Longitudinal trends in U.S. Medicare physician reimbursement for common lumbar spine surgery CPT codes: a systematic...

Medicare physician reimbursement, even while adjusting for inflation, for lumbar spine surgery has decreased over the past two decades. No systematic review has measured these declines or separated out their differences by procedure.

This review's main question asked how inflation-adjusted U.S. Medicare physician reimbursement for common lumbar spine surgery CPT codes changed over time. Secondary questions explored how these changes differed across procedure categories and their relationship to surgical volume.

Systematic review following PRISMA 2020 guidelines. The protocol was put together prior to beginning the search but was not registered; no quantitative meta-analysis was performed.

Eleven retrospective studies (published between 2018 and 2026) were selected. These studies looked at Medicare physician reimbursement for lumbar spine surgery from 2000 to 2024.

The primary variable this review was focused on was the Compound Annual Growth Rate (CAGR) of Medicare physician reimbursement adjusted for inflation. Secondary outcomes were nominal reimbursement, work relative value unit trends, and procedure volume.

We searched PubMed/MEDLINE, Scopus, and Web of Science from January 2014 to March 2026. Supplemental citation chaining was also done on included studies. Studies were eligible if they reported Medicare physician reimbursement for at least one of 15 lumbar CPT codes (6 decompression, 5 fusion, 4 instrumentation), with at least 3 years of data including one year inside our required range. Risk of bias was measured using the JBI Critical Appraisal Checklist with two review-specific items. Findings were combined as a narrative synthesis. We verified reported estimates by directly analyzing Physician Fee Schedule payment data for all 15 codes (2017-2025). This review received no specific grant funding. Records were screened in duplicate by two independent reviewers. No investigational drug or device was evaluated.

The 11 included studies used data from Physician Fee Schedule look-up tools (n=5), Medicare claims (n=5), and a surgical registry (n=1). Six studies were rated low risk of bias, four moderate, and one high. The median study-level CAGR was -2.00% per year (interquartile range, -2.62% to -1.27%; range, +0.38% to -2.77%). Cumulative declines approached 33% over two decades. In our fee schedule analysis, inflation-adjusted payment for all 15 codes declined from 2017 to 2025, showing a median regression slope of -4.62% per year, with every 95% confidence interval remaining below zero. Decompression codes declined most sharply on average. Among fusion codes, anterior lumbar interbody fusion declined the most (CAGR -2.26% to -2.47%), while posterior lumbar interbody fusion was essentially stable (CAGR -0.01%). Anterior lumbar interbody fusion volume rose 798% even as payment fell 37.8%; total fusion volume increased 94.6% while reimbursement dropped 25%. Studies of post-2017 periods reported greater annualized declines, though shorter observation windows may inflate these rates.

Medicare physician reimbursement for lumbar spine surgery has fallen at roughly 2% per year, with cumulative losses approaching one-third, even as surgical volumes have continued to rise. The growing gap between rising volume and falling payment may threaten practice sustainability, workforce participation, and access to lumbar spine procedures for Medicare beneficiaries.