A 10-year Analysis of Volume-Adjusted Trends in Medicare Reimbursement for Hand Surgery Procedures

Decreased Medicare reimbursement rates have been observed in many surgical subspecialties, which can negatively impact access and sustainability of care. While several studies report decreased reimbursement for hand surgery procedures, none have accounted for changes in case volume.

The CMS Physician and Other Practitioners database was used to extract all procedure codes billed to Medicare Part B by hand surgeons. The Medicare Physician Fee Schedule database was used to collect reimbursement information, and reimbursement trends were weighted by procedure volume.

A total of 95 codes were included for analysis. Two hundred eighty-three codes were excluded for missing information, constituting 2.6% of the total procedure volume. From 2013 to 2022, the mean Medicare reimbursement rate for hand surgery procedures decreased by 19.9% from $235.71 in 2013 to $188.88 in 2022 after inflation adjustment. This results in an average decrease of $5.06 annually (P<0.001). The greatest decrease was observed for application of casts and strapping (21.9%, $82.91 to $64.75). The smallest average decrease was for revision, repair, and/or reconstruction of the hand and fingers (10.8%, $720.10 to $642.13). The only procedure type with an average increase in reimbursement was fracture or dislocation of the forearm and wrist (0.2%, $672.57 to $674.12). There was no correlation between changes in volume and reimbursement (R=-0.08; P=0.451).

Volume-adjusted Medicare reimbursement for hand surgery procedures decreased from 2013 to 2022. The continued decline in reimbursement for hand surgeons can have negative implications for practice management and access to care for patients.