Study: Medicare reimbursement for septic revision TKA has not kept up with inflation
Medicare physician fee reimbursement for septic revision total knee arthroplasty has not kept up with inflation and has been devalued at a greater rate than aseptic revision TKA, according to published results.
Tarun K. Jella, MPH, and colleagues used the CMS Physician Fee Schedule Look-Up Tool to analyze physician fees associated with CPT codes related to septic one-stage revision TKA, septic 2-stage revision TKA and aseptic revision TKAs from 2002 to 2019.
According to the study, researchers adjusted physician fee values for ination and calculated cumulative annual percentage changes to compare rates between procedures.
Jella and colleagues found total mean Medicare reimbursement decreased 24.21% for aseptic one-stage revision TKA and 24.83% for aseptic two-stage revision TKA, while reimbursement fees decreased 23.29% for septic revision TKA with explantation and 33.47% for septic revision TKA with reimplantation.
“Both the dollar amount and the percentage of the total Medicare reimbursement decline for septic revision TKA were signicantly greater than the decline for aseptic revision TKA,” Jella and colleagues wrote in the study. “These ndings suggest a failure of the current CMS reimbursement algorithm to maintain incentives related to [prosthetic joint infection] PJI management. Consequently, this may obstruct patients requiring specialized care from nding providers willing to take on the nancial consequences associated with septic revision TKA,” they wrote.