Volume-based Trends in Medicare Reimbursement for Plastic and Reconstructive Surgery Procedures from 2013 to 2022.

Abstract

Medicare reimbursement rates for plastic surgery have been consistently falling. Our study is the first to analyze reimbursement by case volume of all procedure codes billed to Medicare by plastic and reconstructive surgeons from 2013 to 2022. All procedure codes billed to Medicare Part B by plastic and reconstructive surgeons were extracted from the CMS Physician and Other Practitioners database. Reimbursements were determined through the Medicare Physician Fee Schedule. Dollar amounts were inflation-adjusted to 2022. 254 procedure codes were included for analysis. From 2013 to 2022, the mean Medicare reimbursement rate for plastic surgery procedures decreased by 22.2% from $337.01 in 2013 to $262.07 in 2022. This results in an average decrease of $7.16 annually (p<0.001). The largest average decreases in reimbursement were observed in musculoskeletal procedures (37.3%, $240.17 to $150.56) and flaps and grafts (31.7%, $617.14 to $421.50). The smallest average decreases in reimbursement were for nervous system (9.6%, $419.99 to $379.65) and hand and upper extremity procedures (14.3%, $610.64 to $523.61). Reimbursement for head and neck procedures decreased by 24.1% from $793.37 to $601.89. Reimbursement for breast procedures decreased by 19.5% from $1216.81 to $979.64. None of the procedure types in our study had an average increase in reimbursement. There was no correlation between changes in volume and reimbursement (R=0.01; p=0.848). Medicare reimbursement for plastic surgery is consistently decreasing regardless of case volume. The continued decline in reimbursement for plastic surgeons can have negative implications for practice management and access to care.