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A Regional Analysis Of Medicare Reimbursement Rates For Plastic Surgery
Jason Zhang, B.S., May Li, B.A., Hannah Soltani, B.A., Sophia G. Allison, B.A., Puja Jagasia, B.A., Christian Arcelona, B.S., Michael A. Howard, M.D., Chad M. Teven, M.D., M.B.A..
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
PURPOSE: The purpose of this analysis is to highlight trends in Medicare reimbursement rates in recent years and examine any regional differences in reimbursements that may exist over the past decade.
METHODS: The CMS Physician/Supplier Procedure Summary database was used to extract the top 50 plastic surgery HCPCS codes in 2022 by volume. These codes were further sorted into one of six categories: breast, free flap, integumentary, peripheral nerve and tendon, patient visit, and other. The Medicare Physician Fee Schedule Database was then used to analyze trends in reimbursements for these procedure codes from 2012 to 2024. Dollar amounts were inflation-adjusted to 2021 estimates based on consumer price index (CPI) values.
RESULTS: From 2012 - 2024, the mean overall reimbursement rate for plastic surgery procedures fell 29.3% from $561.31 to $397.08. Breast procedures had the largest decrease (32.5%, $930.67 to $627.88), while patient visit procedures had the smallest decrease (15.2%, $97.64 to $82.81). Nevada (33.8%, $581.95 to $384.98) and Wyoming (32.5%, $566.20 to $381.99) had the most dramatic decreases in reimbursement rate, while Puerto Rico (10.6%, $436.34 to $390.25) and Washington (28.0%, $574.94 to $413.67) had the smallest decreases in reimbursement rate. The Midwest had the largest decrease in reimbursement rate (30.8%, $546.45 to $378.40).
CONCLUSION: Medicare reimbursement rates for plastic surgery are decreasing nationally, most drastically for breast procedures and in the Midwest region, which may have important indications for shaping practice and fair compensation for services.
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