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J Neurol Surg B Skull Base
DOI: 10.1055/a-2642-0854
Original Article

Trends in Medicare Reimbursement for the Resection of Vestibular Schwannomas: 2000 to 2021

Shravan Atluri
1   Idaho College of Osteopathic Medicine, Meridian, Idaho, United States
,
Dylan Dupont 
2   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Spencer Singh
2   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Ethan Cline
1   Idaho College of Osteopathic Medicine, Meridian, Idaho, United States
,
Anthony Guidotti
1   Idaho College of Osteopathic Medicine, Meridian, Idaho, United States
,
Rani Nasser
2   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Abstract

Objectives

Current procedural terminology (CPT) for the surgical removal of vestibular schwannoma (VS) has been inconsistently applied due to the redundant plurality of coding possibilities. This report analyzes reimbursement rates between different CPT strategies to determine if financial incentives may be a potential driver of this divergent behavior.

Methods

Medicare Part B National Summary files were queried for reimbursement data concerning VS resections from 2000 to 2021. Data were categorized by CPT codes for approach, excision, or combination codes encompassing both elements for three surgical approaches: middle fossa, translabyrinthine, and retrosigmoid (RS). Separated approach and excision codes were bundled in a pairwise fashion to imitate real-world billing practices. Inflation-adjusted data was curated according to the consumer price index and further analyzed by compound annual growth rate. Utilization trends were measured using gross allowed services.

Results

Inflation-adjusted fees declined for all services. However, some services, namely piecemeal RS codes, experienced nominal payment increases that dampened inflationary value erosion. Intragroup assessment proved RS to be the most popular and best compensated approach within both the pairwise and combination groups. Intergroup assessment proved the RS combination code was most frequently employed overall, with the pairwise RS approach and excision bundle collecting the greatest average reimbursement.

Conclusion

This study suggests the divergence in CPT assignment for surgically managed VS is likely driven, in part or in whole, by financial incentive and indicates the need for fiscal reform, or an erasure of redundant CPT, to unify CPT application.

Keywords

reimbursement - Medicare - vestibular schwannoma - acoustic neuroma - CPT - translabyrinthine - middle fossa - retrosigmoid

Contributors' Statement

This manuscript is the original work of the authors listed and is not under consideration by any other publishing outlet.


Note

This study was previously presented as an oral presentation at the North American Skull Base Society (NASBS) meeting.


Informed Consent

This study utilized publicly available government data, and thus was exempt from any requirement for IRB approval and/or individual consent.




Publication History

Received: 10 December 2024

Accepted: 23 June 2025

Article published online:
15 July 2025

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