Medicare Reimbursement Trends in Sleep Surgery: A 2 Decade Analysis of the Most Billed Codes

OBJECTIVES: The prevalence of sleep-disordered breathing, including obstructive sleep apnea, has driven the rapid growth of sleep surgery as a subspecialty. Medicare reimbursement plays a pivotal role in the economic viability of sleep surgery, but trends remain understudied. This study analyzes reimbursement trends for commonly performed sleep surgery procedures from 2000 to 2024, assessing inflation-adjusted changes in facility-based professional reimbursement. METHODS: The 11 most frequently billed sleep surgery procedures at a single institution in 2024 were identified. Medicare data on facility-based professional reimbursement were extracted from 2000 to 2024 using the CMS Physician Fee Schedule. Inflation adjustments were applied using the CPI Inflation Calculator. Year-to-year percentage changes and linear regression analyses were performed. RESULTS: = .88). Other procedures, such as CPT 30140 (Submucous Resection of Inferior Turbinate) and CPT 31231 (Diagnostic Nasal Endoscopy), experienced aggregate declines exceeding 58%. Procedures like CPT 30130 (Excision of Inferior Turbinate) showed relatively stable pricing with a 2.6% aggregate reduction. CONCLUSION: The substantial decline in inflation-adjusted facility prices for sleep surgery procedures underscores challenges in sustaining the financial and operational viability of this growing subspecialty. Reduced reimbursement may hinder innovation, training, and resource allocation, with potential downstream impacts on patient access and care. Policymakers should consider these findings to ensure equitable and sustainable support within the healthcare system. LEVEL OF EVIDENCE: 4.

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Publication Details

Journal
Annals of Otology Rhinology & Laryngology
Published
2026-04-27
DOI
https://doi.org/10.1177/00034894261441050
Primary Topic
Obstructive Sleep Apnea Research
Type
article
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article

Medicare Reimbursement Trends in Sleep Surgery: A 2 Decade Analysis of the Most Billed Codes

Antony A. Fuleihan, Colin T. Huntley, Maurits S. Boon, Praneet Kaki et al.
Annals of Otology Rhinology & Laryngology
Obstructive Sleep Apnea Research
article

Medicare Reimbursement Trends in Sleep Surgery: A 2 Decade Analysis of the Most Billed Codes

Antony A. Fuleihan, Colin T. Huntley, Maurits S. Boon, Praneet Kaki, Tyler J. Allcroft, Anders Sideris
article en

Abstract

OBJECTIVES: The prevalence of sleep-disordered breathing, including obstructive sleep apnea, has driven the rapid growth of sleep surgery as a subspecialty. Medicare reimbursement plays a pivotal role in the economic viability of sleep surgery, but trends remain understudied. This study analyzes reimbursement trends for commonly performed sleep surgery procedures from 2000 to 2024, assessing inflation-adjusted changes in facility-based professional reimbursement. METHODS: The 11 most frequently billed sleep surgery procedures at a single institution in 2024 were identified. Medicare data on facility-based professional reimbursement were extracted from 2000 to 2024 using the CMS Physician Fee Schedule. Inflation adjustments were applied using the CPI Inflation Calculator. Year-to-year percentage changes and linear regression analyses were performed. RESULTS: = .88). Other procedures, such as CPT 30140 (Submucous Resection of Inferior Turbinate) and CPT 31231 (Diagnostic Nasal Endoscopy), experienced aggregate declines exceeding 58%. Procedures like CPT 30130 (Excision of Inferior Turbinate) showed relatively stable pricing with a 2.6% aggregate reduction. CONCLUSION: The substantial decline in inflation-adjusted facility prices for sleep surgery procedures underscores challenges in sustaining the financial and operational viability of this growing subspecialty. Reduced reimbursement may hinder innovation, training, and resource allocation, with potential downstream impacts on patient access and care. Policymakers should consider these findings to ensure equitable and sustainable support within the healthcare system. LEVEL OF EVIDENCE: 4.

Annals of Otology Rhinology & Laryngology
Johns Hopkins University (US), Thomas Jefferson University Hospital (US)
Industry, innovation and infrastructure
Openalex Percentile: Top 9%
Obstructive Sleep Apnea Research
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