Declining Overall Use of Cervical Disk Arthroplasty in Medicare Beneficiaries Despite Outpatient Migration, 2016 to 2022.

Abstract

Background: Cervical disk arthroplasty (CDA) has gained popularity as a motion-preserving alternative to anterior cervical diskectomy and fusion (ACDF) for treating cervical degenerative disk disease. The aim of this study was to evaluate national trends in Medicare use and reimbursement for CDA across settings, provider types, and geographic regions.

Materials and methods: This is a retrospective national database analysis using Centers for Medicare and Medicaid Services Medicare Part A and Part B claims from 2016 to 2022. Single- and multilevel CDA procedures were identified using Current Procedural Terminology and Medicare Severity Diagnosis Related Group codes. Inflation-adjusted payments and procedure counts were analyzed using descriptive statistics, linear regression, analysis of variance, and t tests. Subgroup comparisons included region, provider type, and core-based statistical area classification. Statistical significance was set at the P < .05 level.

Results: Outpatient single-level CDA volume increased by 1,016.0% from 2016 to 2022, whereas inpatient CDA volume decreased by 90.3%. Outpatient reimbursement rose from $1,459 to $3,143 (P = .011), whereas inpatient reimbursement increased from $24,956 to $32,679 (P = .025). Reimbursement was significantly higher in ambulatory surgical centers than for surgeon-only claims ($11,869 vs $1,219; P < .001), and in inpatient settings compared to surgeons (P < .001). Regional and rural-urban variation was observed, with the West consistently demonstrating higher reimbursement and volume for both outpatient and inpatient CDA.

Conclusion: CDA procedures have shifted dramatically toward outpatient care, with marked differences in Medicare reimbursement across provider types and regions.