Medicare Reimbursement in Hand and Upper Extremity Procedures: A 20-Year Analysis

Area of Science:

• Orthopedic surgery
• Health economics
• Medicare reimbursement analysis

Background:

• Physician reimbursement rates for surgical procedures are a growing concern.
• The Centers for Medicare & Medicaid Services (CMS) is reviewing physician fees for potential overvaluation.
• Trends in Medicare reimbursement for hand and upper extremity procedures require examination.

Purpose of the Study:

• To analyze Medicare reimbursement trends for the top 20 billed hand and upper extremity surgical procedures.
• To assess changes in physician fees from 2000 to 2019.
• To provide data for the upcoming CMS re-evaluation of surgical procedure fees.

Main Methods:

• Utilized financial database of an academic tertiary care center for Current Procedural Terminology (CPT) codes.
• Queried CMS Physician Fee Schedule Look-Up Tool for annual physician fee data (2000-2019).
• Adjusted monetary data for inflation using CPI-U-RS and calculated average annual percent change via linear regression.

Main Results:

• Inflation-adjusted average physician reimbursement decreased by 20.9% from 2000 to 2019.
• Twelve of the top 20 procedures experienced reimbursement decreases exceeding 20%.
• Wrist arthrodesis showed the most significant decline at 33.9%, averaging a 2.3% annual decrease.

Conclusions:

• Physician reimbursement for hand and upper extremity procedures has significantly decreased over the past two decades.
• The findings highlight a concerning trend in Medicare payments for essential surgical services.
• Data supports the need for a comprehensive review of physician fee schedules by CMS.