Trends of Medicare reimbursement rates for gender affirmation procedures

• Published in: Journal of sexual medicine 2024-01, Vol.21 (2), p.181-191
• Main Authors: Siotos, Charalampos, Underhill, Joshua M, Sykes, Jennifer, Jones, Kody B, Schechter, Loren, Dorafshar, Amir H, Hamidian Jahromi, Alireza
• Format: Article
• Language: English
• ISSN: 1743-6095; 1743-6109
• DOI: 10.1093/jsxmed/qdad160

While nearly 1 in 5 Americans receives health insurance coverage through Medicare, literature suggests that Medicare reimbursement is lagging behind inflation for many plastic surgery procedures. This article evaluates trends in Medicare reimbursement for gender affirmation procedures. The most common gender affirmation procedures performed at an urban academic medical center were identified in this cross-sectional study (level 4 evidence). Five nongender surgery codes were evaluated for reference. A standardized formula utilizing relative value units (RVUs) was used to calculate monetary data. Differences in reimbursement between 2014 and 2021 were calculated for each procedure. The main outcome was inflation-adjusted difference of charges from 2014 to 2021. Between 2014 and 2021, Medicare reimbursement for gender affirmation procedures had an inflation-unadjusted average change of -0.09% (vs +5.63% for the selected nongender codes) and an inflation-adjusted change of -10.03% (vs -5.54% for the selected nongender codes). Trends in reimbursement varied by category of gender-affirming procedure. The overall average compound annual growth rate had a change of -0.99% (vs -0.53% for the selected nongender codes). The average changes in work, facility, and malpractice RVUs were -1.05%, +9.52%, and -0.93%, respectively. Gender surgeons and patients should be aware that the decrease in reimbursement may affect access to gender-affirming care. Our study is one of the first evaluating the reimbursement rates associated with the full spectrum of gender affirmation surgery. However, our study is limited by its cross-sectional nature. From 2014 to 2021, Medicare reimbursement for gender affirmation procedures lagged inflation.