Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by state
Background: Medicare reimbursement for spine procedures has been decreasing, and it is well-established that Medicaid reimburses physicians even less than Medicare. This study seeks to provide an updated analysis of Medicaid reimbursement using 24 common spine procedure codes. Methods: Medicaid rate...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
|
| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548425000058 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1825199408417865728 |
|---|---|
| author | Adam P. Henderson, BS M. Lane Moore, MD, MBA Camryn S. Payne, BA Jack M. Haglin, MD, MS Joseph C. Brinkman, MD Paul R. Van Schuyver, MD Joshua S. Bingham, MD Michael S. Chang, MD |
| author_facet | Adam P. Henderson, BS M. Lane Moore, MD, MBA Camryn S. Payne, BA Jack M. Haglin, MD, MS Joseph C. Brinkman, MD Paul R. Van Schuyver, MD Joshua S. Bingham, MD Michael S. Chang, MD |
| author_sort | Adam P. Henderson, BS |
| collection | DOAJ |
| description | Background: Medicare reimbursement for spine procedures has been decreasing, and it is well-established that Medicaid reimburses physicians even less than Medicare. This study seeks to provide an updated analysis of Medicaid reimbursement using 24 common spine procedure codes. Methods: Medicaid rates were obtained from state online fee schedules, and Medicare rates from the Centers for Medicare and Medicaid online fee database. Rates were compared directly to each other by state and averaged to reflect national differences. The Medicare Wage Index was used to control for variability in wages between states and was used to adjust Medicaid data for comparison. Variability between states and codes was quantified using coefficient of variation values. Results: Medicaid reimbursement was lower than Medicare for all 24 included Current Procedural Terminology codes. Nationally, Medicaid rates were 13% less than Medicare, and this difference increased to 25% when adjusting for wage differences. Average cost differences were −$118 per code. Substantial variability between states and codes was also found for Medicaid, while little variability in Medicare rates existed. Conclusions: We found that Medicaid reimbursement to surgeons for 24 common spine surgeons was 13% less than Medicare on average. This difference increased to 25% when adjusting for wage differences. For Medicaid, wide variability existed between states and between different codes, indicating that some state payment systems may lack objective metrics when determining rates. |
| format | Article |
| id | doaj-art-463b4d52adce47bb9887dd91ebb47c05 |
| institution | Kabale University |
| issn | 2666-5484 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj-art-463b4d52adce47bb9887dd91ebb47c052025-02-08T05:01:20ZengElsevierNorth American Spine Society Journal2666-54842025-03-0121100585Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by stateAdam P. Henderson, BS0M. Lane Moore, MD, MBA1Camryn S. Payne, BA2Jack M. Haglin, MD, MS3Joseph C. Brinkman, MD4Paul R. Van Schuyver, MD5Joshua S. Bingham, MD6Michael S. Chang, MD7Mayo Clinic Alix, School of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, United States; Corresponding author. Mayo Clinic Florida, Mayo Clinic Alix School of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, USA.Mayo Clinic, Department of Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054, United StatesMayo Clinic, Alix School of Medicine, 13400 E Shea Blvd, Scottsdale, AZ 85259, United StatesMayo Clinic, Department of Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054, United StatesMayo Clinic, Department of Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054, United StatesMayo Clinic, Department of Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054, United StatesMayo Clinic, Department of Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054, United StatesMayo Clinic Department of Orthopedic Surgery, University of Arizona School of Medicine, Sonoran Spine Center, 1255 W Rio Salado Pkw Suite 107, Tempe, AZ 85281, United StatesBackground: Medicare reimbursement for spine procedures has been decreasing, and it is well-established that Medicaid reimburses physicians even less than Medicare. This study seeks to provide an updated analysis of Medicaid reimbursement using 24 common spine procedure codes. Methods: Medicaid rates were obtained from state online fee schedules, and Medicare rates from the Centers for Medicare and Medicaid online fee database. Rates were compared directly to each other by state and averaged to reflect national differences. The Medicare Wage Index was used to control for variability in wages between states and was used to adjust Medicaid data for comparison. Variability between states and codes was quantified using coefficient of variation values. Results: Medicaid reimbursement was lower than Medicare for all 24 included Current Procedural Terminology codes. Nationally, Medicaid rates were 13% less than Medicare, and this difference increased to 25% when adjusting for wage differences. Average cost differences were −$118 per code. Substantial variability between states and codes was also found for Medicaid, while little variability in Medicare rates existed. Conclusions: We found that Medicaid reimbursement to surgeons for 24 common spine surgeons was 13% less than Medicare on average. This difference increased to 25% when adjusting for wage differences. For Medicaid, wide variability existed between states and between different codes, indicating that some state payment systems may lack objective metrics when determining rates.http://www.sciencedirect.com/science/article/pii/S2666548425000058MedicaidSpine surgeryReimbursementMedicareFee scheduleRates |
| spellingShingle | Adam P. Henderson, BS M. Lane Moore, MD, MBA Camryn S. Payne, BA Jack M. Haglin, MD, MS Joseph C. Brinkman, MD Paul R. Van Schuyver, MD Joshua S. Bingham, MD Michael S. Chang, MD Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by state North American Spine Society Journal Medicaid Spine surgery Reimbursement Medicare Fee schedule Rates |
| title | Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by state |
| title_full | Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by state |
| title_fullStr | Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by state |
| title_full_unstemmed | Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by state |
| title_short | Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by state |
| title_sort | common spine codes are reimbursed 13 less by medicaid compared to medicare ranging from 46 to 160 by state |
| topic | Medicaid Spine surgery Reimbursement Medicare Fee schedule Rates |
| url | http://www.sciencedirect.com/science/article/pii/S2666548425000058 |
| work_keys_str_mv | AT adamphendersonbs commonspinecodesarereimbursed13lessbymedicaidcomparedtomedicarerangingfrom46to160bystate AT mlanemooremdmba commonspinecodesarereimbursed13lessbymedicaidcomparedtomedicarerangingfrom46to160bystate AT camrynspayneba commonspinecodesarereimbursed13lessbymedicaidcomparedtomedicarerangingfrom46to160bystate AT jackmhaglinmdms commonspinecodesarereimbursed13lessbymedicaidcomparedtomedicarerangingfrom46to160bystate AT josephcbrinkmanmd commonspinecodesarereimbursed13lessbymedicaidcomparedtomedicarerangingfrom46to160bystate AT paulrvanschuyvermd commonspinecodesarereimbursed13lessbymedicaidcomparedtomedicarerangingfrom46to160bystate AT joshuasbinghammd commonspinecodesarereimbursed13lessbymedicaidcomparedtomedicarerangingfrom46to160bystate AT michaelschangmd commonspinecodesarereimbursed13lessbymedicaidcomparedtomedicarerangingfrom46to160bystate |