 2022 after adjusting for inflation. Achilles tenotomy with local anesthesia saw the greatest decrease (-54.38%), whereas the procedure revision of spinal fusion saw the highest increase (26.00%) in mean adjusted reimbursement during this study period. Adjusted reimbursement decreased by an average of 2.08% on a yearly basis. Conclusion This study is the first to take an in-depth view and evaluate trends in procedural Medicare reimbursement for pediatric orthopedic surgery. When adjusted for inflation, Medicare reimbursement for 20 of 22 included procedures has steadily decreased from 2000 to 2022. There needs to be an increased awareness and consideration of these trends as they will be important for policymakers, hospitals, and surgeons to ensure continued access to meaningful surgical pediatric orthopedic care in the United States.

Unveiling the Hidden Discrepancies Between Medicare Physician Reimbursement Rates and Inflation Across Different Surgical Specialties.

This study aimed to analyze the trends of Medicare physician reimbursement from 2011 to 2021 and compare the rates across different surgical specialties. Knowledge of Medicare is essential because of its significant contribution in physician reimbursements. Previous studies across surgical specialties have demonstrated that Medicare, despite keeping up with inflation in some areas, has remained flat when accounting for physician reimbursement. The Physician/Supplier Procedure Summary data for the calendar year 2021 were queried to extract the top 50% of Current Procedural Terminology codes based on case volume. The Physician Fee Schedule look-up tool was accessed, and the physician reimbursement fee was abstracted. Weighted mean reimbursement was adjusted for inflation. Growth rate and compound annual growth rate were calculated. Projection of future inflation and reimbursement rates were also calculated using the US Bureau of Labor Statistics. After adjusting for inflation, the weighted mean reimbursement across surgical specialties decreased by -22.5%. The largest reimbursement decrease was within the field of general surgery (-33.3%), followed by otolaryngology (-31.5%), vascular surgery (-23.3%), and plastic surgery (-22.8%). There was a significant decrease in median case volume across all specialties between 2011 and 2021 (P < 0.001). This study demonstrated that, when adjusted for inflation, over the study period, there has been a consistent decrease in reimbursement for all specialties analyzed. Awareness of the current downward trends in Medicare physician reimbursement should be a priority for all surgeons, as means of advocating for compensation and to maintain surgical care feasible and accessible to all patients.

Trends of Medicare Reimbursement Rates for Gender-Affirming Surgery Procedures.

Awareness of Medicare reimbursement is important for gender-affirming surgeons who treat transgender patients with Medicare. In 2014, Medicare began to provide coverage for medically necessary transition-related surgery. The purpose of this study was to analyze trends in Medicare reimbursement rates for gender-affirming surgery procedures from 2014 to 2022. The Medicare Physician Fee Schedule Look-Up Tool provided by the Centers for Medicare and Medicaid Services was used, and the Current Procedural Terminology codes for 43 gender-affirming surgery services were obtained. Monetary units, conversion factors, relative value units (RVUs) for work, facility, and malpractice costs for 30 transmasculine and 13 transfeminine procedures were analyzed. Descriptive statistics were performed to account for inflation and to determine the relative differences between 2014 and 2022. For all gender-affirming surgery procedures covered by Medicare, the average relative difference of monetary units decreased by 2.99% between 2014 and 2022. On average, there was a 3.97% decrease of work-based RVU charges for transmasculine procedures and a 1.73% decrease of work-based RVU charges for transfeminine procedures. After adjusting for inflation, the average relative difference of monetary units for all gender-affirming surgery procedures decreased by 23.42% between 2014 and 2022. Reimbursement rates for gender-affirming surgery procedures covered under Medicare have decreased over the observed period, and trends in reimbursement rates have not kept up with consumer price index inflation. Gender-affirming surgeons should be conscious of these changes in reimbursement rates and advocate for fairer compensation to promote medical care among an underserved population.

Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy.

Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures. From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends. Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% ( P < 0.001) and 24.64% ( P < 0.001), respectively, over the study period. Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.

Trends in Medicare utilization and reimbursement for hematology/oncology procedures from 2012 to 2023: A geriatric oncology perspective.

Given the scarcity of data exploring reimbursement trends in the field of hematology/oncology, we sought to characterize these trends for common procedures in this field from 2012 to 2023. Using the Centers for Medicare and Medicaid Services' Physician Fee Schedule Look-Up Tool we collected reimbursement data for 40 hematology/oncology procedure codes from 2012 to 2023. Data was adjusted to 2023 United States (US) dollars using the Consumer Price Index (CPI). From 2012 to 2023 gross reimbursement for the facility price decreased 4.4% and increased 9.2% for the non-facility price. When adjusted for inflation, compensation decreased 96.1% and 96.6%, respectively. None of the 40 examined Current Procedural Terminology (CPT) codes increased in net reimbursement over the study period. Medicare reimbursement for common hematology/oncology procedures decreased from 2012 to 2023. Further research is necessary to explore the implications of these trends on the delivery of patient care.

Financial (dis)incentives to surgical management of head and neck cancer care.

Patients with head and neck cancer (HNC) often require complex surgical reconstruction. This retrospective, cross-sectional study compares financial factors influencing HNC and breast cancer (BC) care to examine care disparities. Pricing data from 2012 to 2021 was abstracted from the CMS Physician Fee Schedule Look-Up Tool. Nonprofit and research support was quantified by searching the NIH, IRS, and GuideStar databases. New York State Department of Health data from 2015 to 2019 was analyzed to compare costs, charges, and payer mix. HNC reconstructive procedures reimburse lower than comparable breast procedures (p < 0.05). Nonprofit and research support for HNC is disproportionately low relative to disease burden. Patients hospitalized for HNC surgical procedures generated higher costs and lower charges than patients with BC (p < 0.05). Comparatively low procedure reimbursement, low nonprofit support, and high cost of care for patients with HNC relative to patients with BC may contribute to care disparities for patients with HNC.

Inflation-adjusted medicare physician reimbursement for adult spinal deformity surgery substantially declined from 2002 to 2020.

Physician fees for orthopaedic surgeons by the Centers for Medicare and Medicaid Services (CMS) are increasingly scrutinized. The present retrospective review aims to assess whether adult spinal deformity (ASD) surgeries are properly valued for Medicare reimbursement. Current Procedural Terminology (CPT) codes related to posterior fusion of spinal deformity of ≤ 6, 7-12, and ≥ 13 vertebral levels, as well as additional arthrodesis and osteotomy levels, were assessed for (1) Compound annual growth rate (CAGR) from 2002 to 2020, calculated using physician fee data from the CMS Physician Fee Schedule Look-Up Tool; and (2) work relative value units (RVUs) per operative minute, using data from the National Surgical Quality Improvement Program. From 2002 to 2020, all CPT codes for ASD surgery had negative inflation-adjusted CAGRs (range, - 18.49% to - 27.66%). Mean physician fees for spinal fusion declined by 26.02% (CAGR, - 1.66%) in ≤ 6-level fusion, 27.91% (CAGR, - 1.80%) in 7- to 12-level fusion, and 28.25% (CAGR, - 1.83%) ≥ 13-level fusion. Fees for both 7-12 (P < 0.00001) and ≥ 13 levels (P < 0.00001) declined more than those for fusion of ≤ 6 vertebral levels. RVU per minute was lower for 7- to 12-level and ≥ 13-level (P < 0.00001 for both) ASD surgeries than for ≤ 6-level. Reimbursement for ASD surgery declined overall. CAGR for fusions of ≥ 7 levels were lower than those for fusions of ≤ 6 levels. For 2012-2018, ≥ 7-level fusions had lower RVU per minute than ≤ 6-level fusions. Revaluation of Medicare reimbursement for longer-level ASD surgeries may be warranted. III.

