Introduction: The landscape of Medicare reimbursement for lateral skull base and neurotologic procedures
is currently unclear. Understanding the financial health of this niche field is imperative
in ensuring consistent and adequate patient care going forward. The purpose of this
study is to comprehensively characterize and evaluate reimbursement trends for lateral
skull base and neurotologic procedures between the years of 2000 and 2024.
Materials and Methods: The publicly available physician fee scheduling Look-Up Tool from the Centers for
Medicare and Medicaid Services (CMS) was utilized to gather Medicare reimbursement
rates for lateral skull base and neurotologic procedures by Current Procedural Terminology
(CPT) code between 2000 and 2024. Reimbursement rates were then adjusted for inflation
to 2024. Trend analyses were performed including overall-adjusted and yearly adjusted
percent changes for each code.
Results: Medicare reimbursement rates for 35 distinct lateral skull base and neurotologic
CPT codes were evaluated between 2000 and 2024. All codes experienced a decline in
reimbursement rate after adjusting for inflation. While the average unadjusted reimbursement
rate for all CPT codes increased by 12.4%, the average adjusted reimbursement rate
decreased by 38.5%. CPT codes with the largest overall decline were 62,100 (repair
of CSF leak by middle cranial fossa, −46.7%), 69910 (transmastoid labyrinthectomy,
−46.0%), and 61,526 (translabyrinthine resection of posterior fossa tumor, −45.9%).
The least overall decline was observed for code 62,120 (repair of encephalocele by
middle fossa, −27.0%). The average yearly adjusted change for all codes was −1.6%
overall, though recent years demonstrated a larger magnitude in negative change compared
with earlier years.
Conclusion: This is the first study to closely investigate Medicare reimbursement trends for
lateral skull base and neurotologic procedures. A concerning and persistent decline
in reimbursement rates across all specified procedures is seen when accounting for
inflation between 2000 and 2024. Moreover, this downtrend appears to accelerate in
the latest years. Recognizing these patterns is paramount in advocating for and ensuring
the development of adequate reimbursement policies surrounding lateral skull base
and neurotologic procedures.
