Medicaid Reimbursement for 20 Commonly Billed Orthopaedic Sports Medicine Procedures Was 14.9% Less Than Medicare

Purpose: To compare Medicaid and Medicare rates for the 20 most commonly billed orthopaedic sports medicine procedures.

Methods: Medicaid reimbursement rates were obtained from state-specific fee schedules. Medicare rates were collected from the Centers for Medicare & Medicaid Services Physician Fee Schedule, along with relative value units for each procedure. State rates were compared using averages and dollar differences. Reimbursement rates were adjusted for cost of living using the Medicare Wage Index. Variability between states and between procedures was assessed using coefficients of variation.

Results: Mean Medicaid reimbursement was lower than that of Medicare for 19 of the 20 procedures. In total, Medicaid reimbursed surgeons 14.9% less when data were unadjusted and 26.0% less when data were adjusted for cost of living. Variation in Medicare rates between states was constant, with a coefficient of variation of 0.06. For Medicaid, the coefficients of variation ranged from 0.27 to 0.70 for unadjusted data and from 0.35 to 0.69 for adjusted data.

Conclusions: On average, Medicaid reimburses orthopaedic sports medicine specialists less than does Medicare, with substantial variability between states. Adjustment for cost of living increases the percentage difference and the variability between states' Medicaid reimbursement rates.

Level of evidence: Level IV, economic analysis.