Decreasing Medicare Payments for Anterior Cervical Discectomy and Fusion From 2013 to 2023

Despite its clinical utility and consistent procedural volume, Medicare reimbursement for anterior cervical discectomy and fusion (ACDF) has undergone policy-driven changes over the past decade. This study investigated longitudinal Medicare reimbursement trends for ACDF among orthopedic and neurological spine surgeons from 2013 to 2023.

A retrospective analysis was performed using publicly available Centers for Medicare and Medicaid Services databases. Surgeons who billed ≥10 ACDF procedures (current procedural terminology 22551) per year were included. Provider demographics, procedural volumes, average Medicare standardized amount (AMSA), inflation-adjusted AMSA, and average annual procedural income (API) were analyzed. Comparisons were made by surgical subspecialty by year.

A total of 10 311 spine surgeons performed 187 062 ACDF procedures between 2013 and 2023. Neurosurgeons comprised 65% of providers and procedures, while orthopedic surgeons comprised 35%. Average annual case volumes were similar across specialties. Between 2013 and 2023, inflation-adjusted AMSA declined 23% and API declined 27%, despite stable procedural volumes. These declines were consistent across neurosurgeons (-23% AMSA, -27% API) and orthopedic surgeons (-22% AMSA, -27% API). The number of neurosurgeons performing ACDF decreased over the study period (17% decrease), while the number of orthopedic surgeons increased (31% increase). Both specialties saw a reduction in average procedures per provider.

While unadjusted Medicare reimbursement for ACDF remained stable from 2013 to 2023, inflation-adjusted reimbursement declined substantially, reflecting an erosion in surgeon compensation. These findings raise concerns about the financial sustainability of providing ACDF services in the Medicare population and underscore the need for policy strategies that protect access to surgical care for an aging population.