Demographic trends and Medicare reimbursement for rotator cuff repair 2013–2023

Introduction: Rates of rotator cuff repair (RCR) have increased over the past two decades, while reimbursement rates may not have increased to compensate for inflation. The purpose of this study was to examine the trends in reimbursement and provider demographics in RCR surgery for Medicare patients from 2013 to 2023. The null hypothesis is that there has been no significant change in reimbursement for physicians performing RCR surgery over the period. Methods: This retrospective cohort study used the Center for Medicare and Medicaid Services (CMS) “Physicians and Other Practitioners: By Provider and Service” database combined with the National Downloadable File. The database was queried from 2013 to 2023 to find surgeons performing RCR using CPT codes 29827, 23410, 23412, and 23420. Physicians were included if classified under “Orthopedic Surgery.” After exclusions, the cohort comprised 17,336 surgeons for CPT 29827, 245 for 23410, 1911 for 23412, and 325 for 23420. Data collected included demographics and reimbursement. Results: A total of 19,847 orthopedic surgeons performed RCR. The majority (87%) performed arthroscopic repair (CPT-29827), which accounted for 89% of total cases while generating the greatest reimbursement (adjusted AMSA $1,001; API $20,803). From 2013 to 2023, all CPT codes demonstrated declining reimbursement after inflation adjustment, with AMSA decreasing 24% for CPT-29827, 26% for CPT-23410, 24% for CPT-23412, and 38% for CPT-23420. Conclusions: Arthroscopic RCR is replacing open techniques, while reimbursement for all RCR procedures continues to fall significantly. These trends may impact financial sustainability and worsen disparities in access to care. Level of Evidence: Level IV—Descriptive Epidemiology/Economic Study