Defining the Prevalence and Factors Associated with Medicare Non-Participation in the Plastic and Reconstructive...

Declining Medicare reimbursement rates have generated financial pressures for surgeons providing services to patients with Medicare. The purpose of this study was to determine the overall prevalence and characteristics of plastic and reconstructive surgeons not participating in Medicare.

This was a cross-sectional analysis of plastic and reconstructive surgeons in the United States. Data from the Centers for Medicare and Medicaid Services were obtained from 2000 to 2025 including the names and practice locations of physicians who opted out of Medicare. The overall prevalence of physicians opting out of Medicare was calculated for the top twenty-five specialties by number of physicians.

In 2025, there were 354 plastic and reconstructive surgeons in the Medicare non-participation group (8.3%) and this prevalence increased over the study period (0 to 8.3%, P<0.001). Most plastic and reconstructive surgeons opted out of Medicare at ≥30 years (48.6%) after medical school graduation. The top subspecialties represented in the Medicare non-participation group were aesthetic surgery (13.1%) and hand surgery (7.6%). The West (12.2%) had the highest rate of Medicare non-participation, and the Midwest had the lowest rate (4.3%) (P<0.001). The states with the highest rates of Medicare non-participation were Nevada (35.0%), North Dakota (28.6%), Alaska (25.0%), and Arizona (23.3%). Plastic and reconstructive surgery ranked second highest in the rate of Medicare non-participation compared to other specialties.

Plastic and reconstructive surgeons exhibited among the highest rates of Medicare non-participation. Future research is needed to understand underlying motivators of plastic and reconstructive surgeons opting out of Medicare.