An In-Depth Review of Physician Reimbursement for Digit and Thumb Replantation
Related Experiment Video
Updated: Jan 26, 2026
Microscopic Replantation of Penile Glans Amputation Due to Circumcision
Published on: June 3, 2022
Rachel C Hooper1, Jennifer M Sterbenz1, Lin Zhong1
1Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, MI.
Insights
Digit and thumb replantation yields significantly lower physician reimbursement than revision amputations, despite higher hospital earnings. This disparity impacts surgeon recruitment and retention for complex limb salvage procedures.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Health Economics
Background:
- Digit and thumb replantation are complex procedures aimed at restoring function after traumatic amputation.
- Revision amputation, while less complex, involves removing tissue and may be perceived as a simpler procedure.
- Understanding the economic factors influencing the provision of these surgical services is crucial for healthcare policy and practice.
Purpose of the Study:
- To compare physician and hospital reimbursement for digit and thumb replantation versus revision amputation.
- To analyze reimbursement in relation to work Relative Value Units (wRVU) and Medicare Physician Fee Schedule (MPFS).
- To identify economic barriers affecting the practice of replantation surgery.
Main Methods:
- Utilized the 2009-2016 Truven Health MarketScan Research Databases to identify patient cohorts.
- Included patients with digit or thumb amputations, dividing them into replantation and revision amputation groups based on inclusion criteria.
- Extracted mean physician and hospital reimbursements, and compared wRVU and MPFS for various hand surgery procedures.
Main Results:
- Replantation patients (n=219) had mean physician reimbursements of $3,938-$7,753 and hospital reimbursements of $30,683-$56,256.
- Revision amputation patients (n=6,209) had mean physician reimbursements of $1,030-$1,206 and hospital reimbursements of $2,877-$4,188.
- Hospitals earned $37,788 more per replantation case; however, replantation reimbursed at $78/wRVU compared to higher rates for revision amputation and other common hand procedures.
Conclusions:
- Low physician reimbursement for replantation, relative to less complex procedures, hinders surgeon recruitment and retention.
- Understanding the wRVU and MPFS systems is essential for advocating for fair valuation of replantation.
- Collaboration between hand surgeons, professional societies, and CMS is needed to improve reimbursement policies for limb salvage procedures.
Purpose:
To examine physician and hospital reimbursement for digit and thumb replantation compared with revision amputation.
Methods:
Using the 2009-2016 Truven Health MarketScan Research Databases, we identified patients with a digit or thumb amputation. Following application of our inclusion and exclusion criteria, we divided patients into replantation and revision amputation groups. We extracted the mean physician and hospital reimbursement associated with each patient encounter. For comparison, we examined the work Relative Value Unit (wRVU) and Medicare Physician Fee Schedule (MPFS) for the respective procedures in addition to several common hand surgery procedures.
Results:
We identified 51,716 patients. Following application of our inclusion and exclusion criteria, 219 replantation and 6,209 revision amputation patients were included in our analysis. For replantation, the mean physician and hospital reimbursements ranged from $3,938 to $7,753 and $30,683 to $56,256, respectively. For revision amputation, the mean physician and hospital reimbursements ranged from $1,030 to $1,206 and $2,877 to $4,188, respectively. On multivariable analysis, hospitals performing replantation earned $37,788 more per case compared with revision amputation. Using the wRVU and MPFS data, we determined that replantation reimburses at $78/wRVU compared with higher earnings for revision amputation ($108), carpal tunnel release ($101), cubital tunnel release ($97), trigger finger release ($116), open reduction and internal fixation (ORIF) distal radius fracture ($87), flexor tendon repair ($98), extensor tendon repair ($122), repair of digital nerve ($89), and ORIF articular fracture ($82), respectively.
Conclusions:
Low physician reimbursement for replantation compared with less complex hand procedures makes it difficult to recruit and retain hand surgeons for this purpose. By understanding the wRVU and MPFS system, hand surgeons and professional societies can explore ways to promote change in the way replantation is valued by the Centers for Medicare and Medicaid Services (CMS) as well as by hospital administrators.
Type Of Study/Level Of Evidence:
Economic/Decision Analysis III.
Related Concept Videos
01:10Review and Preview
Percentiles are a type of fractile that partition data into...
01:13Review and Preview
01:27Uniform Depth Channel Flow
01:13Range Rule of Thumb to Interpret Standard Deviation
For instance, the range rule of thumb can be used to find the tallest and the shortest student in a class, given the mean student height and standard deviation. If the mean student height is 1.6 m and the standard deviation, s is 0.05 m, the height...
01:15Depth Perception and Spatial Vision
01:18Uniform Depth Channel Flow: Problem Solving