Connections : Join the Conversation - The blog of Biomet CEO Jeffrey R. Binder
How much does Medicare reimburse surgeons for common orthopedic procedures? Part I: joint replacement and fracture procedures
Several readers commented on concerns regarding reimbursement and future patient access to specialists, prompting us to provide the following information on Medicare reimbursement for commonly performed joint replacement and fracture repair procedures. We will provide additional information in future posts.
Since 2009, the payment rate has declined for the vast majority of these procedures, and has not kept up with inflation. We suspect that patients would be surprised that these beneficial procedures are reimbursed at such low rates, and also by the fact that the rates have declined in absolute dollars and in purchasing power. Medicare requires physicians to provide 90 days of post-operative care for no additional reimbursement. Orthopedic surgeons have been expected to labor for dramatically decreasing reimbursement, while the expenses of running a medical practice continue to climb. Is it any wonder that the government predicts severe shortages of orthopedic surgeons?
Source: Musculoskeletal Clinical Regulatory Advisors, Washington, DC. Research commissioned by Biomet, Inc.
| 2009 | 2000 | 2000 | % change | % change | ||
| CPT Code | Description | Actual | Actual | in 2008$ | Actual | in 2008$ |
| 27445 | Arthroplasty, knee, hinge prosthesis | $1,185 | $1,206 | $1,494 | -2% | -21% |
| 27446 | Partial knee replacement | $1,052 | $1,130 | $1,401 | -7% | -25% |
| 27447 | Primary total knee replacement | $1,456 | $1,457 | $1,807 | 0% | -19% |
| 27486 | Revision of total knee arthroplasty, one component | $1,327 | $1,327 | $1,645 | 0% | -19% |
| 27487 | Revision of total knee arthroplasty; femoral and entire tibial component | $1,677 | $1,686 | $2,090 | -1% | -20% |
| 27488 | Removal of prosthesis, including total knee prosthesis, cement, with or without spacer | $1,121 | $1,116 | $1,383 | 1% | -19% |
| 27091 | Removal of hip prosthesis; complicated, cement with or without spacer | $1,502 | $1,482 | $1,837 | 1% | -18% |
| 27125 | Hemiarthroplasty, hip, partial | $1,052 | $1,048 | $1,299 | 0% | -19% |
| 27130 | Primary total hip replacement | $1,360 | $1,392 | $1,726 | -2% | -21% |
| 27132 | Conversion of previous hip surgery to total hip replacement | $1,588 | $1,659 | $2,057 | -4% | -23% |
| 27134 | Revision total hip arthroplasty, both components | $1,846 | $1,974 | $2,448 | -7% | -25% |
| 27138 | Revision of total hip arthroplasty, femoral component only | $1,463 | $1,580 | $1,960 | -8% | -25% |
| 27236 | Femoral fracture, internal fx or prosthesis | $1,113 | $1,111 | $1,378 | 0% | -19% |
| 23470 | Hemi shoulder replacement | $1,145 | $1,258 | $1,560 | -10% | -27% |
| 23472 | Total shoulder replacement | $1,417 | $1,359 | $1,685 | 4% | -16% |
| 23616 | Prox humeral fracture, internal fx or prosthesis | $1,212 | $1,471 | $1,824 | -21% | -34% |
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