Purpose: To compare the costs and reimbursement rates of retinal detachment (RD) repair surgeries in pediatric vs adult patients. Methods: Current Procedural Terminology (CPT) codes for scleral buckle (67107), standard RD repair (67108), and complex RD repair (67113) from January 2017 to May 2024 were extracted. A total of 103 pediatric cases and 549 adult cases were included. A cost analysis was performed using the time-driven activity-based costing methodology. Results: For scleral buckles, total costs were not significantly different between the pediatric and adult groups (8, 884. 23 vs 7, 878. 26, respectively; P =. 14). For standard RD repair, there was a significant difference in total material costs (1, 366. 71 vs 1, 023. 66; P =. 0013), grand total costs (8, 163. 56 vs 5, 076. 18; P <. 001), and day-of-surgery time costs (6, 796. 87 vs 4, 087. 74; P <. 001) for pediatric vs adult cases, respectively. For complex RD repair, grand total costs (10, 261. 2 vs 9, 528; P =. 14) were equivalent. Net margins of RD repair under Medicare were −3, 296. 52 and −2, 323. 55 for scleral buckle, −2, 568. 45 and +430. 93 for standard pars plana vitrectomy (PPV) repair, and −4, 467. 92 and −3, 745. 72 for complex PPV repair, for pediatric and adult patients, respectively. Conclusions: Pediatric standard vitrectomy had 60. 8% higher total costs compared with that of adults. There was a net margin loss for standard PPV in pediatric patients (−2, 568. 45), with only 68. 5% of costs covered under Medicare. Net margin losses were also observed for complex RD repairs in both pediatric (−4, 467. 92) and adult surgeries (−3, 745. 72), with 56. 4% and 60. 7% of the costs covered under Medicare, respectively. Pediatric standard vitrectomy, scleral buckle, and complex PPV had greater losses compared with adult surgeries.
Pan et al. (Fri,) studied this question.
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