Abstract 15616: Decline in Temporal Trends of Medicare Physician Reimbursement for Cardiovascular Procedures

Introduction: Utilization of cardiac procedures are common among Medicare beneficiaries and projected to increase over time. Temporal trends of physician fee reimbursement for CV procedures have not been studied. Methods: Cross-sectional study was conducted for national payment amounts that were extracted from Centers for Medicare &amp; Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool using Current Procedural Terminology (CPT) codes. Study time period ranged from 2013 through 2023. CPT codes were analyzed for coronary (percutaneous coronary intervention, coronary artery bypass graft), valvular (surgical aortic, mitral, tricuspid repair/replacement), and structural (transcatheter aortic valve replacement, mitral transcatheter edge-to-edge repair, left atrial appendage occlusion) procedures. All prices were adjusted for inflation to January 2023 US dollars. Primary outcomes were unadjusted and adjusted mean percentage changes (annual and total over 10-year period) and compound annual growth rates for each CV procedure. Results: From 2013 to 2023, mean total unadjusted percentage changes ranged from -0.54% to -21.78%; which decreased further after adjusting for inflation, ranging from -21.07% to -39.83%. The decline was seen in all studied CV procedures. Annual rates (mean and compound) were -3% for most procedures after adjusting for inflation. Conclusions: Our findings suggest a declining trend in physician reimbursement for CV procedures by Medicare, which may adversely influence access to procedures, affect commercial insurance pricing/coverage, and inform trainees and practicing CV physicians of current financial situation. Emphasis needs to be placed on value-based payment model for sustainable and efficient CV care.

Trends of Medicare Reimbursement Rates for Lower Extremity Procedures.

Data collected across many surgical specialties suggest that Medicare reimbursement for physicians consistently lags inflation. Studies are needed that describe reimbursement rates for lower extremity procedures. Our goal is to analyze the trends in Medicare reimbursement rates from 2010 to 2021 for both lower extremity amputation and salvage surgeries. The Physician Fee Schedule Look-Up Tool of the Centers for Medicare and Medicaid Services was assessed and Current Procedural Terminology codes for common lower extremity procedures were collected. Average reimbursement rates from 2010 to 2021 were analyzed and adjusted for inflation. The rates of work-, facility-, and malpractice-related relative value units (RVUs) were also collected. We found an overall increase in Medicare reimbursement of 4.73% over the study period for lower extremity surgery. However, after adjusting for inflation, the average reimbursement decreased by 13.19%. The adjusted relative difference was calculated to be (-)18.31 and (-)11.34% for lower extremity amputation and salvage procedures, respectively. We also found that physician work-related RVUs decreased by 0.27%, while facility-related and malpractice-related RVUs increased. Reimbursement for lower extremity amputation and salvage procedures has steadily declined from 2010 to 2021 after adjusting for inflation, with amputation procedures being devaluated at a greater rate than lower extremity salvage procedures. With the recent marked inflation, knowledge of these trends is crucial for surgeons, hospitals, and health care policymakers to ensure appropriate physician reimbursement. IV (cross-sectional study).

Trends in Medicare Reimbursement for Interventional Radiology Procedures: 2007-2020.

