Trends of Medicare reimbursement rates for gender affirmation procedures

Background: While nearly 1 in 5 Americans receives health insurance coverage through Medicare, literature suggests that Medicare reimbursement is lagging behind inflation for many plastic surgery procedures.

Aim: This article evaluates trends in Medicare reimbursement for gender affirmation procedures.

Methods: The most common gender affirmation procedures performed at an urban academic medical center were identified in this cross-sectional study (level 4 evidence). Five nongender surgery codes were evaluated for reference. A standardized formula utilizing relative value units (RVUs) was used to calculate monetary data. Differences in reimbursement between 2014 and 2021 were calculated for each procedure.

Outcome: The main outcome was inflation-adjusted difference of charges from 2014 to 2021.

Results: Between 2014 and 2021, Medicare reimbursement for gender affirmation procedures had an inflation-unadjusted average change of -0.09% (vs +5.63% for the selected nongender codes) and an inflation-adjusted change of -10.03% (vs -5.54% for the selected nongender codes). Trends in reimbursement varied by category of gender-affirming procedure. The overall average compound annual growth rate had a change of -0.99% (vs -0.53% for the selected nongender codes). The average changes in work, facility, and malpractice RVUs were -1.05%, +9.52%, and -0.93%, respectively.

Clinical implications: Gender surgeons and patients should be aware that the decrease in reimbursement may affect access to gender-affirming care.

Strengths and limitations: Our study is one of the first evaluating the reimbursement rates associated with the full spectrum of gender affirmation surgery. However, our study is limited by its cross-sectional nature.

Conclusions: From 2014 to 2021, Medicare reimbursement for gender affirmation procedures lagged inflation.