Shifts in Medicare Reimbursement for Common Lower Extremity Orthopaedic Trauma Procedures, 2006-2024.

OBJECTIVES: To analyze Medicare reimbursement trends from 2006 to 2024 for open treatment of proximal femoral fractures (CPT 27236), femoral shaft fractures (CPT 27506), tibial shaft fractures (CPT 27759), and bimalleolar ankle fractures (CPT 27814), using data from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule. METHODS: This study analyzed Medicare reimbursement trends for the four most common lower extremity trauma procedures from 2006 to 2024 using data from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) and the M165Ortho dataset from PearlDiver Technologies. Procedures were selected based on frequency: CPT 27236, 27506, 27759, and 27814. Reimbursement data were obtained from the CMS PFS using the corresponding HCPCS codes. Work reimbursement was calculated by multiplying work RVUs by the CMS conversion factor, and total facility reimbursement by multiplying total facility RVUs by the conversion factor. Values were adjusted to 2024 U.S. dollars using the Consumer Price Index. Percentage changes from 2006 were calculated. A 5-year projection (2020-2024) was generated using the mean and standard deviation of reimbursement changes to model negative (-1 SD), neutral (mean), and positive (+1 SD) scenarios to estimate trends through 2029. RESULTS: Between 2006 and 2024, the unadjusted total reimbursement for the four included procedures increased by 2.7%, but when adjusted for inflation, it decreased by 33.7%. The largest inflation-adjusted decline in total reimbursements was observed in open treatment of bimalleolar ankle fracture, which saw a 37.6% reduction. Work reimbursements also decreased by 5.4% unadjusted, and by 38.9% after accounting for inflation, with the greatest reduction seen in bimalleolar ankle fractures with 43.5%. Projections for 2029, relative to 2024 values, indicate that total reimbursements could decline by an average of 48.1%, 33.1%, or 18.1% under negative, neutral, or positive scenarios, respectively. Work reimbursements are expected to decrease by 57.0%, 40.2%, or 23.3% under the same outlooks. CONCLUSIONS: Inflation-adjusted Medicare reimbursements for lower-extremity trauma procedures declined up to 37% from 2006 to 2024, with work reimbursements decreasing up to 44%. If current trends continue, reimbursements are projected to decline further by 2029. These declines may pose financial challenges for orthopaedic trauma surgeons and affect the delivery of trauma care. LEVEL OF EVIDENCE: Prognostic, Level III.