A 20-Year Analysis of Medicare Reimbursement for Abdominal Wall Reconstruction (2000-2020)

The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for 30 abdominal wall reconstruction surgical procedures over a 20-year period (2000-2020). The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was utilized for each of the 30 included current Procedural Terminology (CPT) codes, and reimbursement data was extracted. Monetary data was adjusted for inflation to 2020 US dollars (USD) utilizing changes to the United States consumer price index (CPI). The R-squared, average annual percent change and average total percentage change in reimbursement were calculated based on these adjusted trends for all included procedures. After adjusting for inflation, the average reimbursement for all procedures decreased by 17.1% from 2000 to 2020. The greatest mean decrease was observed for CPT code 49568 (the implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection, -34.4%). The only procedure with an increased adjusted reimbursement rate throughout the study period was CPT code 20680 (+3.9%). From 2000 to 2020, the adjusted reimbursement rate for all included procedures decreased by an average of 0.85% each year, with an average R-squared value of 0.78, indicating a stable decline throughout the study period. Reimbursement rates are declining when adjusted for inflation. Increased awareness of these trends is helpful to maintain access to optimal abdominal reconstruction care in the US.