Trends of Medicare Reimbursement Rates for Common Plastic Surgery Procedures

Charalampos Siotos, M.D.; Michael A. Cheah, M.D.; George Damoulakis, M.S.; Jonathan Kelly, M.B.B.S., B.Ch.D.; Kalliopi Siotou, D.D.S.; Loren S. Schechter, M.D.; Deana S. Shenaq, M.D.; Gordon H. Derman, M.D.; Amir H. Dorafshar, M.D.

Disclosures

Plast Reconstr Surg. 2021;147(5):1220-1225. 

In This Article

Results

An overall average increase in Medicare reimbursement of 2.02 percent was observed from 2010 to 2020 (Figure 1 and Table 2). In particular, the change was −2.32 percent for general plastic surgery procedures (CPT codes 13131, 14300/14301, 15100, 15240, 15736, 15738, and 15830), 2.21 percent for hand surgery (CPT codes 25000, 25265, 25820, 26356, and 26615), 6.34 percent for peripheral nerve surgery (CPT codes 64708, 64721, and 64831), 6.71 percent for craniofacial surgery (CPT codes 21390, 30420, 40700, 42200, and 62140), and 0.83 percent for breast surgery (CPT codes 19318, 19340 19357, 19361, 19366, and 19380).

Figure 1.

Unadjusted differences of Medicare reimbursement rates from 2010 to 2020 for 26 common plastic surgery procedures based on CPT codes. Procedures in orange represent general reconstructive CPT codes; pink, breast surgery codes; green, hand surgery; blue craniofacial surgery; and yellow, peripheral nerve surgery.

For the period between 2010 and 2020, the consumer price index increased 19 percent. After adjusting for the rate of inflation, the average overall Medicare reimbursement decreased by 14.31 percent between 2010 and 2020. The calculated compound annual growth rate for the study period was −1.55 percent, indicating an average annual decrease in reimbursement for the selected procedures during the period 2010 to 2020 (Table 3). In particular, the changes were −17.95 percent for general plastic surgery procedures, −14.14 percent for hand surgery, −10.67 percent for peripheral nerve surgery, −10.36 percent for craniofacial surgery, and –15.31 percent for breast surgery.

During these years, on average, there was a 0.95 percent decrease of physician-based work relative value unit charges, a 3.87 percent increase of facility-based relative value unit charges, and a 23.44 percent increase of malpractice-based relative value unit charges (Table 4). We also observed a decrease of the conversion factor by 1.06 percent for all the procedures.

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