Declining physician reimbursement has been occurring across multiple specialties due to changes in Medicare legislation, including theDeficit Reduction Omnibus Reconciliation Act (DRA),the Balanced Budget Act, and the Sustainable Growth Rate. The purpose of this study was to evaluate trends in Medicare reimbursement rates for various procedural classes in interventional radiology from 2007 to 2020. Common interventional radiology procedures were selected across multiple procedural classes: gastrointestinal, biliary, urinary, fallopian dilatation, other injection/change/removal, iliac vascular, femoral/popliteal vascular, tibial/peroneal vascular, hepatobiliary, and vascular emergency. The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for current procedural terminology (CPT) codes to extract reimbursement data. All monetary data were adjusted for inflation using the United States consumer price index (CPI). The compound annual growth rate (CAGR) and average annual change in reimbursement were calculated based on these adjusted trends. Aside from urinary and vascular emergency procedures, all other procedural classes experienced decreases in inflation-adjusted Medicare reimbursement from 2007 to 2020. The greatest mean decrease in reimbursement rates was observed in biliary procedures (-$21.25), while the largest mean increase in reimbursement rates was observed in vascular emergency procedures ($3.23). All procedures with increases in reimbursement rates and 36.8% of procedures with decreases in reimbursement rates have a CPT code change between 2007 and 2020. After accounting for inflation, reimbursement rates were shown to decline for all procedural classes except for urinary and vascular emergencies. Congressional policies, such as the Deficit Reduction Act (DRA) and the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015, may clarify some of these trends.

A Medicare Physician Fee Schedule Analysis of Reimbursement Trends in Laryngology from 2000 to 2021.

The purpose of this study is to characterize Medicare reimbursement trends for laryngology procedures over the last two decades. This analysis used CMS' Physician Fee Schedule (PFS) Look-Up Tool to determine the reimbursement rate of 48 common laryngology procedures, which were divided into four groups based on their practice setting and clinical use: office-based, airway, voice disorders, and dysphagia. The PFS reports the physician service reimbursement for "facilities" and global reimbursement for "non-facilities". The annual reimbursement rate for each procedure was averaged across all localities and adjusted for inflation. The compound annual growth rate (CAGR) of each procedure's reimbursement was determined, and a weighted average of the CAGR for each group of procedures was calculated using each procedure's 2020 Medicare Part B utilization. Reimbursement for laryngology procedure (CPT) codes has declined over the last two decades. In facilities, the weighted average CAGR for office-based procedures was -2.0%, for airway procedures was -2.2%, for voice disorders procedures was -1.4%, and for dysphagia procedures was -1.7%. In non-facilities, the weighted average CAGR for office-based procedures was -0.9%. The procedures in the other procedure groups did not have a corresponding non-facility reimbursement rate. Like other otolaryngology subspecialties, inflation-adjusted reimbursements for common laryngology procedures have decreased substantially over the past two decades. Because of the large number of physician participants and patient enrollees in the Medicare programs, increased awareness and further research into the implications of these trends on patient care is necessary to ensure quality in the delivery of laryngology care. NA Laryngoscope, 134:247-256, 2024.

Two Decades of Declining Medicare Reimbursement in Cardiac Surgery

BackgroundGiven the uncertainty of US health care finances, an understanding of reimbursement trends has become increasingly important in the field of cardiac surgery. We aimed to assess Medicare reimbursement trends for common cardiac surgical procedures from 2000 to 2022. MethodsReimbursement data were extracted from the Centers for Medicare and Medicaid Services Physician Fee Schedule Look-Up Tool during the study period for 6 common cardiac operations: aortic valve replacement, mitral valve repair and replacement, tricuspid valve replacement, Bentall procedure, and coronary artery bypass grafting. Reimbursement rates were adjusted for inflation to 2022 US dollars using the Consumer Price Index. Total percentage change and compound annual growth rate were calculated. A split-time analysis was performed to assess trends before and after 2015. Least squares and linear regressions were performed. The R2 value was calculated for each procedure, and slope was used to determine change in reimbursements over time. ResultsInflation-adjusted reimbursement decreased by 34.1% during the study period. The overall compound annual growth rate was −1.8%. Reimbursement trends differed by procedure (P < .001), with all reimbursements trending down (R2 > 0.62), except for mitral valve replacement (P = .21) and tricuspid valve replacement (P = .43). Coronary artery bypass grafting decreased the most (−44.4%), followed by aortic valve replacement (−40.1%), mitral valve repair (−38.5%), mitral valve replacement (−29.8%), Bentall procedure (−28.5%), and tricuspid valve replacement (−25.3%). In split-time analysis, reimbursement rates did not significantly change from 2000 to 2015 (P = .24) but decreased significantly from 2016 to 2022 (P = .001). ConclusionsMedicare reimbursement significantly decreased for most cardiac surgical procedures. These trends justify further advocacy by The Society of Thoracic Surgeons to maintain access to quality cardiac surgical care.

