Examining Practice and Payment Gaps in Otolaryngology: Evidence from US Medicare Data

To assess longitudinal differences in Medicare reimbursement, billing patterns, and service composition among US otolaryngologists.

Retrospective cohort study.

Centers for Medicare & Medicaid Services (CMS) Medicare fee-for-service database.

Medicare claims data from 2013 to 2022 were analyzed for US-practicing otolaryngologists. Outcomes included total and per-service charges and reimbursements, service volume, billing diversity, and practice characteristics. Multivariable regression models adjusted for years in practice, geographic region, and clinical volume. Sensitivity analyses assessed inflation-adjusted and log-transformed payment trends over time.

Among 11,010 otolaryngologists, female physicians had fewer years in practice, treated fewer Medicare beneficiaries annually, and billed fewer unique CPT codes than male physicians. In 2022, females received an average of $56,401 (95% CI [$40,805-$71,998]) in Medicare reimbursement compared with $89,880 (95% CI [$82,941-$97,270]) for males. Across top codes, females had lower mean submitted charges (females $63,755 [$59,501-$68,009] vs males $97,834 [$95,489-$100,179]) and reimbursements per service (females $28,894 [$22,692-$23,097] vs males $29,061 [$28,920-$29,202]). Adjusted regression models showed that female physicians were reimbursed 5.3% less per service on average across all services (95% CI [2.7%-8.2%]). A sensitivity analysis of log-transformed payments demonstrated a 1% annual decline in Medicare reimbursement regardless of gender, with a significant gender-year interaction (P = .002).

Despite increasing representation and gross reimbursement, female otolaryngologists consistently received lower Medicare reimbursement than male peers. These findings suggest systemic differences in billing patterns, coding practices, and institutional support. Interventions to address billing education, infrastructure, and equitable compensation models should be explored to mitigate reimbursement differences in otolaryngology.