Medicare Reimbursement and Utilization Trends Within Skull Base Surgery

Medicare reimbursements for otolaryngology and neurosurgery procedures have generally declined since 2000. We explore Medicare reimbursement trends for anterior cranial fossa, middle cranial fossa, posterior cranial fossa, pituitary surgery, and skull base reconstruction surgery from 2000-2022.

Cross-sectional analysis of the Centers for Medicare and Medicaid Services Physician Fee Schedule was performed from 2000-2022 on approach, resection, and repair of the skull base (Current Procedural Terminology codes 31290-31291, 61546, 61548, 61575-61619, and 62165). Reimbursement data were adjusted for inflation to 2022 U.S. dollars, and annual and total changes calculated. The Centers for Medicare and Medicaid Services Part B National Summary Data File was analyzed for trends in Medicare procedure volume and total payment.

Adjusted for inflation since 2000, reimbursements for anterior cranial fossa, middle cranial fossa, posterior cranial fossa, pituitary surgery, and skull base reconstruction codes had an overall decrease of 22.85%, 32.43%, 28.09%, 44.22%, and 38.65%, respectively. Simultaneously, procedure volume increased at an average annual rate of 63.99%, 128.57%, 19.75%, 36.11%, and 12.79%, respectively.

While nominal per-service Medicare reimbursement has increased for skull base surgery codes, there has been a downward trend in inflation-adjusted procedural reimbursement. This parallels findings in other otolaryngology and neurosurgery procedures. Despite this, surgical volume in all skull base surgery subfields has increased, indicating increased utility and adoption of these techniques.