Trends in Medicare Reimbursement for the Resection of Vestibular Schwannomas: 2000 to 2021

Current procedural terminology (CPT) for the surgical removal of vestibular schwannoma (VS) has been inconsistently applied due to the redundant plurality of coding possibilities. This report analyzes reimbursement rates between different CPT strategies to determine if financial incentives may be a potential driver of this divergent behavior.

Medicare Part B National Summary files were queried for reimbursement data concerning VS resections from 2000 to 2021. Data were categorized by CPT codes for approach, excision, or combination codes encompassing both elements for three surgical approaches: middle fossa, translabyrinthine, and retrosigmoid (RS). Separated approach and excision codes were bundled in a pairwise fashion to imitate real-world billing practices. Inflation-adjusted data was curated according to the consumer price index and further analyzed by compound annual growth rate. Utilization trends were measured using gross allowed services.

Inflation-adjusted fees declined for all services. However, some services, namely piecemeal RS codes, experienced nominal payment increases that dampened inflationary value erosion. Intragroup assessment proved RS to be the most popular and best compensated approach within both the pairwise and combination groups. Intergroup assessment proved the RS combination code was most frequently employed overall, with the pairwise RS approach and excision bundle collecting the greatest average reimbursement.

This study suggests the divergence in CPT assignment for surgically managed VS is likely driven, in part or in whole, by financial incentive and indicates the need for fiscal reform, or an erasure of redundant CPT, to unify CPT application.