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. 2024 Jan;19(1):175-179.
doi: 10.1177/15589447221096708. Epub 2022 Jun 7.

Medicare Reimbursement in Hand and Upper Extremity Procedures: A 20-Year Analysis

Samantha N Weiss  1 , Grace V Gilbert  2 , Pietro Gentile  2 , John P Gaughan  1 , Sandra Miskiel  2 , Andre Pagliaro  3 , Rey Ramirez  2 , David A Fuller  2
Affiliations

Medicare Reimbursement in Hand and Upper Extremity Procedures: A 20-Year Analysis

Samantha N Weiss et al. Hand (N Y). 2024 Jan.

Abstract

Purpose: Concern exists that Medicare physician fees for procedures have decreased over the past 20 years. The Centers for Medicare & Medicaid Services (CMS) is set to re-evaluate these physician fees in the near future for concern that these procedures are overvalued. Our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2019 for the top 20 most billed hand and upper extremity surgical procedures at our institution.

Methods: The financial database of a single academic tertiary care center was queried to identify the Current Procedural Terminology codes most frequently utilized in orthopedic hand and upper extremity procedures in 2019. The Physician Fee Schedule Look-Up Tool from the CMS was queried for annual physician fee data. Monetary data were adjusted for inflation using the consumer price index of Urban Research Series (CPI-U-RS) and expressed in 2019 constant US dollars (USD). The average annual and total percent change in reimbursement were calculated via linear regression for all procedures (P < .05).

Results: Accounting for inflation, the total average physician reimbursement decreased by 20.9% from 2000 to 2019, with 12 of 20 codes decreasing by more than 20%. The greatest decrease pertained to arthrodesis of the wrist at 33.9%. Upon linear regression, all procedures were found to decrease annually, with arthrodesis of the wrist decreasing by an average of 2.3% annually over this period.

Conclusions: Over the past 2 decades, physician reimbursement for hand and upper extremity procedures has significantly decreased.

Keywords: epidemiology; hand surgery; health policy; medicare reimbursement; research & health outcomes; upper extremity.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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