Trends in Medicare Reimbursement for Gender-Affirming Procedures

Area of Science:

• Plastic Surgery
• Health Economics
• Public Health Policy

Background:

• Medicare reimbursement rates are critical for gender-affirming plastic surgeons.
• Understanding trends in these rates is vital for healthcare providers and policymakers.
• This study focuses on gender-affirming plastic surgery procedures between 2007 and 2020.

Purpose of the Study:

• To analyze Medicare reimbursement rate trends for gender-affirming plastic surgery procedures.
• To compare reimbursement rate changes with inflation over a 14-year period.
• To assess the financial accessibility of gender-affirming care.

Main Methods:

• Examined 35 common gender-affirming procedure CPT codes from 2007-2020.
• Adjusted reimbursement rates for inflation to 2020 US dollar values using the Consumer Price Index (CPI).
• Utilized Student t-tests for statistical comparisons.

Main Results:

• Mean reimbursement rate change was +16.01%, while CPI increased by +27.45%.
• Inflation-adjusted reimbursement rates showed a negative Compound Annual Growth Rate of -0.76%.
• Overall adjusted reimbursement decreased by an average of -8.97% from 2007 to 2020.

Conclusions:

• This is the first study to evaluate Medicare reimbursement trends for gender-affirming surgeries in the US.
• After adjusting for inflation, Medicare reimbursement rates for these procedures have declined.
• These findings highlight the need for policy considerations to ensure continued access to gender-affirming care.