JSES - 2026-06-01 - Journal Article
Inflation-adjusted Medicare reimbursement for primary and revision shoulder arthroplasty: an updated analysis.
Joshi T, Katakam A, Azer A, Hawryluk C, Bloh A, Calem D, Clements AJ, Kohan EM, Alberta FG
Topics
Key Takeaway
Inflation-adjusted Medicare reimbursement for TSA (CPT 23472) fell 42% from $2,467.96 to $1,433.64 between 2000 and 2025.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study queried CMS Physician Fee Schedule data for six shoulder arthroplasty CPT codes from 2000 to 2025, converting all values to 2025 USD via CPI adjustment. Inflation-adjusted reimbursement declined significantly across all codes (all P<.001, R²=0.885–0.915), with hemiarthroplasty (23470) dropping 51% and full-component revision (23474) falling from a 2015 peak of $2,515.25 to $1,718.62 by 2025. The consistent downward trend occurred despite stable or increasing procedural complexity.
Key Limitation
The analysis captures only Medicare fee-for-service reimbursement and does not account for facility fees, private payer contracts, or total episode-of-care payments, limiting generalizability to real-world surgeon compensation.
Original Abstract
BACKGROUND
Physician reimbursement for orthopedic procedures, such as total shoulder arthroplasty (TSA) and related revision surgeries, has been subject to economic pressures over the past 2 decades. Understanding trends in reimbursement, especially when adjusted for inflation, provides insight into health care economics and informs policy decisions.
METHODS
The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried to extract reimbursement data from 2000 to 2025 for various TSA procedures, including primary and revision surgeries. Current Procedural Terminology (CPT) codes 23470; 23472; 23473; 23474; 23334; and 23335 were included. All monetary values were converted to 2025 United States dollars using the Consumer Price Index to adjust for inflation. For each procedure, we calculated the mean annual reimbursement and trends in inflation-adjusted reimbursement through 2025.
RESULTS
Across all procedures, there was a consistent decline in inflation-adjusted reimbursement. For instance, CPT code 23470 (hemiarthroplasty) decreased from $2,419.81 in 2000 to $1,192.43 in 2025. CPT code 23472 (TSA) showed a similar trend, declining from $2,467.96 in 2000 to $1,433.64 in 2025. Revision procedures, such as CPT code 23474 (humeral and glenoid component), experienced notable reductions, with a peak of $2,515.25 in 2015 falling to $1,718.62 in 2025. All linear regression models showed statistically significant downward trends (P < .001), with R 2 values ranging from 0.885 to 0.915.
CONCLUSION
Inflation-adjusted physician reimbursement for TSA procedures has declined substantially from 2000 to 2025. These findings highlight a continued decline in reimbursement despite stable or increasing procedural complexity, which may impact provider sustainability and access to care.