More work for the same pay: trends in urethroplasty reimbursement from the medicare physician fee schedule (2013-2023).

OBJECTIVES

Urethroplasty is the gold standard for recurrent urethral stricture disease per the 2016 American Urological Association (AUA) guideline. Its sustainability depends on economic viability; however, recent payment cuts and inflationary pressures threaten reimbursement. This study analyzed: (1) trends in Medicare providers performing urethroplasty, (2) urethroplasty procedure volumes, and (3) nominal and inflation-adjusted Medicare reimbursement from 2013-2023, contextualized against comparator urologic procedures.

METHODS

This was a retrospective, cross-sectional study using the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule and Medicare Part B Physician and Other Practitioners datasets from 2013-2023. Urethroplasty procedures were identified using CPT codes 53,400, 53,405, 53,410, 53,415, and 53,430. Comparator procedures included Cystourethroscopy with Direct Vision Internal Urethrotomy (DVIU, CPT 52276) and Endoscopic/Robotic-Assisted Radical Prostatectomy (CPT 55866). Reimbursement values were adjusted to August 2025 U.S. dollars using the Consumer Price Index.

RESULTS

Urethroplasty provider numbers and procedure volumes increased 33-45% and 36-65%, respectively. Nominal urethroplasty reimbursement remained stable (-2.5% to + 22.8%), while inflation-adjusted reimbursement declined 18-25% across all types. By contrast, DVIU demonstrated declining provider participation (-33.9%) and procedure volumes (-46.5%), with inflation-adjusted reimbursement declining 27.4%. Endoscopic prostatectomy showed growing provider participation (+ 33.4%) and volumes (+ 27.3%), but experienced the most severe nominal (-26.5%) and inflation-adjusted (-43.5%) reimbursement decline of all procedures examined.

CONCLUSIONS

Urethroplasty faces a distinctive economic burden: rising clinical demand paired with stagnant nominal and substantially declining real reimbursement. While reimbursement erosion affects all urologic procedures studied, the combination of increasing utilization and inadequate payment adjustment is uniquely pronounced for reconstructive urology. Long-term sustainability will require reimbursement models that align payment with evidence-based, high-value surgical care.