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Trends in Medicare and Medicaid Reimbursement for Metacarpophalangeal and Interphalangeal Joint Arthroplasty 2000-2025
Paige Cummings, MD
1, Adam Henderson, BS
1, Westin Keime, BS
2; Keith T Aziz, M.D.
3(1)Mayo Clinic, Jacksonville, FL, (2)Rocky Vista University, St George, UT, (3)Mayo Clinic Florida, Jacksonville, FL
Introduction: Metacarpophalangeal (MP) joint and interphalangeal (IP) joint arthroplasty are widely accepted interventions for treatment of small joint arthritis refractory to non-operative management . Small joint arthroplasty can aide in pain relief, functional stability, and correction of aesthetic deformity. Despite this, little research exists on reimbursement and utilization trends for these procedures. The purpose of this study was to characterize Medicare reimbursement trends for MP and IP joint arthroplasty over time, along with trends in Medicare utilization and comparison to Medicaid reimbursement.
Materials and Methods: Medicare reimbursement for Current Procedural Terminology (CPT) codes: 26530, 26531, 26535, and 26536 were collected from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool). The Consumer Price Index Inflation Calculator was used to convert all rates into 2025 dollars. Unadjusted and inflation-adjusted trends were analyzed from 2000-2025. Medicare utilization trends from 2000 to 2025 were analyzed using CMS part B data. To compare current Medicare and Medicaid reimbursement, 2025 Medicare rates were obtained from the CMS Physician Fee Schedule Look-Up Tool and most recent Medicaid rates were collected from state fee schedules. Average rates were compared between Medicare and Medicaid, along with dollar differences for each procedure code, with and without adjustment for work Relative Value Units (wRVUs).
Results: Inflation-adjusted Medicare reimbursement for small joint arthroplasty decreased by 48.47% from 2000-2025, averaging a 2.85% annual decline. Utilization trends remained stable, for MP joint arthroplasty (26530), IP joint arthroplasty (26535), and IP joint arthroplasty with prosthetic implant (26536). Medicaid reimbursed 14.4% less than Medicare on average, with substantial state variability, ranging from 44.47% (New Hampshire) to 150.54% (New Mexico) of Medicare reimbursement.
Conclusions: Reimbursement for small joint arthroplasty has declined significantly despite stable utilization in the Medicare population. Medicaid reimbursement is consistently lower and highly variable by state, potentially impacting access to care. Given the effectiveness of small joint arthroplasty in pain relief, preserving motion, and improving hand function policy makers should advocate for equitable reimbursement for this procedure.
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