Trends in Medicare and Medicaid Reimbursement for Total Wrist Arthrodesis

Abstract

Background: Total wrist arthrodesis is a well-established procedure providing pain relief and stability for patients with symptomatic radiocarpal arthritis refractory to nonoperative measures. Little research exists on reimbursement and utilization trends for this procedure. This study aimed to characterize Medicare reimbursement trends for total wrist arthrodesis, along with trends in Medicare utilization and comparison with Medicaid reimbursement.

Methods: Medicare reimbursement for Current Procedural Terminology codes 25800, 25805, and 25810 were collected from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule from 2000 to 2025. Rates were inflation-adjusted to 2025 dollars, and percentage changes were calculated. Medicare utilization trends from 2000 to 2022 were analyzed using CMS Part B data. Most recent Medicaid reimbursement was collected from online state fee schedules and compared with 2025 Medicare rates, with additional analyses of variability and adjustment for work Relative Value Units.

Results: Inflation-adjusted Medicare reimbursement for total wrist arthrodesis decreased by 49.1% from 2000 to 2025 (P < .0001), averaging a 1.96% annual decline. Utilization trends remained stable, with wrist arthrodesis with iliac or other autograft (CPT 25810) being the most commonly billed procedure. Medicaid reimbursed 13.6% less than Medicare on average, with substantial state variability, ranging from 44.7% (New Hampshire) to 135.4% (Alaska) of Medicare reimbursement.

Conclusion: Reimbursement for total wrist arthrodesis has declined significantly despite stable utilization in the Medicare population. Medicaid reimbursement is consistently lower and highly variable by state, potentially impacting access to care. Given the effectiveness of wrist arthrodesis, policymakers should advocate for equitable reimbursement for this procedure.

Keywords: anatomy; arthritis; diagnosis; epidemiology; health policy; research and health outcomes; specialty; surgery; wrist.

Figure 1.

Trends in Medicare reimbursement for the 3 included wrist arthrodesis procedure codes, adjusted for inflation and reported in 2025 dollars.

Figure 2.

Trends in Medicare utilization for the 3 included wrist arthrodesis procedure codes from 2000 to 2022. This reflects the number of times each procedure code was billed to Medicare each year.

Figure 3.

Heatmap of the United States based on the ratio of Medicaid to Medicare reimbursement for the 3 combined total wrist arthrodesis codes. Note. States with reimbursement ratios less than 1 appear red, whereas states with ratios greater than 1 appear blue. Tennessee was not included in this figure as its state does not use a fee-for-service Medicaid reimbursement system.