Medicare Reimbursement for Revision Arthroplasty Procedures Decrease Over 20+ Years, a Concerning Trend for Arthroplasty Subspecialists and Their Patients.

Abstract

Background: Numerous studies have highlighted a rise in procedure volume and fall in physician reimbursement for various primary arthroplasty procedures. The aim of our study was to investigate these same trends in revision hip, knee, ankle, elbow, shoulder, and wrist arthroplasty from 2000 to 2021.

Methods: The Medicare Part B National Summary Data File was analyzed for Current Procedural Terminology (CPT) codes related to revision knee, hip, shoulder, wrist, ankle, and elbow arthroplasty. For each code and year, the total number of procedures and total amount billed and reimbursed was collected. Monetary values were adjusted to the 2021 US Dollar.

Results: All procedures had full data from 2000 to 2021 except codes associated with rTSA and rTEA which only had data from 2013 to 2021. When comparing the first and last year of the study period, all codes had a percent increase in procedure volume except 27137 and 24370, which decreased by -51.6% and -5.3%, respectively. All codes had a percent decrease in reimbursement except 24370, which increased by 8.0%.

Conclusion: Orthopedic surgeons are performing more revision arthroplasty procedures while receiving lower inflation-adjusted reimbursement. This reduction reflects reimbursement not keeping pace with inflation rather than true cuts in absolute payment per procedure. Exceptions to this general trend include code 27137, which had a decrease in both metrics, as well as 24370, with a decrease in volume and increase in reimbursement. These developments should urge policymakers to reassess current reimbursement policies and how it may affect access to quality arthroplasty care.

Level of evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.