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Comparison of Recent Trends in Medicare Utilization and Reimbursement for Anterior Cervical Spine Discectomy and Fusion as Compared to Cervical Disc Arthroplasty.

Study DesignRetrospective Database Study.ObjectivesAnterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are c … d compared between procedures.ResultsIn 2011, 27 974 single-level ACDF procedures were performed on Medicare Part B patients compared to 34 683 performed in 2021. This represents a growth in procedure utilization of 24% over the study period. Over the course of the same study period CDA procedures grew by 1087.3%, from 118 in 2011 to 1401 in 2021. Throughout the …

Comparative Cost Modeling of Out-of-Pocket Costs for External Beam Radiation Therapy Versus Stereotactic Body Radiation Therapy in Metastatic Spine Cancer.

PURPOSE: The choice between stereotactic body radiation therapy (SBRT) and external beam radiation therapy (EBRT) for spine metastases depends on several factors: tumor size, tumor location, patient health, prognosis, other treatments (i.e., surgery, minimally invasive procedures, systemic therapy, and supportive care), and treatment goals. Limited evidence exists on insurance's influence on out-of-pocket (OOP) expenses across radiation modalities. This study assesses costs across various insurance plans, including original Medicare and Medicaid. METHODS AND MATERIALS: National Comprehensive

Trends in utilization rates of the various imaging modalities in emergency departments: nationwide Medicare data from 2000 to 2008.

PURPOSE: To study utilization trends in the various imaging modalities in emergency departments (EDs) over a recent multiyear period. METHODS: The nationwide Medicare Part B databases for 2000 to 2008 were queried. Medicare's location codes were used to identify imaging examinations done on ED patients. All diagnostic imaging Current Procedural Terminology(®) codes were grouped by modality. For each code, the database provides procedure volume; utilization rates per 1,000 beneficiaries were then calculated. Medicare's physician specialty codes were used to determine provider specialty. Utiliz…

Use of gonioscopy in medicare beneficiaries before glaucoma surgery.

PURPOSE: The American Academy of Ophthalmology Preferred Practice Patterns for angle closure and open-angle glaucoma (OAG) patients recommends performing bilateral gonioscopy upon initial presentation to evaluate the possibility of narrow angle or angle-closure glaucoma (ACG) and then repeating the examination at least every 5 years. This study aims to assess how commonly eye care providers perform gonioscopy before planned glaucoma surgery in OAG, anatomic narrow angle, and ACG in the Medicare population. METHODS: Data obtained from a 5% random sample of Medicare beneficiaries undergoing gla

A 10-year Analysis of Volume-Adjusted Trends in Medicare Reimbursement for Hand Surgery Procedures.

PURPOSE: Decreased Medicare reimbursement rates have been observed in many surgical subspecialties, which can negatively impact access and sustainability of care. While several studies report decreased reimbursement for hand surgery procedures, none have accounted for changes in case volume. METHODS: The CMS Physician and Other Practitioners database was used to extract all procedure codes billed to Medicare Part B by hand surgeons. The Medicare Physician Fee Schedule database was used to collect reimbursement information, and reimbursement trends were weighted by procedure volume. RESULTS: …

Causal effect of conventional anti-dementia drugs on economic burden: an orthogonal double/debiased machine learning approach.

BACKGROUND: The Inflation Reduction Act (IRA) did not introduce a cap on out-of-pocket (OOP) for newly approved Alzheimer's Disease (AD) drugs, such as lecanemab which is covered under Medicare Part B. Therefore, expanding the use of conventional anti-dementia drugs is critical to addressing the growing economic burden of dementia. In this study, we aimed to evaluate the causal relationship between specific conventional anti-dementia drug use and various healthcare costs with the Double/Debiased Machine Learning (DML) approach. METHODS: Leveraging data from the Medicare Current Beneficiary Su…

Medicare Coverage for Diabetes Management: A Primary Care Professional's Guide to Advocacy and Navigation.

