Contemporary Markup Trends in Orthopaedic Sports Procedures: An Analysis of 2014-2021 Medicare Data

Examining the markup ratio (MR), which is the ratio of health care institutions submitted charges to Medicare payments, is essential for informing policies on price transparency and health care affordability in the setting of declining reimbursement for orthopaedic procedures. While MRs have been extensively studied in both arthroplasty surgery and other specialties, revealing their high variability, there is limited research on MRs for orthopaedic sports procedures and the potential for "surprise billing" among patients undergoing these services.

This study aimed to (1) quantify MRs for the 15 highest-volume orthopaedic sports procedures and (2) assess longitudinal trends from 2014 to 2021. It was hypothesized that the submitted charges and Medicare reimbursements for these procedures would reveal persistently high MRs.

Cross-sectional study.

This review evaluated the top 15 Healthcare Common Procedure Coding System (HCPCS) codes related to orthopaedic sports medicine in December 2023. The mean and median MRs for each Current Procedural Terminology procedure were analyzed at the national, regional, and sex levels over the study period. Descriptive statistics-including median, interquartile range, mean, and standard deviation-were calculated for the included MRs at the national, state, and HCPCS-code levels. Mann-Kendall trend tests were used to analyze the trend of MRs from 2014 to 2021.

The included orthopaedic sports procedures had a median MR between 5.81 and 6.30, revealing no significant changes from 2014 to 2021. Two types of primary procedures had MRs of >10, including shoulder arthroscopy with extensive debridement (16.79) and patellar tendon repair (13.66). No significant sex differences were observed for the median MR among men (P = .081) and women (P = .266).

Our review revealed that orthopaedic sports procedures consistently had high MRs; however, no significant changes were found in MR trends from 2014 to 2021. Our findings suggest that while inflation-adjusted Medicare reimbursement has declined, MRs have remained stable.