Medicare Reimbursement for Hip and Knee Arthroplasty From 2000 to 2019: An Unsustainable Trend

J Arthroplasty. 2020 May;35(5):1174-1178. doi: 10.1016/j.arth.2019.12.008. Epub 2019 Dec 16.


Background: While reimbursement models for physicians continue to evolve, limited data exist regarding recent trends in physician reimbursement for hip and knee arthroplasty. The purpose of this study is to evaluate monetary trends in Medicare reimbursement rates from 2000 to 2019 for the most common hip and knee arthroplasty procedures.

Methods: The American Academy of Orthopedic Surgeons coding reference was queried to determine the Current Procedural Terminology codes most frequently used in hip and knee adult reconstruction. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was queried for each Current Procedural Terminology code, and physician fee data were extracted. All monetary data were adjusted for inflation using the consumer price index and expressed in 2019 US dollars. The average annual and the total percent change in reimbursement were calculated based on these adjusted trends for all procedures.

Results: After adjusting for inflation, the average physician reimbursement decreased by 31.9% for all hip arthroplasty procedures and by 33.3% for all knee arthroplasty procedures from 2000 to 2019. During this period, primary total hip arthroplasty physician fees decreased by 37.1% and primary total knee arthroplasty fees decreased by 40.6%. From 2000 to 2019, the inflation-adjusted reimbursement rate for all procedures decreased by an average of 1.7% per year.

Conclusion: Throughout the study period, physician reimbursement decreased for all knee and hip arthroplasty procedures. Increased awareness and consideration of these trends will be important for policy-makers, hospitals, and surgeons to assure equitable access to quality hip and knee arthroplasty care in the United States.

Keywords: Medicare; bundled payments; healthcare economics; payments; physician fees; total joint arthroplasty.

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Hip*
  • Arthroplasty, Replacement, Knee*
  • Current Procedural Terminology
  • Humans
  • Insurance, Health, Reimbursement
  • Medicare
  • United States