National and Location-Specific Medicare Physician Fee Reimbursement Trends in Urologic Oncology From 2002 to 2024.

Introduction: In recent years, Medicare physician reimbursement has been a target for national health care spending adjustments, but detailed national and location-specific trends in urologic oncology are lacking. This study investigated reimbursement trends over the past 2 decades.

Methods: The Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool was used to extract physician reimbursement data for urologic oncology procedures from 2002 to 2024. We analyzed 20 common or relevant urologic oncology Current Procedural Terminology codes. Reimbursement data were recorded biennially and inflation adjusted to 2024 US dollars. The compound annual growth rate (CAGR) over the study period was calculated for each procedure. Location-specific reimbursement trends were analyzed for robot-assisted radical prostatectomy (RARP, Current Procedural Terminology 55866) in all available Medicare localities (n = 89).

Results: Reimbursement data for the 20 procedures were retrieved with an average inflation-adjusted percentage change of -41.08% from 2002 to 2024. For all procedures, the 2014 to 2024 CAGR indicated a faster rate of decline compared with the 2002 to 2014 CAGR. RARP showed the most significant inflation-adjusted decline. Kidney procedures experienced an average inflation-adjusted CAGR of -2.15%, bladder -2.49%, prostate -2.53%, and testicular -2.34%. Open surgeries averaged a CAGR of -2.32%, endoscopic -2.60%, and laparoscopic/robotic -2.73%. Reimbursement for RARP declined across all 89 Medicare localities from 2014 to 2024, with slight variability in magnitude.

Conclusions: Inflation-adjusted Medicare physician reimbursement has been declining for all urologic oncology procedures over the past 2 decades, with more substantial declines noted in recent years. As key stakeholders, urologists must remain active in policy decisions pertaining to physician reimbursement.