National trends in medicare utilization and reimbursement fees for common shoulder arthroscopy procedures performed in ambulatory surgery centers from 2013 to 2022.

Background: Arthroscopic shoulder surgeries rank high among the most commonly performed orthopedic procedures at ambulatory surgery centers (ASCs). However, evolving Medicare reimbursement policies have impacted the financial landscape of these procedures. Understanding the utilization and reimbursement trends is paramount to providing accessible patient care for surgeons and facilities. This study reviews the recent national trends in utilization and billing practices for arthroscopic shoulder operations performed in ASCs for Medicare patients from 2013 to 2022. Methods: This study analyzed Medicare Part B claims data using the Centers for Medicare and Medicaid Services Medicare Physician & Other Practitioners database. Current Procedural Terminology (CPT) codes for arthroscopic shoulder operations were used to identify data from 2013 to 2022. The top 4 utilized arthroscopic shoulder CPT codes were included for analysis. Outcomes analyzed included yearly service counts and allowed reimbursement rates from Medicare. The reimbursements reported in the database were a combined value of both the surgeon fee and ASC facility fee. This data was stratified by geographical region. All monetary values for charges and reimbursements were adjusted to the 2022 US dollar. Results: A total of 435,094 arthroscopic shoulder Medicare claims over the 4 most utilized CPT codes were identified between 2013 to 2022. The number of procedures increased annually by an average of 0.7%, resulting in an overall increase of 6.9% over this 10-year period (from 37,796 to 40,397, P = .180). Arthroscopic rotator cuff repair (CPT 29827) increased by an average of 3.1% annually, a substantial overall increase of 36.1% (P = .004). During the study period, average reimbursements decreased by 2.4% (from $1,782 to $1,740, P = .086). Trends in utilization and billing in ASCs varied by procedure and region, with the South having the highest utilization consistently while the Northeast had the highest reimbursement rate despite a decline. Other regions, such as the West, Midwest, and South, exhibited growth in reimbursement trends. Conclusion: Arthroscopic shoulder procedures are increasingly performed in ASCs. However, reimbursements for these procedures declined during the study period (2013-2022). These findings highlight the growing dominance of ASCs as a preferred surgical setting for shoulder arthroscopy procedures. However, this pattern of decreasing reimbursement could threaten the financial sustainability of these procedures. Policy reforms aimed toward securing efficient and cost-effective avenues to provide high-value care while still fostering incentives for physicians to treat patients covered by Medicare are paramount.