Inflation-adjusted medicare physician reimbursement for adult spinal deformity surgery substantially declined from 2002 to 2020

Purpose: Physician fees for orthopaedic surgeons by the Centers for Medicare and Medicaid Services (CMS) are increasingly scrutinized. The present retrospective review aims to assess whether adult spinal deformity (ASD) surgeries are properly valued for Medicare reimbursement. Methods: Current Procedural Terminology (CPT) codes related to posterior fusion of spinal deformity of ≤ 6, 7–12, and ≥ 13 vertebral levels, as well as additional arthrodesis and osteotomy levels, were assessed for (1) Compound annual growth rate (CAGR) from 2002 to 2020, calculated using physician fee data from the CMS Physician Fee Schedule Look-Up Tool; and (2) work relative value units (RVUs) per operative minute, using data from the National Surgical Quality Improvement Program. Results: From 2002 to 2020, all CPT codes for ASD surgery had negative inflation-adjusted CAGRs (range, − 18.49% to − 27.66%). Mean physician fees for spinal fusion declined by 26.02% (CAGR, − 1.66%) in ≤ 6-level fusion, 27.91% (CAGR, − 1.80%) in 7- to 12-level fusion, and 28.25% (CAGR, − 1.83%) ≥ 13-level fusion. Fees for both 7–12 (P < 0.00001) and ≥ 13 levels (P < 0.00001) declined more than those for fusion of ≤ 6 vertebral levels. RVU per minute was lower for 7- to 12-level and ≥ 13-level (P < 0.00001 for both) ASD surgeries than for ≤ 6-level. Conclusions: Reimbursement for ASD surgery declined overall. CAGR for fusions of ≥ 7 levels were lower than those for fusions of ≤ 6 levels. For 2012–2018, ≥ 7-level fusions had lower RVU per minute than ≤ 6-level fusions. Revaluation of Medicare reimbursement for longer-level ASD surgeries may be warranted. Level of evidence: III.