Trends in Medicare and Medicaid Physician Fee and Facility Pricing Reimbursements for Craniofacial Trauma Procedures From 2007 to 2024.

Authors

Khoa Nguyen, Celia J Ernstrom, Anna Lee, Ariel Johnson, Mark Greyson, David Mathes, Christodoulos Kaoutzanis, Joseph Lopez, Phuong Nguyen, Jason W Yu

Published in

The Journal of craniofacial surgery. Oct 05, 2026. Epub Oct 05, 2026.

Abstract

Reimbursement trends influence the sustainability of craniofacial trauma practices, yet limited literature addresses long-term patterns. This study evaluates national trends in Medicare physician fees (PF) and facility pricing (FP) for craniofacial trauma procedures from 2007 to 2024. Reimbursement data were obtained from the Medicare Physician Fee Schedule Look-Up (MPFS) tool by the Centers for Medicare & Medicaid Services (CMS). Craniofacial trauma surgeries were identified using Current Procedural Terminology (CPT) codes. PF values were calculated using national payment amounts, incorporating work, practice expense, and malpractice relative value units with Geographic Practice Cost Indices set to 1.000. Conversion factors were obtained from CMS. PF calculations followed the standard CMS reimbursement formula. FP data were also retrieved from MPFS and adjusted for inflation using the Consumer Price Index. Percentage change and year-over-year (YOY) analyses were performed. Fifty-six CPT codes were analyzed. From 2007 to 2024, average PF reimbursement declined by 26.65%. The smallest decrease occurred with CPT 21485, closed treatment of temporomandibular dislocation (-2.58%), while CPT 21315, closed reduction of a nasal bone fracture, showed the largest (-70.45%). Facility pricing (FP) declined by 19.84%, with 95% of codes experiencing an average net decrease of 21.65%. Only 5% of codes saw an average increase of 12.17%. Closed reduction of a nasal bone fracture had the greatest FP reduction (-68.44%), while CPT 21452, external fixation of a mandibular fracture, had the highest increase (19.16%). YOY changes corresponded with major economic events, including the 2007 to 2008 financial crisis and the 2020 to 2021 SARS-CoV-2 pandemic. Craniofacial trauma reimbursement through Medicare declined markedly between 2007 and 2024, with volatility during key economic periods, emphasizing the need for proactive reimbursement advocacy.

PMID:
42832351
Bibliographic data and abstract were imported from PubMed on 06 Oct 2026.

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