Regional and specialty-based Medicare reimbursement trends in arterial endovascular procedures

Medicare Part B reimbursements have been overall declining at the national level. Our goal was to characterize Medicare reimbursement trends for endovascular lower extremity interventions stratified based on geographic region and physician specialty.

The 2018 to 2022 Medicare Physician and Other Practitioners by Provider and Service dataset was queried for eight lower extremity Current Procedural Terminology codes. Mean reimbursement was calculated, and the data were stratified by setting (facility vs non-facility), Centers for Medicare and Medicaid Services region, and physician specialty (Vascular Surgery [VS], Interventional Radiology [IR], and Interventional Cardiology [IC]). Percentage change in reimbursements were compared between specialties. All monetary values were adjusted to the 2022 United States dollar.

Of the eight included procedures, only iliac stent placement (9%) and infrapopliteal atherectomy (1%) had an increase in facility reimbursements. Intravascular ultrasound (IVUS) and femoral-popliteal stent placement had the largest declines at -20% and -19%, respectively. In non-facility settings, femoral-popliteal atherectomy (-41%) and IVUS (-36%) had the largest decreases in reimbursements. Only infrapopliteal stent (0.4%) and infrapopliteal atherectomy (2%) had a small increase in non-facility reimbursements. In facility settings, the reimbursement declined in all but three regions. Regions 4 (Southeast), 6 (South), and 9 (West Coast) had increases in reimbursements of 1%, 7%, and 9%, respectively. Of note, regions 8 (Mountain West) and 10 (Pacific Northwest) had the largest declines in facility reimbursements at -19% each. For non-facility locations, the average reimbursement declined in all 10 regions, with regions 3 (Mid-Atlantic) and 8 (Mountain West) having the largest decreases at -28% and -35%, respectively. Overall, all three specialties experienced a similar decline in facility reimbursements, with decreases of -14%, -17%, and -19% for VS, IR, and IC, respectively. The non-facility reimbursements also similarly declined for all specialties. VS, IR, and IC had decreases of -29%, -28%, and -20% (P = .51), respectively.

Our analysis of arterial endovascular procedures billed to Medicare Part B from 2018 to 2022 shows a continued decline in reimbursements regardless of physician specialty. However, regional patterns did reflect disproportionate changes in reimbursements, with 6 (South) and 9 (West Coast) having an increase in reimbursements for facility locations. Region 8 (Mountain West) had the largest declines in reimbursement for both practice settings.