Medicare Reimbursement for Primary and Revision Total Hip and Knee Arthroplasty: An Updated Analysis From 2000 to 2024.

Background: With physician reimbursements for primary and revision total hip (THA) and knee arthroplasty (TKA) remaining central to health care policy and payment reforms, an updated analysis of inflation-adjusted Medicare surgeon fees for these procedures is essential. Examining recent payment trends offers valuable insights for surgeons, payers, and health care policymakers to understand the evolving reimbursement landscape. This study aimed to analyze physician reimbursement trends for THA and TKA from 2000 to 2024.

Methods: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried to extract reimbursement data from 2000 to 2024 for primary THA and TKA and both-component revision TKA and THA. Utilizing the consumer price index, all monetary data were reported in 2024 United States dollars to account for inflation. For each procedure, both unadjusted and inflation-adjusted mean annual reimbursement rates, mean annualized percent change and total percent change, in reimbursement were calculated.

Results: Between 2000 and 2024, the mean reimbursement decreased by 56% for primary THA and TKA and decreased by 51% for revision THA and TKA. The largest decrease in reimbursement was seen for primary TKA, with a decrease of 57% in inflation-adjusted dollars, while the smallest decrease was revision TKA, which decreased by 50%. The mean reduction in inflation-adjusted Medicare reimbursement for all procedures examined was 53%. For all procedures, the mean adjusted annualized reimbursement rate for all procedures decreased by 2% per year.

Conclusions: Physician reimbursement rates for both primary and revision THA and TKA procedures have declined substantially since 2000. These updated reimbursement models demonstrate that compensation needs to be adjusted, at the minimum with inflation, to accurately reflect the services rendered and resources employed by surgeons to maintain equitable access for all patients.

Level Of Evidence: IV.