Trends in Medicare Reimbursement for Gender-Affirming Procedures

Medicare reimbursement rates are essential knowledge for gender-affirming plastic surgeons. The goal of this project was to examine trends in Medicare reimbursement rates for gender-affirming plastic surgery procedures from 2007 to 2020.

Changes in reimbursement rates were measured for 35 commonly used gender-affirming procedure CPT codes from 2007 to 2020 adjusted for inflation to the 2020 US dollar value. The Unadjusted Percent Change in Consumer Price Index (CPI) was calculated using data from the US Bureau of Labor Statistics. Reimbursement rates were adjusted for inflation using the CPI for each year. Student t test was utilized for mean comparisons.

Mean percent change in reimbursement rates was +16.01% while the percent change in CPI was +27.45%. Comparison between rate change of inflation versus rate change in adjusted medical reimbursement was significantly higher in the inflation group ( P < 0.0001). Inflation adjustments for the Compound Annual Growth Rate was negative (-0.76%). The adjusted total percent change was also calculated at an average of -8.97%.

This is the first study evaluating trends in Medicare reimbursement rates for commonly selected gender-affirming procedures in the United States. After adjusting for inflation, Medicare reimbursement rates for all gender-affirming surgeries analyzed declined from the years 2007 to 2020 compared to expected inflation base. Increased consideration of these trends will be important for US policymakers, hospitals, and surgeons to ensure ease of access to gender-affirming care for transgender individuals.