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Decline in Hand Surgery Procedure Reimbursements Vary Widely Over Last Fifteen Years in the United States
Joshua W. Hustedt, MD, MHS1; Michael Murri, BS2; Jill A. Goodwin, MD3
1University of Arizona-Phoenix College of Medicine, Phoenix, AZ; 2Baylor College of Medicine, Houston, TX; 3Banner-University Medical Center, Phoenix, Phoenix, AZ

Introduction: Reimbursement rates for surgical procedures have been slowly declining over the past 15 years in the United States. We sought to examine the rate of decline in the most commonly performed hand surgery procedures and compare that decline to the overall decline in general orthopedic procedures.
Materials and Methods: The top 25 most common current procedural terminology (CPT) codes were selected for hand surgery and general orthopedics from the American Academy of Orthopedic Surgeons Part 2 database. Medicare reimbursement rates were identified for each CPT code from the yearly Physician Fee Schedule provided by the Centers for Medicare and Medicaid Services. Reimbursements were adjusted for inflation throughout the study period according to the Consumer Price Index. T-tests were utilized to examine differences in average reimbursement declines over time.
Results: 48 of 50 (96%) CPT codes experienced a decline throughout the study period. The average rate of decline for hand surgery procedures was 22.2%. However, reimbursement declines varied widely from a 5.5% increase (open treatment of metacarpal fracture) to a 40.9% decrease (wrist arthroscopy; p<0.001). In comparison, general orthopedic procedures declined significantly more than hand surgery procedures over the study period (33.5% versus 22.2%; p<0.001). Overall, the average reimbursement for the most common hand procedures has not declined since 2007, while general orthopedic procedures have continued to decline.
Conclusions: There are wide discrepancies among declining reimbursement rates in hand surgery. These wide discrepancies could mean large differences in practice revenues based on procedure volumes and subspecialties within hand surgery. Overall, hand surgery reimbursements have plateaued since 2007, while general orthopedic procedures continue to decline.

CPT Code Description of Procedure Percent Decline
Top 5    
29846 Arthroscopy, wrist 40%
26115 Excision, tumor or vascular malformation 35%
24685 Open treatment of ulnar fracture 31%
25000 Incision tendon, (e.g., De Quervain disease) 31%
26055 Incision tendon, (e.g., for trigger finger) 31%
Bottom 5    
26615 Treatment of metacarpal fracture 12%
26951 Amputation, finger or thumb 12%
11760 Repair of nail bed 5%
64718 Neuroplasty and/or transposition; ulnar 5%
26746 Treatment of metacarpal fracture; articular 5% Increase

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