No Exceptions: Inflation-Adjusted Medicare Reimbursement Fell for Every High-Volume Orthopaedic Procedure from 2013 to 2023

Abstract

Introduction: Medicare is the largest federal health insurance program, covering more than 66 million beneficiaries. Reimbursement rates can affect patient access to care. We hypothesized a decline in reimbursement rates for the 20 most frequently billed orthopaedic procedures from 2013 to 2023.

Methods: The top 20 orthopaedic CPT codes were extracted from CMS data. Medicare professional payments were extracted from the CMS Physician Fee Schedule (PFS) and adjusted for inflation. Annual trends in reimbursement rates were analyzed.

Results: All procedures showed declining reimbursement rates from 2013 to 2023 (p < 0.0001). The mean annual decline was $26.26, and reimbursement ranges fell from $231–$2,321 in 2013 to $173–$1,771 in 2023. All CAGR values were negative, indicating consistent annual declines.

Conclusions: Inflation-adjusted Medicare reimbursement rates for high-volume orthopaedic procedures have consistently declined from 2013 to 2023. These findings raise questions about implications for economic barriers to patient access, hospital financial stability, and academic practice viability. Future investigations should compare Medicare and private insurance rates and evaluate procedure utilization rates, in order to help determine whether declining economic trends reduce access to orthopaedic care for older patients.

Level of Evidence: Level III; Retrospective Longitudinal Economic Analysis

Keywords: Medicare; reimbursement; orthopaedic surgery; physician fee schedule; inflation; Current Procedural Terminology; healthcare economics; patient access