Volume 168, Issue 1 p. 59-64
Original Research

Reimbursement Trends in Pediatric Otolaryngology From 2000 to 2020: A CMS Physician Fee Schedule Analysis

Noah M. Yaffe

Noah M. Yaffe

School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA

co-first authorship

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Humzah A. Quereshy MD, MBA

Corresponding Author

Humzah A. Quereshy MD, MBA

Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

co-first authorship

Correspondence Humzah A. Quereshy, MD, MBA, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.

Email: [email protected]

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Brooke A. Quinton

Brooke A. Quinton

School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA

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Todd D. Otteson MD, MPH

Todd D. Otteson MD, MPH

Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

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Jay R. Shah MD

Jay R. Shah MD

Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

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First published: 05 April 2022
Citations: 3

Abstract

Objective

The aim of this study was to evaluate the financial trends in Medicare reimbursement rates for the most billed procedures at a single institution from 2000 to 2020 within pediatric otolaryngology.

Study Design

Retrospective data analysis.

Setting

United States.

Methods

The most billed surgical and in-office procedures in pediatric otolaryngology at our institution were identified in the Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services to extract reimbursement data for each CPT code (Current Procedural Terminology). Monetary data were adjusted for inflation to 2020 US dollars per the changes to the consumer price index. Mean annual and total percentage changes in reimbursement were calculated by the adjusted values for all included procedures (N = 25).

Results

From 2000 to 2020, without adjusting for inflation, reimbursement for the most billed procedures increased by 10.9%, while the allocated relative value unit per procedure increased by 15.4%. However, when adjusted for inflation, reimbursement for these procedures decreased by 27.5% over the study period.

Conclusions

The study findings identify a downward trend in reimbursement for the most billed procedures in pediatric otolaryngology at our institution. Given the low predominance of pediatric otolaryngology codes within Medicare reimbursement, these codes are rarely reviewed for accurate revaluation. It is imperative that our professional society remain active and engaged within this process to ensure quality delivery of care to our patients.