RS03 - Regional and Specialty-Specific Medicare Billing Trends in Lower Extremity Endovascular Interventions

Wednesday, June 4, 2025

10:12 AM – 10:19 AM CT

Location: Morial CC, First Floor, Great Hall A

Presenting Author only(s)

Daniel J. Koh, MD

Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA

Slides

Senior Author Discussant(s)

Jeffrey J. Siracuse, MD, MBA

Professor of Surgery and Radiology, Chief of Vascular and Endovascular Surgery
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts

Discussant(s)

OJ

Omid Jazaeri, MD

Denver, Colorado

Co-Author(s)

BT

Brian Tao
Andrea Alonso, MD

Surgery Resident
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts
BL

Brenda Lin

Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
AL

Alex M. Lin

Vascular Surgery Fellow
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts
Stephen Dalton-Petillo, MD

PGY3 General surgery resident
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Jeffrey A. Kalish

Associate Professor of Surgery and Radiology
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts
EK

Elizabeth King-Paulson, MD
AF

Alik Farber, MD, MBA

Professor of Surgery
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts

Objectives: Medicare Part B reimbursements have been overall declining at the national level. Our goal was to characterize Medicare reimbursement trends for endovascular lower extremity interventions stratified based on geographic region and physician specialty.

Methods: The 2018-2022 Medicare Physician and Other Practitioners by Provider and Service dataset was queried for eight lower extremity CPT codes. Mean reimbursement was calculated. The data were stratified by setting (facility, hospital v. non-facility, physician office), Centers for Medicare and Medicaid Services (CMS) region, and physician specialty (Vascular Surgery (VS), Interventional Radiology (IR), Interventional Cardiology (IC)). Percentage change in reimbursements were compared between specialties. All monetary values were adjusted to the 2022 US dollar.

Results: In facility settings, the reimbursement declined in all but three regions (Figure). Regions 4 (Southeast), 6 (South), and 9 (West Coast) had increases in reimbursements of 1%, 7%, and 9%, respectively. Of note, regions 8 (Mountain West) and 10 (Pacific Northwest) had the largest declines in facility reimbursements at -19% each. For non-facility locations, the average reimbursement declined in all ten regions, with regions 3 (Mid-Atlantic) and 8 (Mountain West) having the largest decreases at -28% and -35%, respectively. Facility reimbursements on average decreased by -7%. Out of the eight included procedures, only iliac stent placement (2%), femoral-popliteal atherectomy (10%), and infrapopliteal atherectomy (14%) had an increase in facility reimbursements. Intravascular ultrasound (IVUS) and femoral-popliteal stent placement had the largest declines at -19% and -17%, respectively. In non-facility settings, the average reimbursement declined by -24%, with femoral-popliteal atherectomy (-43%) and IVUS (-36%) having the largest decreases. Only infrapopliteal stent placement (2%) had a small increase in non-facility reimbursements. Overall, all three specialties experienced a similar decline in facility reimbursements, with VS having the lowest magnitude decrease at -14% and IR having the largest at -19%. IC had a decrease in reimbursement of -17% (P=.1). The non-facility reimbursements also similarly declined for all specialties. VS and IR had a decrease of -29% and -28%, respectively. IC had a decline of -20% (P=.51) (Table I).

Conclusions: Our analysis of arterial endovascular procedures billed to Medicare Part B from 2018 to 2022 shows a continued decline in reimbursements regardless of physician specialty. However, regional billing patterns did reflect disproportionate changes in reimbursements, with regions 4 (Southeast), 6 (South), and 9 (West Coast) having the sole increase in reimbursements for facility locations. Region 8 (Mountain West) had the largest declines in reimbursement for both practice settings.