Medicare Reimbursement for Primary Hip and Knee Arthroplasty Is Disproportionately Decreasing Relative to Other High-Volume Inpatient Procedures: Leader of the Pack.

Abstract

Decreasing Medicare surgeon reimbursement for total hip arthroplasty (THA) and total knee arthroplasty (TKA) may limit access to care. The purpose of this study was to examine trends in Medicare reimbursement fees for primary THA and TKA and compare reimbursement to other high-volume nonarthroplasty procedures. A nationally representative database was retrospectively queried to identify the most frequently performed inpatient procedures in the United States from 2016 to 2020. The Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool was then used to obtain reimbursement data for these commonly billed Current Procedural Terminology codes from 2000 to 2024. Utilizing the consumer price index, all monetary data were adjusted and reported in 2024 US dollars to account for inflation. Unadjusted and 2024 inflation-adjusted mean annual reimbursement rates, mean annualized percent change, and total percent change in reimbursement were calculated and reported for each procedure. Between 2000 and 2024, unadjusted Medicare reimbursement for primary TKA and THA decreased by 22.3 and 17.7%, respectively. In contrast, reimbursement increased for colectomy by 20.8%, appendectomy by 15.7%, and total shoulder arthroplasty by 11.0%. After adjusting for inflation, the largest decreases in surgeon reimbursement were for primary TKA and primary THA, with decreases of 56.9 and 54.3%, respectively. The mean inflation-adjusted decrease in Medicare reimbursement for all nonarthroplasty procedures was 44.0%. Spine fusion, total ankle arthroplasty, femoral open reduction internal fixation, and total shoulder arthroplasty decreased by 50.8, 49.4, 43.6, and 38.4%, respectively. Inflation-adjusted reimbursement rates for all common inpatient procedures have dropped in the United States, with primary TKA and THA being the most importantly affected. Since 2000, the reductions in reimbursement for primary TKA and THA have been 4,750 and 3,788%, respectively, greater than the mean decline in reimbursement for the other most common inpatient procedures performed in the United States.