OBJECTIVE: To provide primary care professionals with practical strategies for navigating Medicare coverage across all domains of diabetes management to reduce financial and administrative barriers while optimizing treatment access. RESEARCH DESIGN AND METHODS: This comprehensive guide examines Medicare coverage policies for diabetes care across Parts A, B, C (Medicare Advantage), and D. We analyze coverage requirements for clinical services, pharmacotherapy, diabetes technologies, and preventive care, with particular attention to recent legislative reforms including the Inflation Reduction A

Factors Associated With an Elder Mistreatment Diagnosis Among Medicare Home Health Care Recipients.

OBJECTIVES: To identify risk factors of elder mistreatment (EM) diagnosis among Medicare fee-for-service beneficiaries receiving Medicare Home Health Care (HHC). DESIGN: Longitudinal retrospective cohort study. SETTING AND PARTICIPANTS: Beneficiaries aged 66 and older receiving HHC in 2016, without an EM diagnosis in 2015 or 2016, and Medicare Part A/B/D eligible with no HMO through 2018 were included (N = 270,935). METHODS: Predictor variables from 20% national Medicare claims (eg, demographics, health conditions, social determinants of health) and the Outcomes and Assessment Information S

Costs of Surveillance Care After Definitive Treatment of Head and Neck Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Medicare Analysis.

INTRODUCTION: Following curative treatment of squamous carcinoma of the head and neck, surveillance care is indicated to detect recurrence. Historically, physical exams are the backbone of surveillance, but serial imaging and flexible endoscopy are also utilized. Recently, assays have become commercially available, which could aid in early detection of recurrence. To understand the potential economic impact of these assays, a baseline of surveillance costs must be established. We performed a Surveillance, Epidemiology, and End Results (SEER)-Medicare analysis to quantify the costs of classic s

Surgical and Transcatheter Mitral Valve Therapy: Medicare Utilization and Reimbursement.

BACKGROUND: We aimed to examine trends in the utilization and reimbursement of surgical and transcatheter mitral valve therapies and their changing relationship. METHODS: A query of administrative data on US Medicare beneficiaries undergoing mitral valve therapy was conducted from 2015 to 2020 using the Centers for Medicare and Medicaid Services Part B National Summary Data File. Inflation adjustment was to the 2020 Consumer Price Index. Trend analysis was quantified with growth rate and simple linear regression calculations. RESULTS: The annual number of all mitral valve procedures remained

How Much Does Attendance Impact Weight Loss and Health Care Spending in a Diabetes Prevention Program Serving Older Adults?

PURPOSE: Measure attendance to the Young Men's Christian Association (YMCA) of the USA (Y-USA) diabetes prevention program (DPP) and show how attendance impacts weight loss and medical spending in a population of Medicare beneficiaries. DESIGN: Observational study using a pre- and post-specification. SETTING: A total of 17 participating YMCAs nationwide. PARTICIPANTS: 3317 Medicare beneficiaries with prediabetes. INTERVENTION: Community-based trainings of lifestyle intervention (National DPP). MEASURES: We used weight measurements from the Y-USA DPP participants, and Medicare fee-for-serv

Identifying observable medication use time in administrative databases: a tutorial using nursing home residents.

Nursing home (NH) residents are an important population for pharmacoepidemiologic research due to their prevalence of multimorbidity and polypharmacy. Medicare claims are commonly used to study medication use in this population, but medications dispensed during hospitalizations or post-acute care are unobservable due to bundled payment structures. We developed algorithms to identify NH days when medication dispensings can be observed in claims. Using a cohort of NH residents in the United States from 2013 to 2020, we linked Medicare fee-for-service (FFS) claims with Minimum Data Set clinical a

Consensus guidelines on optimal sizing, administration and documentation of cellular, acellular and matrix-like products (CAMPs).

In January 2026, the Centers for Medicare & Medicaid Services (CMS) reclassified cellular, acellular and matrixlike products (CAMPs) from 'biologicals' to 'incident-to supplies' under Medicare Part B, introducing a flat-fee reimbursement model. However, there was clinical ambiguity regarding the definition, measurement and documentation of administered and discarded product. This uncertainty has increased audit risk and been associated with reduced confidence among providers in appropriate CAMPs use. In February 2026, a multidisciplinary US panel of wound care and reimbursement specialists con…

Transcatheter atrial septal defects and patent foramen ovale closure: Medicare utilization and reimbursements.

