Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B298
Session Name: Poster Session
Free Flap Medicare Reimbursement and Utilization Trends in Otolaryngology, Plastic Surgery, and Maxillofacial Surgery from 2013-2022
Kyle Polen, BS1; Alan Napole, BS1; Gavin Turner, BS2; Robert M Brody, MD2; Ryan M Carey, MD2; 1Perelman School of Medicine, University of Pennsylvania; 2Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health SystemFree flap reconstructive surgery allows restoration of complex head and neck defects in otolaryngology (ENT), plastic surgery, and maxillofacial surgery. Despite the widespread reconstructive applications, Medicare reimbursement trends for free flap procedures between these specialties have not been extensively studied. Between 2013 and 2022, Medicare spending increased from $585.7 billion to $944.3 billion – an increase by over 60%. This growth necessitates further investigation into utilization, charges, and reimbursements for free flap procedures across specialties.
This study analyzed Centers for Medicare & Medicaid Services (CMS) Medicare Physician & Other Practitioners Data (2013–2022) for CPT codes 15757 (free skin flaps) and 20969 (free osteocutaneous flaps) by specialty (otolaryngology, plastic and reconstructive surgery, and maxillofacial surgery). We assessed procedure utilization, average reported costs (total charges/total procedures), reimbursements (total reimbursements/total procedures), and charge-to-reimbursement ratios (CRRs) stratified by specialty and adjusted for inflation.
The analysis included 5,078 free flap services reported to Medicare Part B between 2013 and 2022. ENT providers increased utilization by over 70% from 2013 to 2022, while plastic surgery and maxillofacial surgery utilization remained stable over the same period. Among ENT providers, reimbursements decreased significantly from 2013 to 2020, 2021, and 2022 (p<0.01), and charges declined significantly from 2016 to 2021 and 2022 (p<0.05). The CRR for ENT remained stable over time around 7.65, whereas plastic surgery exhibited the largest CRR gap at 9.54 in 2022, indicating a substantial discrepancy between charges and reimbursements. Maxillofacial surgery had limited data availability for 2016, 2017, and 2019 but showed the second-highest CRR at 8.87 in 2022.
The expanding role of free flap reconstruction in managing complex defects and its Medicare reimbursement trends underscore a changing financial landscape. While ENT providers have increased free flap procedure volume, charges and reimbursements for these services have significantly declined over the past decade. In contrast, utilization by plastic and maxillofacial surgery has remained steady, with a notable discrepancy between costs and reimbursements in plastic surgery. Though this database is limited to Medicare Part B data, the findings question whether current reimbursement policies align with evolving practices across specialties utilizing the same CPT codes. The growing prevalence of free flap reconstruction highlights the need for a deeper understanding of trends to ensure policies reflect the true clinical value of these technically complex procedures.
