Inflation-Adjusted Changes in Medicare Reimbursements for Commonly Performed Oculoplastics Procedures Over the Last...

This study examines the inflation-adjusted changes in Medicare reimbursements for the most commonly performed oculoplastic procedures performed in the clinic and in the operating room from 2014 to 2023.

The 2021 Medicare National Summary Data File was used to identify the 15 most often performed oculoplastics office procedures and operating room procedures in Medicare Part B beneficiaries by Current Procedural Terminology (CPT) code. The yearly reimbursements for each of these 30 CPT codes over the last decade were found using the Medicare Physician Fee Schedule Online Tool available on CMS.gov. Adjustments for inflation were made using the Consumer Price Index from the United States Bureau of Labor Statistics. Descriptive statistics were computed to show the change in reimbursement amount over time. Spearman rank correlation coefficients between the inflation-adjusted reimbursement amount and year were used to evaluate the trend over time for each procedure.

The average nominal change in payment amount was -3.5% (range: -63.6% to 12.5%) for office CPT codes and -7.7% (range: -35.3% to 6.5%) for facility CPT codes. The average inflation-adjusted change in payment amount was -24.6% (range: -71.5% to -12.1%) for office codes and -27.8% (range: -49.4% to -16.8%) for facility codes. There was a statistically significant negative correlation between inflation-adjusted reimbursement level and year of assessment for 29 of 30 CPT codes tested.

Medicare inflation-adjusted reimbursements for the most commonly performed oculoplastic procedures have significantly decreased over the last decade with an average decline of 24.6% for office procedures and 27.8% for operating room procedures.