Medicaid's Cranio-Cap: Medicaid Reimbursement for Craniosynostosis Repair is Not Trending With the Rate of Inflation

Craniosynostosis requires early diagnosis and intervention to mitigate the risks of impaired cranial growth; however, patients with Medicaid face treatment delays for craniosynostosis care. Medicaid reimbursement rates have failed to match the inflation rate in medicine, remaining relatively static in many surgical fields. This study investigates Medicaid reimbursement and the longitudinal impact of economic inflation on reimbursement for craniosynostosis care.

Using the Current Procedural Terminology (CPT) codes for operations for craniosynostosis, the authors analyzed Medicaid reimbursement rates from 2013 to 2023, adjusting for inflation to 2023 US dollars. Data were collected from the Physician Fee Schedules of the states with the top regional pediatric hospitals with specialized craniosynostosis care teams. Annual percentage changes in inflation-adjusted reimbursements and reimbursement Compounded Annual Growth Rate (CAGR) were compared with the annual change in the US Consumer Price Index (CPI).

The average inflation-adjusted growth in reimbursement for the most billed craniosynostosis surgical interventions was -21.31% from 2013 to 2023. The average CAGR during the same period was -2.41% with all procedures presenting with a negative CAGR, indicating negative growth. In comparing percent change in unadjusted reimbursements and CPI, all CPT codes were significantly less except for extensive craniectomy for multiple cranial suture craniosynostosis (CPT 61559) ( P =0.054). All inflation-adjusted CPT codes presented with significant negative growth.

After the inflation adjustment, the reimbursement for the most common operations for craniosynostosis had a negative growth rate. This could contribute to care delays, access to craniofacial care, and compromise the financial sustainability of regional multidisciplinary craniofacial teams.