Medicare Reimbursement Trends for Mandibular Fracture Repair, 2000-2024

Medicare physician fee schedule (MPFS) reimbursement, historically subjected to complex policy changes, has decreased in numerous surgical specialties after inflation adjustments. Outpatient prospective payment system (OPPS) reimbursement has largely been uninvestigated. This study aims to evaluate monetary trends in Medicare physician and hospital outpatient reimbursement rates for mandibular facial fracture repairs from 2000 to 2024.

The Physician Fee Schedule Tool and Quarterly Addenda Updates provided by the Center for Medicare and Medicaid Services (CMS) were queried for the six most common open mandibular facial fracture procedures. Physician reimbursement rates for facility and non-facility clinical settings, hospital outpatient reimbursement rates, work relative value units (RVUs), and total billed services pertaining to these six procedures were collected and analyzed. Monetary data was adjusted for inflation to reflect 2024 dollars based on the consumer price index (CPI) released by the US Department of Labor's Bureau of Labor Statistics.

Average facility physician reimbursement, after adjusting for inflation, of the six mandibular fracture procedures from 2000 to 2024 decreased by 24.1%. All procedures continuously billed in non-facility settings exhibited physician reimbursement increases, even after post-inflation adjustments. Hospital outpatient reimbursement, after adjusting for inflation, from 2004 to 2024 increased by 110.6%.

Facility physician reimbursement for mandibular fractures has declined over the past two decades despite increasing hospital compensation and work RVUs. Future reform should incorporate solutions to address declining facility physician compensation in order to mitigate financial strain on providers and barriers to patient access to care.