National Trends in Anterior Cervical Discectomy and Fusion Among Medicare Beneficiaries: Declining Reimbursement,...

Retrospective database study.

To evaluate national and regional trends in anterior cervical discectomy and fusion (ACDF; CPT 22551) reimbursement, utilization, and patient population characteristics among Medicare fee-for-service beneficiaries from 2013 to 2023.

ACDF is among the most commonly performed spine procedures in the United States. Despite its high prevalence in the Medicare population, geographic variation in surgeon reimbursement, procedural volume, and patient characteristics has not been comprehensively characterized at the national level.

The CMS "Medicare Physician & Other Practitioners" database was queried for all billing episodes of ACDF from 2013 to 2023 among neurosurgeons and orthopaedic surgeons. Population-based utilization rates were calculated using CMS Monthly Enrollment data. Inflation-adjusted reimbursement, procedural volume, and patient characteristics were extracted and stratified by US Census region and rural-urban commuting area (RUCA) codes. Kruskal-Wallis tests, Wilcoxon rank-sum tests, and linear regression analyses were performed.

Population-based utilization decreased 22.9% (5.63 to 4.34 per 10,000 FFS beneficiaries) and inflation-adjusted surgeon reimbursement decreased 19.0% ($1,562 to $1,265). The number of performing surgeons declined 26.3% (1,146 to 845). Between 2019 and 2020, national ACDF volume fell 26.8%, reflecting the impact of the COVID-19 pandemic. In 2023, reimbursement was highest in the Northeast ($1,282) and did not differ significantly across RUCA categories (P=.056). Neurosurgeons performed the majority of procedures (60.4% in 2023) but their volume share declined from 72.4% in 2013. Average beneficiary age was the only significant predictor of reimbursement (P <.001).

ACDF volume and surgeon reimbursement declined substantially among Medicare FFS beneficiaries from 2013 to 2023. Sensitivity analysis demonstrated that the reimbursement decline was concentrated in the 2021 to 2023 period, suggesting a policy-driven rather than pandemic-driven trend. Persistent geographic variation in utilization underscores the need for targeted policy attention, including recalibration of recent conversion factor reductions and equity-focused initiatives to address regional access disparities in cervical spine surgery.

Level III; Retrospective Database Study.