Reimbursement for Maxillofacial Surgery: Regional Analysis of the Physician Fee Schedule Reveals Unique Payment Increases in the Western United States From 2010 to 2019

Abstract

AbstractIntroductionMedicare Part B reimbursement data has been thoroughly evaluated in several surgical subspecialties to date, with significant ramifications for continued policy research and payment reform discussions. However, trends in maxillofacial surgery payment remain unstudied.MethodsIn this cross-sectional study of Part B reimbursement data, we analyzed regional trends in reimbursement for common maxillofacial repair and reconstruction procedures (N=17). All payment data converted to January 2019 United States dollars.ResultsFrom 2010 to 2019, fees for maxillofacial surgery evidenced strong region- and procedures-specific changes. After adjusting for inflation, the Southern United States reported an unweighted mean change in Medicare reimbursement of negative 12.59% (SD = 2.63%), while the Western United States reported an unweighted mean change in Medicare reimbursement of +0.08% (SD = 2.82%). In the Midwest, only Part B billing for reconstruction of the mandibular rami and/or body without internal rigid fixation (CPT code 21195) kept up with inflation. In the West, 8 CPT codes (47%) kept up with inflation: 21422, 21246, 21196, 21195, 21194, 21193, 21048, and 21046. In the Northeast and the South, all analyzed procedures reported decreased reimbursement rates after adjusting for inflation.ConclusionReimbursement for maxillofacial surgery has lagged behind inflation with pronounced regional bias.