Trends in Atrial Fibrillation Ablation Utilization Following 2022 CMS Reimbursement Reduction: A Nationwide Analysis

In 2022, the Centers for Medicare & Medicaid Services (CMS) implemented a bundled payment policy that substantially reduced reimbursement for atrial fibrillation (AF) ablation procedures, raising concerns about potential effects on utilization and procedural complexity.

To evaluate national trends in AF ablation volumes, reimbursement, and procedural complexity following the 2022 CMS reimbursement change.

Using the Medicare Physician and Other Practitioners by Geography and Service Dataset from 2016 to 2023, we identified pulmonary vein isolation (PVI) procedures using CPT 93656 and additional ablations beyond PVI using CPT 93657. Reimbursement rates were inflation-adjusted to 2023 dollars. Joinpoint regression was used to assess trends before and after the 2022 policy change.

From 2016 to 2023, national AF ablation volume increased with an average annual percent change (AAPC) of 11.7% (95% CI, 8.2%-14.0%; p < 0.01). Following the 2022 CMS bundled payment policy, inflation-adjusted reimbursement declined by 27.7% in 2022 and by a further 20% in 2023 (slope change p = 0.01). Despite this, total AF ablation volume rose by 24.3% between 2021 and 2023, and procedures involving additional ablation beyond PVI increased by 42.4% over the same period. Joinpoint regression showed no significant inflection in PVI or additional ablation volume trends following the policy change (p = 0.87 and p = 0.97, respectively).

Despite significant reimbursement reductions following Medicare's 2022 policy change, electrophysiologists continued to perform increasing numbers of AF ablations, including procedures with additional ablations beyond PVI.