Trends in costs, reimbursements, and surgeon payments for cervical disc arthroplasty cost of care from 2009 to 2019.

The use of cervical disc arthroplasty (CDA) continues to increase in the Medicare population. As healthcare costs continue to rise, payors have begun to implement bundled payment structures for spine surgery. While Medicare has steadily decreased reimbursements for cervical fusions, Medicare reimbursements for CDA have not been studied. The purpose of this study was to assess trends in 1) hospital costs and reimbursement, 2) physician reimbursement, and 3) potential cost drivers for CDA in a Medicare population. This is a retrospective longitudinal study of CDA in Medicare patients. The Medicare Provider Analysis and Review Limited Data Sets for 2009, 2014, and 2019 were used for this study. Patients undergoing elective CDA were included. Corresponding Inpatient Prospective Payment System files were used to calculate cost through cost-to-charge ratios. Physician fees were obtained from the Medicare Physician Fee Schedule Look-Up Tool. All financial data were adjusted for inflation to 2019 values based on the Consumer Price Index for All Urban Consumers. Demographic, comorbidity, surgical, and hospital trends were assessed. Trends in revenue center-level charges were also assessed. Adjusted for inflation, from 2009 to 2019, mean total hospital charges for elective CDA increased from $64,609 ± $45,787 to $111,874 ± $78,611 (73% increase, p < 0.001) and the mean total cost for index hospital admission increased from $19,665 ± $13,414 to $24,682 ± $13,818 (26% increase, p < 0.001). Over the same period, Medicare reimbursement increased from a mean of $11,154 ± $11,684 to $12,879 ± $13,613 (15% increase, p = 0.003), while total reimbursement increased from a mean of $15,005 ± $15,684 to $15,547 ± $15,829 (4% increase, p = 0.040). The mean hospital profit decreased from -$4076 ± $14,041 to -$9023 ± $16,084 (-121%, p < 0.001). Surgeon reimbursement for CDA decreased from a mean of $1850 ± $165 (2009) to $1722 ± $138 (2019) (7% decrease, p < 0.001). On multivariate analysis, increasing year of surgery (p < 0.001), increasing age (p = 0.001), increasing length of stay (p < 0.001), rural hospital setting (p = 0.027), and hospital geography (p < 0.001) were independently associated with cost of care. Medical/surgical supplies and operating room charges increased 71.6% (p < 0.001) and 98.5% (p < 0.001) and accounted for 41.1%-42.5% and 30.6%-35.1% of total charges, respectively. From 2009 to 2019, costs of care for elective inpatient CDA increased disproportionately to reimbursement. Hospitals operated at increasing losses and surgeon reimbursement decreased. Cost of care was independently associated with year of surgery, increasing age, length of stay, hospital setting, and hospital geography. The main charge drivers were medical/surgical supplies and operating room charges. These results may have implications for the future financial feasibility of inpatient CDA for Medicare patients and targets to improve the value of CDA. Further study is necessary to provide fair reimbursement for CDA in Medicare patients and prevent financially based bias against use of CDA in Medicare patients.

