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Trends In Medicare And Medicaid Reimbursement For Total Wrist Arthroplasty
Adam Henderson, BS
1, Westin Keime, BS
2, Peter Murray, MD
3; Keith T Aziz, M.D.
4(1)Mayo Clinic, Jacksonville, FL, (2)Rocky Vista University, St George, UT, (3)Department of Orthopedic Surgery/Division of Hand Surgery, The Mayo Clinic, Jacksonville, FL, (4)Mayo Clinic Florida, Jacksonville, FL
INTRODUCTION: Total wrist arthroplasty (TWA) is a motion sparing procedure for treatment of radiocarpal arthritis refractory to non-operative management. Despite this, little research exists on reimbursement and utilization trends for this procedure. The purpose of this study was to characterize Medicare reimbursement trends for TWA, along with trends in Medicare utilization and comparison to Medicaid reimbursement.
MATERIALS AND METHODS: State Medicaid rates were obtained from each states' online physician fee schedule for the Current Procedural Terminology (CPT) codes 25446 (total wrist arthroplasty), 25332 (total wrist arthroplasty with interposition), and 25449 (revision total wrist arthroplasty). Tennessee was excluded from the study as the state Medicaid program does not include a fee-for-service payment model. Medicare rates were identified by state using Medicare Administrative Contractor (MAC) localities, which approximate state lines, and obtained from the Centers for Medicare & Medicaid Services (CMS) website for 2024. Reimbursement was compared between Medicare and Medicaid on a state and national level, using averages for each CPT code. Variability between states was assessed using coefficient of variation. To assess the trend in Medicare reimbursement over time, rates for the three CPT codes were collected from 2000-2024 using the CMS Physician Fee Schedule database. All MAC localities nationwide were averaged for each year to represent the entirety of the United States. An inflation calculator was used to adjust each years' rates to 2024 dollars to assess the trend in inflation-adjusted reimbursement.
RESULTS: Nationally, Medicaid reimbursement overall for the three total wrist arthroplasty codes was 16.8% less than Medicare. 37 total states with lower average Medicaid reimbursement compared to Medicare (
Figure 1). The coefficient of variation values were 0.06 for all codes for Medicare and ranged from 0.26-0.31 for Medicaid. From 2000 to 2024, overall Medicare reimbursement for these procedures increased by 2.3% (0.10% per year). When adjusted for inflation, reimbursement decreased by 44.2% (1.8% per year,
Figure 2).
Conclusions: High variability exists in Medicaid reimbursement, representing wide differences in rates between states. Inflation-adjusted Medicare reimbursement has decreased 44.2% for total wrist arthroplasty over the past 25 years.
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