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Trends in Medicare and Medicaid Reimbursement in Hand Surgery: A 10-Year Analysis
Aishu Ramamurthi, MD
1, Gokul Kalyanasundaram, MD
2, Iris Y Deng, BS
3; Sarah Sasor, MD
1(1)Medical College of Wisconsin, Milwaukee, WI, (2)University of Pennsylvania, Philadelphia, PA, (3)Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
Background: Medicare and Medicaid reimbursement for common hand surgery procedures is poor. Between 2000 and 2019, there was a 22% decrease in the average Medicare reimbursement. In 2019, Medicaid reimbursed only $0.78 on the dollar compared to Medicare. Many patients rely on public health insurance programs to receive hand care. The aim of this study is to evaluate recent reimbursement for common hand procedures, considering inflation and the COVID-19 pandemic.
Methods: Nine common hand surgery procedures were selected. CPT codes were utilized to search Medicare reimbursement data for the years 2016-2025 via the Physician Fee Schedule Search tool. Medicaid reimbursement data for 2016 and 2025 was obtained via publicly available fee schedules from each state. The difference in Medicare and Medicaid reimbursement in 2016 and 2025 was standardized to work Relative Value Units (wRVU) as a surrogate. The data was analyzed using descriptive statistics and paired t-tests. Trends in Medicare reimbursement over time were studied using linear regression. All reimbursement values were converted to 2025 dollars.
Results Between 2016 and 2025, Medicare reimbursement decreased by 29% ($108.86/wRVU to $77.33/wRVU, p<0.0001) and Medicaid reimbursement decreased by 22.8% ($88.81/wRVU to $68.58/wRVU, p=0.0002)(Figure 1). Linear regression demonstrated a negative trend of Medicare reimbursement over time ($3.57/wRVU per year, R
2=0.9663, p<0.0001, Figure 2). Inflation rates increased significantly from 2020-2022 (1.2% to 8.0%). During this time, Medicare reimbursement decreased by 14.8%. There was a significant gap between Medicare and Medicaid reimbursement in 2016 ($20.05/wRVU, 18.4%) which decreased in 2025 ($8.75/wRVU, 11.3%), and there was variability by state (Figure 3).
Conclusion After adjusting for inflation, Medicare and Medicaid reimbursement for hand surgeries decreased significantly over the last ten years. While gap between Medicare and Medicaid reimbursement has improved, this is due to a decrease in Medicare reimbursement, rather than an increase in Medicaid reimbursement. Approximately 36% of the U.S. population receives health care coverage through Medicare or Medicaid. Lobbying efforts are required to ensure adequate access to hand care for these populations.
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