Declining Medicare Reimbursement for Total Ankle Arthroplasty: A Comparison of Podiatrists and Orthopaedic Surgeons, 2014 to 2023

BACKGROUND: Total ankle arthroplasty (TAA) is a well-established motion-preserving treatment for end-stage ankle arthritis. Although utilization has increased, declining Medicare payments for orthopaedic procedures remains a growing concern. Limited data exist comparing Medicare reimbursement trends for TAA between orthopaedic surgeons and podiatrists performing this procedure. METHODS: A retrospective analysis of the Centers for Medicare & Medicaid Services Medicare Physician and Other Practitioners database was done from 2014 to 2023 using Current Procedural Terminology code 27702. Providers billing ≥10 TAA procedures annually were included and stratified by specialty. Provider demographics, geographic distribution, mean reimbursement (average Medicare standardized amount), and annual procedural income (API) were analyzed. All payments were adjusted to 2023 US dollars using the Consumer Price Index. Statistical comparisons were made with t-tests and Chi-squared analyses with alpha set at 0.05. RESULTS: A total of 388 providers (351 orthopaedic surgeons, 37 podiatrists) performed 6,263 TAAs for Medicare beneficiaries over the study period. Podiatrists represented 9.5% of all providers and 8.3% of all TAA procedures. Podiatrists were reimbursed $61 (7.4%) more per TAA than orthopaedic surgeons ($890 ± $138 vs. $829 ± $167; P = 0.033) and had a higher mean payment ratio (0.25 ± 0.07 vs. 0.21 ± 0.11; P = 0.004). No notable differences existed in mean APIs between podiatrists and orthopaedic surgeons (P = 0.409). After inflation adjustment, reimbursement decreased 24% for podiatrists and 18% for orthopaedic surgeons, corresponding to API declines of 36% and 22%, respectively, over the study period. CONCLUSIONS: Between 2014 and 2023, Medicare reimbursement for TAA declined markedly for foot and ankle surgeons. Continued reductions in Medicare payments may threaten practice sustainability and patient access to specialized foot and ankle reconstructive care.