Adoption outpaces reimbursement in navigation-assisted pediatric posterior spinal fusion

To evaluate reimbursement trends and surgical volumes associated with computer-assisted navigation (CAN) in pediatric posterior spinal fusion (PSF), with a focus on the impact of payer mix on institutional financial sustainability.

We conducted a retrospective cohort study of patients aged 11-19 years undergoing CAN-assisted PSF at a single pediatric institution from 2021 to 2024. Billing records associated with CPT code 61,783 (computer-assisted spinal navigation add-on) were used to identify procedures. Annual procedure volumes were calculated and analyzed by payer type (private vs. public). Matched payments were adjusted to 2024 USD and analyzed using Wilcoxon rank-sum tests.

A total of 759 CAN-PSF procedures were analyzed, with 58% billed to private insurance, 37% to public insurance, and 5% to other payers. Procedure volume increased 70.5% from 2021 to 2024 (CAGR 19.5%). Across all payers, median reimbursement rates declined from 74% in 2021 to 67% in 2024 (p < 0.01). Private insurer reimbursement declined from 81 to 68%, representing a 13% decrease (p < 0.01), while public insurer reimbursement declined from 11 to 9%, representing a 2% decrease (p < 0.01). An inverse relationship was observed between rising procedure volume and declining reimbursement rates.

Although CAN utilization in pediatric PSF significantly increased from 2021 to 2024, declining reimbursement rates pose financial challenges for institutions. These trends may limit equitable access to advanced surgical technologies, highlighting a need for policy reforms or adjustments in reimbursement practices to sustain CAN integration in pediatric spine surgery.