Trends in Medicare utilization and reimbursement for hematology/oncology procedures.

e13641 Background: Medicare Part B pays for physician services such as office visits and procedures based on the Medicare Physician Fee Schedule which is re-evaluated annually to maintain budget neutrality. Moreover, national cancer-attributed medical care costs in 2015 were $183 billion and projected to increase 34% to $246 billion by 2030 (Green et al: J Clin Oncol, PMID: 31804856). The aim of this study is to evaluate trends in Medicare reimbursement for procedures in hematology/oncology between 2012-2022. Methods: The data analyzed were extracted from the Physician Fee Schedule Look-Up Tool. CPT Codes were obtained from the Medicare Coverage Database. The following CPT codes were extracted: antineoplastic chemotherapy administration (96405, 96406, 96401, 96409, 96411, 96413, 96415, 96416, 96417, 96420, 96422, 96423, 96425, 96440, 96446, 96450, 96542), antineoplastic hormone therapy administration (96402), non-chemotherapy infusion (96360, 96361, 96365, 96366, 96367, 96368, 96369, 96370, 96371, 96372, 96373, 96374, 96375, 96376 ), bone marrow sampling (38220, 38221, 38222), bone marrow harvest (38230, 38232) and bone marrow transplant (38240, 38241, 38242). Consumer Price Index (CPI) obtained from the U.S. Department of Labor's Bureau of Labor Statistics was used to adjust reimbursement rates for cumulative inflation to 2022 U.S. dollars. The T-test was used to compare the mean prices for each procedure. This research contains publicly available data and as such is exempt from the IRB according to the Institutional Review Board at LSU Health Sciences Center in New Orleans, Louisiana. Results: The procedure with the highest reimbursement rate in 2012 was bone marrow harvest and the procedure with the lowest reimbursement rate in the same year was antineoplastic hormone therapy administration. The procedure with the highest reimbursement rate in 2022 was bone marrow harvest. The procedure with the lowest reimbursement rate in 2022 was antineoplastic hormone therapy. All procedure reimbursement fell significantly (p value of &lt;0.001) over the timer period studied. Conclusions: Between 2012 and 2022 the reimbursement rates for common hematology oncology services fell significantly when adjusted for inflation due to reforms in Medicare part B. [Table: see text]

Medicare Reimbursement Rates and Utilization Trends in Sacroiliac Joint Fusion.

Sacroiliac joint (SIJ) fusion is a surgical treatment option for SIJ pathology in select patients who have failed conservative management. More recently, minimally invasive surgical (MIS) techniques have been developed. This study aimed to determine the trends in procedure volume and reimbursement rates for SIJ fusion. Publicly available Medicare databases were assessed using the National Summary Data Files for 2010 to 2020. Files were organized according to current procedural terminology (CPT) codes. CPT codes specific to open and MIS SI joint fusion (27279 and 27280) were identified and tracked. To track surgeon reimbursements, the CMS Medicare Physician Fee Schedule Look-Up Tool was used to extract facility prices. Descriptive statistics and linear regression were used to evaluate trends in procedure volume, utilization, and reimbursement rates. Compound annual growth rates were calculated, and discrepancies in inflation were corrected for using the Consumer Price Index. A total of 33,963 SIJ fusions were conducted in the Medicare population between 2010 and 2020, with an overall increase in procedure volume of 2,350.9% from 318 cases in 2010 to 7,794 in 2020. Since the introduction of the 27279 CPT code in 2015, 8,806 cases (31.5%) have been open and 19,120 (68.5%) have been MIS. Surgeon reimbursement for open fusions increased nominally by 42.8% (inflation-adjusted increase of 20%) from $998 in 2010 to $1,425 in 2020. Meanwhile, reimbursement for MIS fusion experienced a nominal increase of 58.4% (inflation-adjusted increase of 44.9%) from $582 in 2015 to $922 in 2020. SIJ fusion volume in the Medicare population has increased substantially in the past 10 years, with MIS SIJ fusion accounting for most of the procedures since the introduction of the 27279 CPT code in 2015. Reimbursement rates for surgeons have also increased for both open and MIS procedures, even after adjusting for inflation.