BACKGROUND: The Food and Drug Administration has approved percutaneous atrial septal defect (ASD) and patent foramen ovale (PFO) closure devices for hemodynamically significant interatrial shunts, paradoxical emboli including stroke, and decompression sickness. We aimed to study the trends in utilization and reimbursements of transcatheter ASD/PFO closure devices. AIM: To analyze trends in utilization and Medicare reimbursements for transcatheter ASD/PFO closure procedures from 2013 to 2022. METHODS: A query of administrative data on United States Medicare beneficiaries undergoing transcathe

Utilization and costs of cardiovascular disease medications in dialysis patients in Medicare Part D.

BACKGROUND: Cardiovascular disease (CVD) is a major source of mortality and morbidity in dialysis patients. Population-level descriptions of CVD medication use are lacking in this population. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Adult dialysis patients in the United States, alive on December 31, 2006, with Medicare Parts A and B and enrollment in Medicare Part D continuously in 2007. PREDICTOR: CVDs and demographic characteristics. OUTCOME: ≥1 prescription fill during follow-up (2007). MEASUREMENTS: Average out-of-pocket costs per user per month and average to

Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes.

ImportanceIn 2016, the US Centers for Medicare & Medicaid Services initiated the Oncology Care Model (OCM), an alternative payment model designed to improve the value of care delivered to Medicare beneficiaries with cancer.ObjectiveTo assess the association of the OCM with changes in Medicare spending, utilization, quality, and patient experience during the OCM's first 3 years.Design, setting, and participantsExploratory difference-in-differences study comparing care during 6-month chemotherapy episodes in OCM participating practices and propensity-matched comparison practices initiated before

Cataract surgery and the primary care practitioner.

Cataract surgery with intraocular lens implantation is the most frequently performed operation in the Medicare Part B population. Such patients will seek the advice of their primary care practitioner, and the safety of the procedure may depend on the information the practitioner provides to the surgeon and anesthesia team. This article reviews pertinent issues surrounding the decision to operate; how various intraocular lens implants are selected; how surgery is now performed; postoperative complications, activities, and care; the role of the primary care physician; and the issue of medical cl…

Resource Use and Care Quality Differences Among Medicare Beneficiaries Undergoing Chemotherapy.

ImportanceMedicare Advantage (MA) has grown significantly over the last decade; however, MA's performance for patients with serious conditions, such as cancer, remains unclear.ObjectiveTo compare resource use and care quality between MA and traditional Medicare (TM) beneficiaries undergoing cancer chemotherapy.Design, setting, and participantsThis cohort study used TM claims and MA encounter records from January 2015 to December 2019. Participants were MA and TM beneficiaries who initiated cancer chemotherapy between January 2016 and December 2019. Inverse probability of treatment weighting ba

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… Measuring the scope of prior authorization policies: applying private insurer rules to Medicare Part B . JAMA Health Forum . 2021 ; 2 ( 5 ): e210859 . doi: 10.1001/jamahealthforum.2021.0859 35977311 PMC8796979 17 Anderson KE , Alexander GC , Ma C , Dy SM , Sen AP . …

A covered benefit with an untrusted on-ramp: Why medicare principal illness navigation still is not reaching patients.

Principal Illness Navigation (PIN) represents an important Medicare policy advance, but coverage has not translated reliably into access. PI … reassignment adds further friction when an eligible organization seeks to submit claims and receive Medicare Part B payment. This commentary argues that PIN's implementation challenges reflect not only physician education gaps but also a broader trust problem in the administrative pathway. Historical warnings from the U.S. Department of Health and Human Services …

Characteristics, treatment, and health care expenditures of Medicare supplemental-insured patients with painful diabetic peripheral neuropathy, post-herpetic neuralgia, or fibromyalgia.

OBJECTIVE: To describe the characteristics, treatment, and health care expenditures of Medicare Supplemental-insured patients with painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), or fibromyalgia. DESIGN: Retrospective cohort study. SETTING: United States clinical practice, as reflected within a database comprising administrative claims from 2.3 million older adults participating in Medicare supplemental insurance programs. SUBJECTS: Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009,