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Brief Report
September 15, 2021

Inflation-Adjusted Trends in Medicare Reimbursement for Common Dermatologic Procedures, 2007-2021

Author Affiliations
  • 1Case Western Reserve University School of Medicine, Cleveland, Ohio
  • 2Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
  • 3Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 4Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Dermatol. Published online September 15, 2021. doi:10.1001/jamadermatol.2021.3453
Key Points

Question  What are 15-year trends in Medicare reimbursement for common dermatologic procedures?

Findings  In this cross-sectional study of 2007 to 2021 Medicare fee schedules for 46 common dermatological procedures, the mean inflation-adjusted reimbursement for dermatologic procedures decreased by 4.8%. Changes in reimbursement during this time varied significantly by procedure category.

Meaning  Changes in Medicare reimbursement are important to monitor and can have several possible downstream effects, including decreased patient access.

Abstract

Importance  Medicare enrollment, dermatologist utilization of Medicare, and dermatologic procedural volume have all increased over time. Despite this, there are limited studies evaluating changes in Medicare reimbursement within dermatology.

Objective  To identify trends in Medicare reimbursement for 46 common dermatologic procedures from 2007 to 2021.

Design, Setting, and Participants  In this cross-sectional study, reimbursement data were obtained from the Centers for Medicare & Medicaid Services Physician Fee Schedule for commonly used dermatologic Current Procedural Terminology (CPT) codes from 2007 to 2021. The CPT codes in several major dermatologic categories were analyzed, including skin biopsy, shave removal, benign/premalignant/malignant destruction, benign/malignant excision, Mohs micrographic surgery, simple/intermediate/complex repair, flap, graft, and laser/phototherapy. All procedure prices were adjusted for inflation to January 2021 dollar value.

Main Outcomes and Measures  The primary outcomes were percentage changes and cumulative annual growth rates of pricing for each dermatologic procedure.

Results  From 2007 to 2021, there was a mean decrease in dermatologic procedure reimbursement of −4.8% after adjusting for inflation. Mean inflation-adjusted changes in reimbursements during this time period significantly varied by procedure type, including skin biopsy (+30.3%), shave removal (+24.5%), benign/premalignant/malignant destruction (−7.5%), Mohs micrographic surgery (−14.4%), benign/malignant excision (−3.9%), simple/intermediate/complex repair (−9.9%), flap repair (−14.1%), graft repair (−12.0%), and laser/phototherapy (−6.6%; P < .001). Changes in reimbursement did not vary by anatomical risk categories.

Conclusions and Relevance  The findings of this cross-sectional analysis suggest that changes in Medicare reimbursement can have several downstream effects, including concomitant private insurance changes and decreased patient access. Future adjustments in reimbursement should balance high-value care with sustainable pricing to optimize patient access.

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