Comparing Otolaryngology Subspecialties' Changes in Medicare Reimbursement From 2013 to 2024.

Abstract

Objective: Identify differences in Medicare reimbursement changes for general otolaryngology, pediatric otolaryngology, head and neck oncology, laryngology, rhinology, otology, facial plastic and reconstructive surgery, and sleep surgery subspecialties from 2013 to 2024.

Methods: Subspecialty-based procedures' facility prices and relative value units (RVUs) were sourced from the Centers for Medicare & Medicaid Services' Physician Fee Schedule. Prices were adjusted for inflation, and the average percent change in facility price and RVUs for each subspecialty was calculated. Each subspecialty's average inflation-adjusted, facility price change was compared to general otolaryngology using t-tests, and differences between subspecialties were assessed using Dunn's test.

Results: From 2013 to 2024, general otolaryngology's average percent change was -29.9% and significantly differed from facial plastic and reconstructive surgery (-26.4% [-5.5 to -0.7%]; p = 0.011) and sleep surgery (-23.7% [-19.2 to -2.2%]; p = 0.016). Rhinology (-32.5% [-1.3 to 6.1%]), otology (-30.2% [-6.5 to 7.6%]), laryngology (-29.3 [-4.2 to 2.1%]), head and neck (-27.4% [-5.7 to 0.2%]), and pediatric otolaryngology (-25.8% [-14.6 to 3.8%]) also decreased drastically but were not significantly different from general otolaryngology. For the multiple comparisons test, rhinology was statistically different from sleep surgery and facial plastic and reconstructive surgery.

Conclusion: General otolaryngology and rhinology were more negatively affected due to changes in work and practice expense RVUs. Universal decreases were due to inflation and legislative reductions to the conversion factor. Medicare's budget constraints, potential effects on access to otolaryngology services, and continuing inflation warrant lobbying efforts to address these changes to maintain financial viability.

Level of evidence: NA Laryngoscope, 2025.