Trends in Medicare Reimbursement for Critical Care and Non-Critical Care Services Billed by Neurosurgeons

Introduction: To analyze trends in Medicare reimbursement for critical care (CC) and non-critical care (non-CC) procedures billed by neurosurgeons from 2013 to 2020 and evaluate beneficiary risk scores.

Methods: Medicare billing data from the CMS website were analyzed for CC services (CPT codes 99291 and 99292) and non-CC services. Key metrics included the number of beneficiaries, submitted and allowed charges, and Medicare standard amounts. Linear regression was used to assess the impact of neurosurgeons, beneficiaries, and submitted charges on reimbursement amounts, with a focus on risk score trends.

Results: From 2013 to 2020, the average submitted charge for CC services increased from $808 to $1,024, while the allowed amount decreased from $193 to $175. The number of neurosurgeons billing for CC increased from 138 to 165. Each neurosurgeon billed an average of 37 beneficiaries annually, with minor fluctuations over the years. Revenue from CC services as a percentage of total revenue generated by neurosurgeons grew from 9.07% in 2013 to 11.77% in 2020. The percent reimbursed for CC services decreased from 30.15% in 2013 to 22.47% in 2020. The percent reimbursed for non-CC services was consistently lower than for CC services, decreasing from 21.32% in 2013 to 20.84% in 2020. The average risk score for CC beneficiaries increased from 1.66 in 2013 to 1.90 in 2020 (Estimate: +0.037, p < 0.001), indicating more complex cases. Similarly, the average risk score for non-CC services rose from 1.40 to 1.57 (Estimate: +0.026, p < 0.001).

Conclusion : Despite increasing submitted charges, reimbursement for CC services has decreased, reflecting a widening gap between charges and payments. Rising beneficiary risk scores indicate that CC services are being used for increasingly severe cases. Non-CC services showed a similar trend, with a consistently lower reimbursement rates compared to CC services.