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Connections : Join the Conversation - The blog of Biomet CEO Jeffrey R. Binder

8
Sep

How much does Medicare reimburse surgeons for common orthopedic procedures? Part I: joint replacement and fracture procedures

Posted: Sep-8-2009 2:19 PM ET  |  Add Comment

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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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