Trends in Medicare and Medicaid Reimbursement for Total Wrist Arthroplasty

Abstract Total wrist arthroplasty (TWA) is a motion-sparing surgical alternative to wrist arthrodesis for patients with radiocarpal arthritis, but prior reports have indicated that its utilization remains limited. This study aimed to quantify Medicare and Medicaid reimbursement for TWA, along with utilization trends for the procedure using Medicare data. Medicare and Medicaid reimbursement rates for three TWA Current Procedural Terminology (CPT) codes—25446 (TWA), 25332 (TWA with interposition), and 25449 (revision TWA)—were collected for all states except Tennessee for the year 2024 and compared with each other. Prior Medicare rates from 2000 to 2023 were also obtained, adjusted for inflation to represent 2024 dollars, and analyzed for reimbursement trends with a two-tailed t-test between average inflation-adjusted 2000 and 2024 reimbursement. Utilization data from 2000 to 2022 were obtained from the Medicare Part B database. Medicaid reimbursement averaged 16.8% less than Medicare across the three TWA codes, with high variability between states. Inflation-adjusted Medicare reimbursement decreased by an average of 44.2% from 2000 to 2024, with the greatest decline seen in CPT 25446 (TWA) with a 45.1% decrease. Reimbursement for all three codes had decreased significantly from 2000 to 2024 via the two-tailed t-test. Besides an initial dramatic fall from 2000 to 2021 for revision TWA, Medicare utilization gradually increased, with 25332 (TWA with interposition) being the most commonly billed code. TWA reimbursement has decreased significantly over the past two decades for Medicare. Current Medicaid reimbursement is substantially less than Medicare. Although utilization has increased modestly, low reimbursement, along with a variety of other factors, may contribute to a limited adoption of TWA. Addressing these disincentives may encourage further innovation and technological development in TWA.