104. Trends in Medicare Reimbursement Rates for Common Procedures in Pediatric Neurosurgery from 2000-2019

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Authors: Sarah A. Merrill; Andrew Pines; Walker Asprey; Jack Haglin; Kent Richter; David Daniels, MD, PhD (Mesa, AZ)

Introduction:

There is currently a scarcity of published data on financial trends for Medicare reimbursement for procedures in pediatric neurosurgery. Analysis of this data will aid the development of reimbursement models that allow for sustainable, high-quality care of pediatric neurosurgical patients. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for common procedures in pediatric neurosurgical care from 2000 to 2019.

Methods:

The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for each of the included Current Procedural Terminology (CPT) codes and reimbursement data was extracted. The list of CPT codes was compiled utilizing the 10 most commonly performed procedures in neurosurgery for patients <=17 years old at the Rochester campus of the Mayo Clinic. We recorded the rate of reimbursement change for all procedures during from 2000-2019 and determined statistical significance using an unpaired t-test. All monetary data was adjusted for inflation to 2019 US dollars (USD) utilizing changes to the United States consumer price index (CPI). 

Results:

Adjusting for inflation, the average reimbursement from 2000 to 2019 for 10 common procedures in pediatric neurosurgery decreased by 32.77%. This change was statistically significant (p < .0001).  Reimbursement data was not available for stereotactic computer-assisted intracranial procedures prior to 2010 and not included in the above average. Reimbursement for this procedure has decreased by 8.11% since 2010; this was also statistically significant (p=.0003).

Conclusion:

This is the first known study to evaluate trends in Medicare reimbursement for pediatric neurosurgical procedures. When adjusted for inflation, reimbursement for the included procedures decreased markedly from 2000 to 2019. Increased awareness and consideration of these trends will aid policy-makers, hospitals, and physicians to assure continued access to meaningful care in the United States.

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