Trends in Medicare Reimbursement for Reconstructive Plastic Surgery Procedures: 2000 to 2019

Abstract

Background: An understanding of financial trends is important to advance agreeable reimbursement models in plastic surgery. This study aimed to evaluate trends in Medicare reimbursement rates for the 20 most commonly billed reconstructive plastic surgery procedures from 2000 to 2019. Methods: The Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File was used to identify the 20 reconstructive procedures most commonly billed to Medicare by plastic surgeons in 2016. Reimbursement data were extracted from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services for each CPT code. Monetary data were adjusted for inflation to 2019 U.S. dollars. Average annual and total percentage changes in reimbursement were calculated based on these adjusted trends. Results: The average adjusted reimbursement for all procedures decreased by 14.0 percent from 2000 to 2019. The greatest mean decrease was observed in complex wound repair of the scalp, arms, or legs (−33.2 percent). The only procedure with an increased adjusted reimbursement rate was layer-closure of the scalp, axillae, trunk, and/or extremities (6.5 percent). From 2000 to 2019, the adjusted reimbursement rate for all procedures decreased by an average of 0.8 percent annually. Conclusions: This is the first comprehensive study evaluating trends in Medicare reimbursement in plastic surgery. When adjusted for inflation, Medicare reimbursement for the included procedures has steadily decreased from 2000 to 2019. Increased consideration of these trends will be important for U.S. policymakers, hospitals, and surgeons to ensure continued access to meaningful reconstructive plastic surgery care.

Analysis of 20-Year Trends in Medicare Reimbursement for Reconstructive Microsurgery

“…A combination of rising physician practice expenses, decreasing microsurgical reimbursement, and relatively high cost and resource requirements required to practice microsurgery Similar trends to those found in the present study have been identified in recent years across numerous surgical fields. [3][4][5][6] Specifically within microsurgical reconstruction, declining reimbursement has been documented for head and neck reconstruction, hand surgery, flap reconstruction, and breast surgery. 12,18,19 Despite overall diminishing reimbursement, the current study indicates a deceleration in the declining reimbursement rates from an average of À23.16% during the 2000s to À3.95% in the following decade (►Table 4).…”

“…As in previous studies, the CMS Physician Fee Schedule Look-Up Tool was utilized to collect reimbursement rate data for each CPT code. 3,5,6,14 This tool was chosen as it is the only public tool that provides comprehensive information on over 10,000 services billable to Medicare, including reimbursement, relative value units, and payment modifiers. Modifiers that can impact reimbursement include unilateral versus bilateral procedure, use of an assistant or co-surgeon, return to operating room, and repeat procedure.…”

“…In the past 20 years, several surgical disciplines, including neurosurgery, orthopedics, general surgery, and plastic surgery, have witnessed a steady, significant decline in Medicare reimbursement rates. [3][4][5][6] In contrast, during this period, physician expenses have risen by over 60%. 7 Moving forward, these findings, together with a fluctuating political climate and the absence of a universally accepted payment model for health-related services, may hamper future vitality of the U.S. health care system.…”

Nationwide analysis of plastic and reconstructive procedural volume in the United States during the COVID-19 pandemic

“…Previous literature in plastic surgery has reported on data obtained from TrinetX. 16 A literature review was conducted to identify a representative sample of the most common plastic and reconstructive procedures nationally [17][18][19][20] . TrinetX was queried for the associated Current Procedural Terminology (CPT) codes (Table 1) of both inpatient and outpatient operations.…”

Trends in Medicare Reimbursement within Dermatology: 2011-2021

“…1 This was a longitudinal analysis of reimbursement rates through time for common services, both E/M and procedural, performed by dermatologists to ascertain if trends were similar to other fields studied to date. [2][3][4][5]…”