Medicare Reimbursement in Orthopaedic Foot and Ankle Surgery: A Continued Decline

Category: Other Introduction/Purpose: The absence of an annual inflationary update for physician reimbursement from the Centers for Medicare & Medicaid Services threatens the financial stability of orthopaedic practices nationwide. Inflation-adjusted Medicare physician reimbursement for foot and ankle procedures has decreased by over 30% from 2000 to 2020. The effects of recent inflationary trends on orthopaedic foot and ankle reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2024 for orthopaedic foot and ankle surgical procedures. Methods: The financial database of a single academic tertiary care center was queried to identify the Current Procedural Terminology (CPT) codes most frequently utilized in orthopaedic foot and ankle care. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the Consumer Price Index and reported in 2024 US dollars. The average annual and total percent change in reimbursement were calculated for included procedures. The compound annual growth rate (CAGR) was calculated using 2024 and 2000 inflation-adjusted monetary data. Results: Prior to adjusting for inflation, the average physician reimbursement decreased by 7.9% from 2000 to 2024 for all included foot and ankle CPT codes. After adjusting for inflation, the average physician reimbursement decreased by 48.0% for included CPT codes, with all 30 CPT codes decreasing by more than 40.8%. The greatest decrease in reimbursement observed from 2000 to 2024 was for open reduction internal fixation of calcaneal fracture at 58.9% ($2,697.69 to $1,109.05) followed by repair of flexor tendon at 58.5% ($886.82 to $368.05) and ankle arthroscopy at 55.4% ($1,031.07 to $459.40). The average CAGR was -2.83%. Conclusion: Our study demonstrates that Medicare physician reimbursement for common orthopaedic foot and ankle procedures continues to decrease at an unsustainable rate. It is imperative that policy-makers understand these untenable trends to ensure continued access to quality foot and ankle care, especially for Medicare beneficiaries.