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Original Investigation
January 23, 2020

Medicare Reimbursement for Balloon Catheter Dilations Among Surgeons Performing High Volumes of the Procedures to Treat Chronic Rhinosinusitis

Author Affiliations
  • 1Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
JAMA Otolaryngol Head Neck Surg. Published online January 23, 2020. doi:10.1001/jamaoto.2019.4357
Key Points

Question  What is the trend in balloon catheter dilation use to treat chronic rhinosinusitis among otolaryngologists, specifically in regard to surgeons performing high volumes of these procedures?

Findings  This retrospective analysis of Medicare databases found that there has been a 486% increase in the total number of balloon catheter dilations performed between 2011 and 2017 and a 270% increase in the number of otolaryngologists who performed more than 10 such procedures per year between 2012 and 2016.

Meaning  The number of balloon catheter dilation procedures continues to rise yearly, with surgeons who perform high volumes of these procedures performing most dilations.

Abstract

Importance  Chronic rhinosinusitis is among the most common and costly conditions treated by physicians. After failure of medical treatment, surgical intervention in the form of endoscopic sinus surgery is traditionally offered. Balloon catheter dilation (BCD) has become a less-invasive alternative with increasing popularity among otolaryngologists.

Objective  To evaluate the most recent BCD data in the Medicare population, with a specific focus on the percentage of procedures performed by surgeons who perform high volumes of this procedure, their reimbursements, and their national geographic distributions.

Design, Setting, and Participants  This retrospective review included data from 2011 through 2017 from Medicare Part B National Summary Data Files and Medicare Provider Utilization and Payment Data. Patients with procedures including Current Procedural Terminology codes 31295 (maxillary sinus dilation), 31296 (frontal sinus dilation), and 31297 (sphenoid sinus dilation) were included.

Exposures  Balloon catheter dilation of the paranasal sinuses.

Main Outcomes and Measures  Total and mean reimbursements over time to physicians for BCDs, as well as the percentage of BCDs performed by and reimbursed to ear, nose, and throat (ENT) surgeons who perform high volumes of BCDs (>10 procedures) in a given year.

Results  The total number of BCDs rose from 7496 in 2011 to 43 936 in 2017 (a 486% increase). The overall reimbursement increased from $11 773 049 in 2011 to $63 927 591 in 2017 (a 433% increase). From 2012 to 2016, ENT surgeons who performed high volumes of the procedures rose from 101 to 382 surgeons (a 270% increase). In 2016, 25 214 of 41 960 BCDs (60.1%) were performed by ENT surgeons performing high volumes of the procedure, compared with 5603 of 13 109 procedures (42.7%) in 2012. In a line of best fit, at the 75th percentile of procedure volume, there was an increase of 4.2 BCDs in the median number of procedures done per physician per year, compared with an increase of 1.5 BCD procedures per physician per year in the line of best fit for the 50th percentile.

Conclusions and Relevance  Balloon catheter dilation continues to increase in popularity among otolaryngologists treating chronic rhinosinusitis. Most BCDs are performed by ENT surgeons who perform high volumes of the procedure.

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