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Shifts in Medicare Reimbursement for Common Lower Extremity Orthopaedic Trauma Procedures, 2006-2024
Amir Human Hoveidaei1, Seyedarad Mosalamiaghili2, James E Feng3
1International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
Objectives:
The aim of this study was to analyze Medicare reimbursement trends from 2006 to 2024 for open treatment of proximal femoral fractures [Current Procedural Terminology (CPT) 27236], femoral shaft fractures (CPT 27506), tibial shaft fractures (CPT 27759), and bimalleolar ankle fractures (CPT 27814), using data from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule (PFS).
Design:
This study analyzed Medicare reimbursement trends for the 4 most common lower extremity trauma procedures from 2006 to 2024.
Setting:
Reimbursement data were obtained from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule (PFS), and procedure frequency data were obtained from the M165Ortho dataset from PearlDiver Technologies.
Patient Selection Criteria:
Procedures were selected based on frequency and included CPT codes 27236, 27506, 27759, and 27814.
Outcome Measures And Comparisons:
Reimbursement data were obtained from the CMS PFS using the corresponding Healthcare Common Procedure Coding System codes. Work reimbursement was calculated by multiplying work relative value units (RVUs) by the CMS conversion factor (CF), and total facility reimbursement was calculated by multiplying total facility RVUs by the CF. Values were adjusted to 2024 US dollars using the Consumer Price Index. Percentage changes from 2006 were calculated. A 5-year projection based on 2020 to 2024 trends was generated using the mean and SD of reimbursement changes to model negative (-1 SD), neutral (mean), and positive (+1 SD) scenarios and estimate trends through 2029.
Results:
Between 2006 and 2024, the unadjusted total reimbursement for the 4 included procedures increased by 2.7%, but when adjusted for inflation, it decreased by 33.7%. The largest inflation-adjusted decline in total reimbursements was observed in open treatment of bimalleolar ankle fracture, which saw a 37.6% reduction. Work reimbursements also decreased by 5.4% unadjusted and by 38.9% after accounting for inflation, with the greatest reduction observed in bimalleolar ankle fractures with 43.5%. Projections for 2029, relative to 2024 values, indicate that total reimbursements could decline by an average of 48.1%, 33.1%, or 18.1% under negative, neutral, or positive scenarios, respectively. Work reimbursements are expected to decrease by 57.0%, 40.2%, or 23.3% under the same outlooks.
Conclusions:
Inflation-adjusted Medicare reimbursements for lower-extremity trauma procedures declined up to 37% from 2006 to 2024, with work reimbursements decreasing up to 44%. If current trends continue, reimbursements are projected to decline further by 2029. These declines may pose financial challenges for orthopaedic trauma surgeons and affect the delivery of trauma care.
Level Of Evidence:
Economic, Level IV. See Instructions for Authors for a complete description of levels of evidence.
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