Medicare Reimbursement Trends in Zenker's Diverticulectomy

Objective

To analyze Medicare reimbursement and utilization trends of Zenker's diverticulectomy from 2000 to 2024.

Study Design

Retrospective cross-sectional study.

Setting

Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule (2000–2024) and Part B Medicare Fee-For-Service National Summary Data (2000–2022).

Methods

Utilization and payment trends for open (Current Procedural Terminology [CPT] code 43130) and endoscopic (CPT code 43180, introduced in 2015) repair of Zenker's diverticulum were analyzed, with reimbursement rates adjusted for inflation using the Consumer Price Index (CPI). Linear regression analysis was performed to assess the relationship between reimbursement rates and time.

Results

From 2000 to 2022, the total number of Zenker's diverticulectomy procedures decreased by 14.8% (1775–1513), with a 72.1% decrease (1775–495) for open approach. There was a 22.5% increase (831–1018) in endoscopic approach from 2015 to 2022. By 2022, endoscopic procedures accounted for 67.3% of all Zenker's diverticulectomies, compared to 32.7% for the open approach. From 2000 to 2024, inflation-adjusted reimbursement for open procedures declined by 49.96% ($1586.26–$670.41), with an annual decrease of 2.08%. Endoscopic procedures, tracked separately from 2015 to 2024, saw a 29.32% decline ($773.24–$547.13) and an annual decrease of 3.26%. Unadjusted reimbursement for both approaches combined declined by an average of 0.88% per year, while inflation-adjusted rates decreased by 3.45% annually (p < 0.001).

Conclusion

There has been a downward trend in the Medicare reimbursement of Zenker's diverticulectomy, with an average adjusted decline of 3.45% annually. This trend raises concerns about the sustainability of such specialized procedures, potentially limiting access for elderly patients reliant on Medicare coverage.

Level of Evidence

4.