JOT - 2026-09-01 - Journal Article
Shifts in Medicare Reimbursement for Common Lower Extremity Orthopaedic Trauma Procedures, 2006-2024.
Hoveidaei AH, Mosalamiaghili S, Feng JE, Anoushiravani AA
Topics
Key Takeaway
Inflation-adjusted Medicare reimbursement for four common lower extremity trauma procedures fell 33.7% from 2006 to 2024, with work RVU-based reimbursement declining 38.9%, and projections suggest a further 33–48% decline by 2029 under neutral-to-negative scenarios.
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Summary
This study queried CMS Physician Fee Schedule data for four high-volume lower extremity trauma CPT codes to quantify real-dollar reimbursement trends from 2006 to 2024, adjusting values to 2024 USD via CPI. Unadjusted total reimbursement rose 2.7%, but inflation-adjusted total and work reimbursements fell 33.7% and 38.9%, respectively, with bimalleolar ankle fracture repair (CPT 27814) sustaining the steepest work reimbursement decline at 43.5%. Under a neutral projection model, total reimbursements are expected to fall an additional 33.1% by 2029 relative to 2024 values.
Key Limitation
The analysis is restricted to Medicare fee schedule data and does not capture private payer reimbursement, uncompensated care, or facility-level revenue streams, limiting generalizability to the full economic picture of trauma practice.
Original Abstract
OBJECTIVES
The aim of this study was to analyze Medicare reimbursement trends from 2006 to 2024 for open treatment of proximal femoral fractures [Current Procedural Terminology (CPT) 27236], femoral shaft fractures (CPT 27506), tibial shaft fractures (CPT 27759), and bimalleolar ankle fractures (CPT 27814), using data from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule (PFS).
DESIGN
This study analyzed Medicare reimbursement trends for the 4 most common lower extremity trauma procedures from 2006 to 2024.
SETTING
Reimbursement data were obtained from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule (PFS), and procedure frequency data were obtained from the M165Ortho dataset from PearlDiver Technologies.
PATIENT SELECTION CRITERIA
Procedures were selected based on frequency and included CPT codes 27236, 27506, 27759, and 27814.
OUTCOME MEASURES AND COMPARISONS
Reimbursement data were obtained from the CMS PFS using the corresponding Healthcare Common Procedure Coding System codes. Work reimbursement was calculated by multiplying work relative value units (RVUs) by the CMS conversion factor (CF), and total facility reimbursement was calculated by multiplying total facility RVUs by the CF. Values were adjusted to 2024 US dollars using the Consumer Price Index. Percentage changes from 2006 were calculated. A 5-year projection based on 2020 to 2024 trends was generated using the mean and SD of reimbursement changes to model negative (-1 SD), neutral (mean), and positive (+1 SD) scenarios and estimate trends through 2029.
RESULTS
Between 2006 and 2024, the unadjusted total reimbursement for the 4 included procedures increased by 2.7%, but when adjusted for inflation, it decreased by 33.7%. The largest inflation-adjusted decline in total reimbursements was observed in open treatment of bimalleolar ankle fracture, which saw a 37.6% reduction. Work reimbursements also decreased by 5.4% unadjusted and by 38.9% after accounting for inflation, with the greatest reduction observed in bimalleolar ankle fractures with 43.5%. Projections for 2029, relative to 2024 values, indicate that total reimbursements could decline by an average of 48.1%, 33.1%, or 18.1% under negative, neutral, or positive scenarios, respectively. Work reimbursements are expected to decrease by 57.0%, 40.2%, or 23.3% under the same outlooks.
CONCLUSIONS
Inflation-adjusted Medicare reimbursements for lower-extremity trauma procedures declined up to 37% from 2006 to 2024, with work reimbursements decreasing up to 44%. If current trends continue, reimbursements are projected to decline further by 2029. These declines may pose financial challenges for orthopaedic trauma surgeons and affect the delivery of trauma care.
LEVEL OF EVIDENCE
Economic, Level IV. See Instructions for Authors for a complete description of levels of evidence.