97 Burning a Hole in Our Pockets: 12 Year Trends of Medicare Reimbursement for Burn Procedures

Abstract Introduction Burn injuries cost the USA ~$976.6 million annually. Physician reimbursement has lagged despite years of lobbying by physician groups. The Centers for Medicare and Medicaid Services plan to cut physician reimbursement by 4.2% in 2023. Evaluating reimbursement data for hospital-based procedures is timely, including burn procedures. We hypothesized Medicare reimbursement trends for common burn procedures decreased from 2010-2022. Methods We obtained pricing data from the publicly-available Medicare Physician Fee Schedule Look-Up Tool for 26 Current Procedural Terminology (CPT) codes: “Burns–preparation of wound bed” (15002-15005), “Burns–split thickness skin graft” (15100-15101 &amp; 15120-15121), “Burns–skin substitute” (15271-15278), “Cultured epidermal autograft” (15150-15152 &amp; 15155-15157), and “Cell Suspension Epidermal Autograft” (15110-15111 &amp; 15115-15116). We calculated percent differences for reimbursement; compound annual growth rate (CAGR); and percent differences for work, facility, non-facility, and malpractice relative value units (RVUs). Analysis was conducted in R 4.1.2. Results The three largest reimbursement increases were for CPT codes 15272 (24.6%), 15155 (23.7%), and 15003 (10.9%); the three largest decreases were for 15121 (-16.8%), 15120 (-6.1%), and 15275 (-5.0%). The three largest CAGR increases were for CPT codes 15272 (2.2%), 15155 (1.8%), 15274 (0.9%), and 15003 (0.9%); the three smallest were for 15121 (-1.5%), 15120 (-0.5%), and 15275 (-0.5%). Table 1 shows trends of RVUs. Conclusions Our 12-year analysis of Medicare reimbursement trends for 26 burn procedures demonstrated an overall increase in hospital reimbursement and parallel net decrease in physician work RVUs. Reimbursements were increasingly allocated away from surgeons to facility fees and malpractice insurance. Cultured epidermal autograft to the head, neck, hands, and feet (15155) saw the largest increase in Medicare reimbursement with no change in direct physician reimbursement while split-thickness skin grafts to the head, neck, &amp; genitals (15120 &amp; 15121) showed decreased rates. Future work is needed to understand why these trends are occurring to advocate against physician reimbursement cuts. Applicability of Research to Practice Studies contributing to price transparency allow stakeholders to focus on why burn surgeons are receiving lower reimbursements.

D107. Head and Neck Cancer Reconstruction and Relative Disincentives to Surgical Reconstruction

PURPOSE: The incidence of head and neck cancers (HNC) is rising as HPV becomes the dominant disease etiologic factor. Financial support for HNC care is critical for ensuring equitable access to care. Examining non-profit support, reimbursement rates and hospital-associated costs for HNC patients relative to other patients requiring complex reconstruction may reveal possible care disparities. METHODS: Reimbursement data from HNC and breast cancer (BC) reconstructive procedures was abstracted from the Centers for Medicare and Medicaid Services Physician Fee Schedule Look-Up Tool. Patient-level data for 2015 to 2017 was acquired from the New York State Department of Health. Inflation-adjusted reimbursement values from 2012 to 2021 were compared using Student’s t-test. Wilcoxon-Mann-Whitney tests were used for inter-group analyses. Analysis was completed in R Studio (v1. 3.1). RESULTS: Procedure reimbursements for free and pedicled flaps indicate that HNC reconstruction procedures are reimbursed significantly lower than both breast and extremity reconstruction (p < 0.01). New York State inpatient data indicates that HNC procedure recipients are more likely to have public insurance, generate higher hospital costs and require longer lengths of stay than patients hospitalized for BC procedures (p < 0.01). CONCLUSION: Reimbursements for HNC reconstructive procedures are significantly lower than BC and extremity reconstructive procedures of comparable work effort. HNC patients are more likely to be publicly insured and have longer lengths of stay than patients undergoing breast reconstruction. The large discrepancy in reimbursement may financially disincentivize investment in care for HNC patients and limit future access to care in this vulnerable and growing patient population.

