Evaluating Medicare Trends for Traumatic and Elective Hand Procedures

Abstract

Objectives: The CDC estimates that approximately 25% of the U.S. population will be 65 years or older by 2060, reflecting projected increases in Medicare utilization and presenting new challenges for patients and providers. The objective of this study is to evaluate trends in Medicare reimbursement and utilization for trauma–related and elective hand surgeries. We hypothesize that historical trends in inflation–adjusted reimbursements will continue to decline; to compensate, procedural volume is expected to increase. 

Design: Retrospective economic trend analysis of CMS Physician Fee Schedule reimbursement and Medicare Part B procedural utilization data from 2007 to 2025.

Patients: People enrolled in Medicare who underwent surgery were categorized using the following CPT codes: 25609, 26720, 26600, 25630, 64721, 25000, 26123, 25111, 64719, 26055.

Main Outcome Measures: CPT code utilization, nominal reimbursement, inflation–adjusted reimbursement, Physician Fee Scale, and Facility Payments over time.

 Results: After adjusting for inflation, reimbursements for both traumatic and elective hand procedures declined, while RVUs increased. For traumatic procedures, distal radius fracture volumes rose, whereas metacarpal and phalangeal fracture volumes decreased. Most elective procedure volumes increased, except for ganglion cyst and Guyon’s canal releases. Facility payments were slightly lower than physician fee schedule reimbursements across all procedures.

Conclusions: From 2007 to 2025, inflation–adjusted Medicare reimbursement declined across all examined hand procedures despite consistent increases in RVUs. Traumatic procedures saw inflation–adjusted physician fee reductions of approximately 20% to 33%, while elective procedures declined by roughly 28% to 35%, with facility payments decreasing by as much as 41% for select elective cases. During the same period, utilization increased substantially for high–volume procedures, including distal radius fracture open reduction internal fixation and carpal tunnel release. These findings demonstrate a sustained divergence between rising procedural demand and declining real reimbursement, suggesting increasing financial pressure on surgeons caring for an expanding Medicare population.

Level of Evidence: Level IV; Retrospective Administrative Database Study

Keywords: Medicare reimbursement; Physician Fee Schedule; Relative Value Units (RVUs); inflation-adjusted reimbursement; hand surgery; orthopaedic hand procedures; distal radius fracture; carpal tunnel release; procedural utilization; healthcare economics; CMS; ambulatory surgical center; facility payments; Medicare Part B; reimbursement trends.