Decreasing medicare reimbursement for transforaminal lumbar interbody fusions.

Abstract

PURPOSE: Despite its demonstrated clinical utility, Medicare reimbursement for transforaminal lumbar interbody fusion (TLIF) has experienced recent policy-driven changes. This study analyzed national trends in Medicare payments for TLIF from 2013 to 2023. METHODS: This retrospective cohort study compared Medicare payments for TLIF between orthopaedic surgeons and neurosurgeons utilizing data from the Center for Medicare and Medicaid Services (2013 to 2023). Payment data included number of services, inflation-adjusted average Medicare standardized amount (AMSA), and annual procedural income (API), which was calculated by multiplying AMSA and number of services. RESULTS: Neurosurgeons billed fewer average services per year (22.7 vs. 23.4; p = 0.008) and had lower API ($37,521 vs. $39,043; p = 0.002) than orthopaedic surgeons. Spine surgeons experienced a $434 (24%) decrease in inflation-adjusted procedural reimbursement over the study period ($1,344 vs. $1,779; p < 0.001). The API for spine surgeons in 2023 was $11,921 (28%) less than the API in 2013 ($42,215 vs. $30,294; p < 0.001). Neurosurgeons experienced a 24% decrease in inflation-adjusted AMSA ($1,777 vs. $1,359; p < 0.001) and a 26% decrease in API ($41,199 vs. $30,380; p < 0.001) over the study period. Orthopaedic surgeons experienced a 25% decrease in inflation-adjusted AMSA ($1,780 vs. $1,329; p < 0.001) and a 30% decrease in API ($43,261 vs. $30,209; p < 0.001) over the study period. CONCLUSION: Inflation-adjusted Medicare reimbursement for TLIF has decreased over the past decade, despite stable case volumes and growing surgeon experience. These findings underscore increasing financial pressures associated with performing TLIF for Medicare beneficiaries.