Medicare Reimbursement Trends in Sleep Surgery: A 2 Decade Analysis of the Most Billed Codes

The prevalence of sleep-disordered breathing, including obstructive sleep apnea, has driven the rapid growth of sleep surgery as a subspecialty. Medicare reimbursement plays a pivotal role in the economic viability of sleep surgery, but trends remain understudied. This study analyzes reimbursement trends for commonly performed sleep surgery procedures from 2000 to 2024, assessing inflation-adjusted changes in facility-based professional reimbursement.

The 11 most frequently billed sleep surgery procedures at a single institution in 2024 were identified. Medicare data on facility-based professional reimbursement were extracted from 2000 to 2024 using the CMS Physician Fee Schedule. Inflation adjustments were applied using the CPI Inflation Calculator. Year-to-year percentage changes and linear regression analyses were performed.

Among the analyzed CPT codes, a consistent decline in inflation-adjusted facility prices was observed, with an average aggregate decrease of 39.8%. The most pronounced decline was in CPT 42975 (Drug-Induced Sleep Endoscopy), which decreased by 72.1% (R² = .88). Other procedures, such as CPT 30140 (Submucous Resection of Inferior Turbinate) and CPT 31231 (Diagnostic Nasal Endoscopy), experienced aggregate declines exceeding 58%. Procedures like CPT 30130 (Excision of Inferior Turbinate) showed relatively stable pricing with a 2.6% aggregate reduction.

The substantial decline in inflation-adjusted facility prices for sleep surgery procedures underscores challenges in sustaining the financial and operational viability of this growing subspecialty. Reduced reimbursement may hinder innovation, training, and resource allocation, with potential downstream impacts on patient access and care. Policymakers should consider these findings to ensure equitable and sustainable support within the healthcare system.

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