Trends in Medicare Reimbursement for Breast Procedures: A National and Geographic Analysis, 2010-2024.
Academic Article
Overview
abstract
BACKGROUND: Medicare reimbursements have stagnated or declined despite rising practice costs. Because regional adjustments through the Geographic Practice Cost Index (GPCI) only partially account for cost variation, surgeons in high-cost or rapidly inflating cities may experience greater real losses in reimbursement. Breast procedures offer a high-volume proxy for evaluating national and geographic changes in plastic surgery Medicare payments. This study aimed to quantify national Medicare reimbursement trends for breast procedures and to examine city-level differences in reimbursement relative to local cost of living and inflation. METHODS: Medicare reimbursement data for 6 breast procedures were obtained from the Medicare Physician Fee Schedule (2010-2024): mastopexy, reduction mammoplasty, immediate implant reconstruction, delayed implant reconstruction, tissue expander reconstruction, and free flap reconstruction. National reimbursement rates were inflation adjusted to 2024-dollars using the Consumer Price Index (CPI) and expressed as cumulative percentage change from 2010. Geographic reimbursement and cost of living was evaluated cross-sectionally using locality-specific Medicare Administrative Contractor (MAC) rates and city-level Cost of Living Index (COLI) values for the 20 largest US cities. For cities with metropolitan CPI data, city-level inflation and reimbursement changes were compared with national trends. RESULTS: From 2010 to 2024, Medicare reimbursement declined for all procedures after adjusting for inflation, ranging from -26.0% (mastopexy) to -46.2% (tissue expander reconstruction). Cross-sectionally, cost-of-living premiums ranged from -12.2% (Indianapolis) to +131.0% (New York), while reimbursement premiums only ranged from -9.5% (Indianapolis) to +16.7% (San Jose). Although higher-cost cities generally had higher reimbursement, the magnitude of reimbursement differences was far smaller than the cost-of-living differences. Among cities with metropolitan CPI data, inflation differentials ranged from -6.3 to +12.6 percentage points relative to the national rate, while reimbursement differentials ranged from -3.5 to +3.4 percentage points. Cities with the highest inflation (eg, Seattle, Denver) did not experience proportionally favorable reimbursement trends. CONCLUSIONS: Inflation-adjusted Medicare reimbursements for breast procedures declined substantially from 2010 to 2024, with the steepest losses in implant-based reconstruction. Geographic adjustments increased payments in higher-cost cities but did not fully account for differences in cost of living or local inflation. As a result, reimbursement trends often lagged behind regional economic conditions, raising concerns about long-term practice sustainability and equitable access to reconstruction.
