Trends in Spinal Pain Procedure Volumes and Reimbursements: An Analysis of 20 Years of Medicare Data

Chronic back/neck pain costs the United States around 250 billion dollars annually. Treatment strategies include medication, physical therapy, and specialized procedures. This study aimed to investigate the trends in procedural frequency and Medicare reimbursement rates for common back pain procedures.

Data from 2000 to 2020 were extracted from Medicare Part B National Summary Data files, using Current Procedural Terminology (CPT) codes to identify reimbursement for cervical/thoracic and lumbar/sacral epidural injections, radiofrequency ablation, facet joint injections, and spinal cord stimulators (both percutaneous and paddle). Key metrics included annual total physician charges, reimbursements, and the number of procedures performed.

From 2000 to 2020, 53,208,205 pain procedures were performed. The most common was lumbar/sacral epidural injections, followed by facet joint injections and radiofrequency ablations. Paddle SCS placement was the least common. Percutaneous SCS had the greatest volume growth, increasing from 3595 to 111,172 [+2992%], followed by lumbar/sacral epidural injections with 118,884 to 1,965,445 [+1553%], and cervical/thoracic epidural injections, 22,480-348,642 [+1451%]. All procedures saw a significant increase in volume except for facet joint injections. Inflation-adjusted reimbursement per service also increased, with paddle SCS demonstrating the largest increase ($618-$2960 [+379.0%]), followed by percutaneous SCS ($353-$1428 [+304.5%]) and cervical/thoracic epidural injections ($128-$153 [+19.5%]).

Pain management procedures have increased in volume and reimbursement over the last 20 years. This increased reimbursement may allow for broader access to these procedures compared to prior decades and support a shift from traditional and more invasive surgical procedures to minimally invasive treatments for chronic pain patients.