April 08, 2020
1 min read

Decline in CMS spine procedure reimbursement seen in 19-year period

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Results of a database study showed the average Medicare reimbursement for 15 common spine procedures decreased by 26% between 2000 and 2019.

Jack Haglin

For the study, which was scheduled to be presented at the American Academy of Orthopaedic Surgeons Annual Meeting, Jack Haglin, BS, and colleagues queried the National Surgery Quality Improvement Project database to identify the 15 most commonly performed spine surgery procedures. They extracted reimbursement data from the CMS Physician Fee Schedule Look-Up Tool for each of the 15 most utilized CPT codes in spine surgery. Researchers adjusted the monetary data for inflation to 2019 U.S. dollars and incorporated changes to the consumer price index.

The calculated average annual change and total percentage change in reimbursement for the procedures included in the study led researchers to conclude that, overall, procedure reimbursements decreased between 2000 and 2019.

“Given a recent shift toward incentivizing high-value care within public insurance payment models for spine surgery, we identified a need to assess and understand recent trends in Medicare reimbursement to spine surgeons. In doing so, we found that when adjusting for inflation, the mean Medicare physician reimbursement for common spine procedures has decreased by over 26% from 2000 to 2019,” Haglin told Healio Orthopedics.

Researchers found anterior cervical arthrodesis had the greatest mean decrease in reimbursement for the period studied, which was -32.2%.

In addition, researchers found vertebral body excision was associated with a -13.5% mean decrease in reimbursement, which was the smallest mean decrease identified by their analysis.

“From 2000 to 2019, the adjusted reimbursement rate for all included procedures decreased by an average of 1.7% each year,” Haglin and colleagues wrote in the study abstract.

“Increased awareness and consideration of these trends will be important moving forward for policy makers, hospitals and physicians as continued progress is made to advance agreeable reimbursement models that allow for the sustained growth of spine surgery within the United States,” Haglin said. – by Susan M. Rapp



Haglin J, et al. ePaper 259. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).


Disclosure: Haglin reports no relevant financial disclosures.