106 Reimbursement Trends in Neuroendovascular Interventions 2013-2022

INTRODUCTION: Neuroendovascular surgeries are increasingly important, particularly with the advent of thrombectomy as the gold standard in the management of large vessel stroke. METHODS: The Physician Fee Schedule Look-Up Tool was queried from 2013 to 2019 for all primary Current Procedural Terminology (CPT) codes identified by the American Medical Association as pertaining to endovascular procedures of the nervous system (61623, 61624, 61630, 61635, 61626, 61645, and 61650). The facility prices were averaged for each procedure and subsequently adjusted for inflation using the United States Bureau of Labor Statistics’ Consumer Price Index Inflation Calculator as adjusted to January of 2022. Statistical analyses, including data aggregation, exploratory analysis, and propensity adjustment, were performed using R, version 4.0.1 (The R Foundation, Vienna, Austria). The two-sided Mann-Kendall trend test, a non-parametric statistical test that assesses for monotonic trends in either an upward or downward trend, was utilized to assess for trends over time. Within each year analyzed, a Chi-squared test for trend in proportions was used. A significance level of 0.05 was used. RESULTS: Decreases in reimbursement were noted for all neuroendovascular procedures. This trend was statistically significant for temporary balloon occlusion, CPT61623 (2013:$677.04; 2022:586.96; p: 0.01), central nervous system transcatheter permanent occlusion or embolization, CPT61624 (2013:$1349.61; 2022:$1175.02; p: 0.02), non-central nervous system transcatheter permanent occlusion or embolization, CPT61626 (2013:$1040.86; 2019:$912.29; p: 0.002), stent placement, CPT61635 (2013:$1697.18; 2022:$1490.68; p: 0.05), and when viewed as aggregate procedures (2013:$1265.01; 2022:$1000.45; p &lt; 0.01). CONCLUSIONS: Inflation-adjusted reimbursement is decreasing for certain neuroendovascular procedures over time and for all neuroendovascular procedures when viewed as an aggregate group. This suggests a need for reevaluation of the market value and advocacy for neuroendovascular providers and procedures in the era of value/quality-based care.

Are Cervical Disc Arthroplasty Medicare Reimbursement Trends Sustainable?

Cervical disc arthroplasty (CDA) was originally approved by the US Food and Drug Administration (FDA) in 2007 as a motion-sparing procedure to treat cervical degenerative disc disease. Since then, promising results from randomized control trials have led to increasing popularity. However, data discussing monetary trends are limited. The aim of this study was to determine how utilization, hospital charges, and Medicare physician reimbursement for CDA have changed over time. In this retrospective cohort study, International Classification of Diseases procedure codes were used to identify all patients who underwent CDA from 2007 to 2017 in the National Inpatient Sample database. The Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services was queried for primary CDA using current procedural terminology codes to determine Medicare physician reimbursement from 2009 to 2021. Nominal monetary values were adjusted for inflation using the Consumer Price Index and inflation-adjusted data reported in 2021 US dollars. A total of 33,079 weighted patients who underwent CDA were included for analysis. CDA utilization increased by 183% from 2007 to 2017, with Medicare beneficiary utilization increasing 149%. Inflation-adjusted total hospital charges for CDA increased by 22.4%. However, inflation-adjusted Medicare physician reimbursement fell by 1.20% per year, demonstrating a total decrease of 12.9%, starting at $1928 in 2009 and declining to $1679 in 2021. While utilization and total hospital charges for CDA continue to rise, Medicare physician reimbursement has not shown the same trend. In fact, inflation-adjusted reimbursement has seen a steady decline since FDA approval in 2007. If this trend persists, it may become unsustainable for physicians to continue offering CDA to Medicare patients. As disproportionate increases in hospital charges incentivize a transition to outpatient CDA, stricter patient selection criteria associated with outpatient procedures may create health care disparities for Medicare patients and those with higher comorbidity burden. This study shows the decreasing reimbursement trends for CDA, which may disproportionately affect Medicare patients and those with increased comorbidities.