Changes in Commercial Payments Following Ventral Hernia Billing Reform

In January 2023, the US Centers for Medicare & Medicaid Services (CMS) made major changes to reimbursement policy for abdominal wall hernia repairs, including removal of postoperative global periods. Similar changes have been proposed for other common surgical procedures (eg, colectomy). The role of this policy reform in spending remains unclear.

To evaluate the association between the 2023 CMS ventral hernia repair reimbursement policy reform and changes in ventral hernia episode spending.

This retrospective cohort study used US national insurance claims data (Merative MarketScan) between January 1, 2022, and October 1, 2023. Data were analyzed from July to October 2025. Participants included commercially insured adult patients who underwent ventral or inguinal hernia repair.

January 2023 CMS ventral hernia repair reimbursement policy reform.

The primary outcome was total episode spending per surgical episode, broken down into professional and facility components as well as payer and patient sources. Utilization of billable postoperative care and component separation were also evaluated. A difference-in-differences approach was used to evaluate changes in spending associated with the January 2023 policy change, with inguinal hernia repair as the unaffected comparison group.

Among 58 069 surgical episodes (34 110 ventral, 23 959 inguinal; median patient age, 52 [IQR, 43-59] years; 28% female; 90% outpatients) per-episode spending for ventral hernia decreased following policy reform by -$492 (95% CI, -$496 to -$470) (7% relative reduction) compared with inguinal hernia. Professional reimbursements decreased by -$198 (95% CI, -$200 to -$197) (20% relative reduction). Facility reimbursements increased by $84 (1.4% relative increase) in absolute terms but decreased by -$260 (95% CI, -$263 to -$239) compared with inguinal hernia (4.6% relative decrease). Patient out-of-pocket costs decreased by -$83 (95% CI, -$87 to -$82) (10% relative decrease) compared with inguinal hernia repair. Of 7561 ventral hernia repair cases (52.3%) had 1 or more related postoperative visits in the 90 days after surgery, with the mean (SD) number of visits being 1.06 (2.7). There was no significant increase in component separation procedures.

In this study, following the January 2023 CMS ventral hernia repair reimbursement policy reform, episode spending decreased, with the largest component of the decrease arising from professional fees. With CMS decreasing reimbursement for numerous surgical procedures, the outcomes for surgeon practices and patient costs warrant careful consideration.