Rhinology Medicare reimbursements have not been keeping up with inflation

Studies have suggested that physicians are steadily being paid less per Medicare service over time based on inflation-adjusted dollars. The objective of this study was to determine whether this phenomenon was true for rhinologic procedures.

This study was a retrospective analysis of the 2000-2021 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule investigating fees for in-office endoscopies (Current Procedural Terminology [CPT] codes 31231-31238), in-office balloon ostial dilation (CPTs 31295-31298), in-facility low-relative value unit (RVU) surgeries (<10 work RVUs [wRVUs]; CPTs 31239-31288 and 61782), and in-facility high-RVU surgeries (>10 wRVUs; CPTs 31290-31294). Total number of and reimbursements for these services was obtained from yearly National Part B Summary Datafiles.

Between 2000 and 2021, adjusted reimbursements for low- and high-wRVU rhinologic surgeries decreased by 50.0% and 36.1%, respectively. The average compound annual growth rate (CAGR) decrease was 3.3% and 2.1%, respectively. Excluding a 48.3% unadjusted reimbursement increase between 2000 and 2004, endoscopies saw an adjusted reimbursement decrease of 29.4% from 2004 onward, an average CAGR of -2.1%. From 2011 onward, balloon ostial dilations saw a decrease in adjusted reimbursement of 43.8%, an average CAGR of -6.0%. Nevertheless, after inflation adjustment, National Part B data reveal that Medicare paid more, in total, for these procedures in 2019 than in 2000 due to increasing utilization.

Medicare reimbursements are complex, adjusted yearly, and undergo constant federal scrutiny due to the increasing costs of health care. These results suggest that, in terms of real dollars, rhinologic procedures have seen a large gradual decrease in Medicare reimbursement, which is important information for policymakers and surgeons alike.