An Analysis of Medicare Reimbursement for Neurosurgeon Office Visits: 2010 Compared to 2018

BACKGROUND: Trends in Medicare billing and procedural reimbursement for outpatient office visits remain unclear within the field of neurosurgery. OBJECTIVE: To analyze financial trends of neurosurgeon reimbursement for Medicare office visits in 2010 compared to 2018. METHODS: The 2010 and 2018 physician/supplier files from the Centers for Medicare and Medicaid Services website were utilized. All payments submitted by neurosurgeons (provider ID 14) were included. Trends in office visit Current Procedural Terminology codes 99201 to 99205 and 99211 to 99215 were analyzed. RESULTS: Neurosurgeons billed for 1109979 office visits (463611 h) in 2010 and Medicare denied 63704 payments (totaling $11205283). Neurosurgeons billed for 1189046 office visits (508526 h) in 2018 and Medicare denied 57048 payments (totaling $15103879). This is a 7.1% increase in total neurosurgery office visits billed to Medicare, 9.7% increase in total office hours, and 34.8% increase in the payment amounts denied over 8 yr. Furthermore, after adjusting for inflation, the average amount paid to physicians by Medicare decreased by 8.3% per office visit. Additionally, Medicare paid 36.1% of the total neurosurgeon submitted charge amount for all office visits in 2010 but paid only 27.8% in 2018 (-8.3%). CONCLUSION: Neurosurgeons are performing more office visits and billing for more time with patients. Meanwhile, Medicare has been paying physicians less per office visit, denying higher amounts of payments and reimbursing a decreasing percentage of submitted charges for office visits. An understanding of these trends is necessary to ensure continued equity and quality access to neurosurgical care in the United States.

Automated summary

Between 2010 and 2018, there was an increase in the number of office visits and total hours billed by neurosurgeons to Medicare. However, Medicare paid less per office visit, denied higher amounts of payments, and reimbursed a decreasing percentage of charges submitted by neurosurgeons.