Reimbursement for Neuroma Surgery Over the Past Decade

This study aimed to determine how Medicare physician reimbursements for operations related to symptomatic neuromas have changed over the past decade.

This retrospective review uses the Medicare Physician Fee Schedule Look-up Tool to access reimbursement rates for common peripheral nerve surgeries. Six CPT codes frequently used to bill for neuroma excision, burying in muscle, targeted muscle reinnervation (TMR), and regenerative peripheral nerve interface (RPNI) procedures were identified as representative of the peripheral nerve operations to treat symptomatic neuromas. Physician reimbursement rates were gathered from 2014 to 2024, with gross and inflation-adjusted changes in reimbursement calculated.

For each included peripheral nerve procedure, there was a significant decrease in Medicare physician reimbursement both with and without inflation adjustments. CPT 64905 (for TMR) decreased 30%; CPT 64787 and 15769 (for intramuscular burying and RPNI) decreased 31% and 21%; and CPT 64784, 64782, and 64774 (for neuroma excision) decreased 28%, 26%, and 24%, respectively (all inflation-adjusted), with an average compound annual growth rate of -3.6%. For every 100 neuroma operations in 2014, surgeons in 2018 needed to perform an additional 5.6 to be reimbursed at equal levels. In 2024, surgeons need to perform an additional 27 operations for every 100 to be reimbursed equivalently as 5 years prior.

There has been a consistent decrease in physician reimbursement for procedures related to symptomatic neuromas, highlighting a larger trend in Medicare payments. Continued decline in reimbursement poses risk to these important treatment modalities, which could limit surgeons' ability to provide care to patients.