(0102) Comparative Analysis of Medicare Payments and Cost-of-Living Adjustments for Common Otolaryngology CPT Codes

Introduction: Each year, the American Academy of Otolaryngology (AAO) reports the top 100 Current Procedural Terminology (CPT) codes gathered through the Medicare enrollment database. This study aims to look at the changes in facility and Medicare reimbursement rates from 2020 to 2024 for the most common non-surgical CPT codes, juxtaposed against the backdrop of the general cost of living changes during the same period.

Methods: The analysis included non-surgical CPT codes falling within the top 10 billed: 99,213 (established patient visit, 20-29 min), 99,214 (established patient visit, 30-39 min), 31,575 (diagnostic laryngoscopy), 69,210 (removal impacted cerumen), 31,231 (nasal endoscopy), 99,203 (new patient visit, 30-44 min), and 99,204 (new patient visit, 45-59 min). Variables of interest included facility payment (absolute and percent change) and Outpatient Prospective Payment System (OPPS), referring to the Medicare payment rates for hospital outpatient services. The cumulative change in the cost of living index (CoLi) from 2020 to 2024 was calculated to be 21.7%, using the compound inflation rate method based on annual inflation rates from the United States Bureau of Labour Statistics.

Results: The mean change in facility pay was $2.84 (-$2.89 to $14.13) or 4% (-8.3% to 22.6%). The OPPS mean change was $15.52 ($3.33 to $32.37) or 11.7% (6.1% to 20.7%). After adjusting for the CoLi over the same period, the computed mean change in facility pay and OPPS were $2.33 and $12.75, respectively. The lowest adjusted change in facility pay and OPPS was CPT 69210, -$2.37 (-6.84%) and +$2.73 (+4.96%) respectively.

Conclusions: Increases in Medicare payments for common non-surgical CPT codes in otolaryngology from 2020 to 2024 have not kept pace with the cumulative change in the cost of living. This underscores the necessity for Medicare payment structures to consider inflationary trends to maintain the real value of healthcare reimbursements.