Medicare Reimbursement for Balloon Catheter Dilations Among Surgeons Performing High Volumes of the Procedures to Treat Chronic Rhinosinusitis

Abstract

IMPORTANCE Chronic rhinosinusitis is among the most common and costly conditions treated by physicians. After failure of medical treatment, surgical intervention in the form of endoscopic sinus surgery is traditionally offered. Balloon catheter dilation (BCD) has become a less-invasive alternative with increasing popularity among otolaryngologists.OBJECTIVE To evaluate the most recent BCD data in the Medicare population, with a specific focus on the percentage of procedures performed by surgeons who perform high volumes of this procedure, their reimbursements, and their national geographic distributions. DESIGN, SETTING, AND PARTICIPANTS This retrospective review included data from 2011 through 2017 from Medicare Part B National Summary Data Files and Medicare Provider Utilization and Payment Data. Patients with procedures including Current Procedural Terminology codes 31295 (maxillary sinus dilation), 31296 (frontal sinus dilation), and 31297 (sphenoid sinus dilation) were included. EXPOSURES Balloon catheter dilation of the paranasal sinuses.MAIN OUTCOMES AND MEASURES Total and mean reimbursements over time to physicians for BCDs, as well as the percentage of BCDs performed by and reimbursed to ear, nose, and throat (ENT) surgeons who perform high volumes of BCDs (>10 procedures) in a given year.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…With development of new surgical technologies and heightened awareness toward delivering cost‐effective healthcare, office‐based sinonasal procedures have become a common part of the rhinology practice 1787 . One example is the rise of balloon catheter dilation (BCD); an analysis of Medicare reimbursements found that in the 6 years after the introduction of CPT codes specific to BCD (in 2011), the frequency of BCD (both in‐office and operating room) increased from 7496 to 43,936 procedures per year 1788 . Office‐based procedures offer several potential patient benefits, including avoidance of general anesthesia, reduced recovery time, and lower costs compared to procedures in the operating room 1789 …”

“…Evidence suggests that population‐adjusted rates of ESS may be decreasing, with 1 study showing a 24% reduction between 2005 and 2011 in California 1906 . Concurrently, balloon catheter dilation (BCD) has become increasingly adopted by some otolaryngologists as a procedural management option for CRSsNP, 1907–1910 with 1 analysis of a Medicare database demonstrating a 486% increase in utilization from 2011 to 2017 1788 . While 1 hypothesis for the decrease in population ESS rates may be that balloon catheter dilation (BCD) techniques are supplanting traditional ESS procedures, it appears that the overall number of ESS procedures over this timeframe has remained relatively stable, 1907,1908 and providers who performed more BCDs did not reduce their volume of other sinus procedures 1911 .…”

Decrease in Medicare Reimbursement for Single‐laceration Repairs in the Emergency Department

“…However, other payers often base their reimbursement rates on Medicare Reimbursement. 4,9 From 2010 to 2018, Medicare has increased the proportion of denied services and decreased its prices and allowed charges for these three single-laceration repairs that constitute a large portion of emergency physician services provided. The procedure with the lowest value correlated to the largest decrease in relative submissions made and vice versa.…”

“…2,3 Decreasing reimbursement trends have been examined for procedures in multiple specialties, but there is no universal trend among all procedures and specialties. 1,4 An in-depth analysis of single-laceration repairs in the ED has yet to be performed. In this study, Medicare reimbursement trends are analyzed in the context of physician submissions for laceration repairs.…”

“…6 Due to its public availability, our study is exempt from institutional review board approval. 4,6 To focus on emergency physicians, only submissions under provider code 93 were obtained. 6 The data was further filtered for the three chosen Current Procedural Terminology (CPT) codes.…”