Analyzing Billing Patterns and Medicare Reimbursement Among Otolaryngologists Performing In-Office Cerumen Removal

General physicians and other providers are progressively referring patients requiring cerumen disimpaction to otolaryngologist (ORL) physicians and permitting advanced practice providers (APPs) to perform these procedures, suggesting a shift in landscape of medical practice among these providers, according to findings from a recent study (Ann Otol Rhinol Laryngol. 2022;34894221096980. doi:10.1177/00034894221096980).

Rahul Patel (Frank H Netter, MD, School of Medicine at Quinnipiac University, North Haven, CT) and colleagues conducted a retrospective study to evaluate trends in billing patterns, Medicare reimbursement, and practice setting for ORLs and other provider types performing in-office cerumen removal.

Researchers utilized data from Medicare-billing providers from the Medicare Part B: Provider Utilization and Payment Datafiles from 2012 to 2018. Number of providers performing in-office cerumen removal, total sums and medians for Medicare reimbursements and services, and services per patient were compiled along with geographic distributions.

Results revealed that there have been near-linear declines in number of general physicians and other provider types performing cerumen extractions with 42.6% and 40.7% declines, respectively, and near-linear growth in number of ORLs and advanced practice providers (APPs) with 9.7% and 51.1% growth, respectively.

At the median, general physicians, APPs, and other provider types have been billing for a comparable and constant number of cerumen extractions per provider, while ORLs have noticed a 10.6% growth.

Total Medicare reimbursement to general physicians and other provider types has dropped 45.0% and 32.5%, respectively, and has increased 16.9% and 103.4% to ORLs and APPs, respectively. Unlike with non-ORLs, ORLs tend to bill for cerumen extraction out of an urban setting rather than a rural setting (P <0.001).

Dr Patel and colleagues concluded, “Though cerumen disimpaction is a common in-office procedure among ORL physicians and general practice physicians, there is a lack of understanding surrounding the billing patterns, Medicare reimbursement, and practice-setting for providers performing such procedures. Our study suggests that general physicians and other provider types are increasingly referring cerumen disimpaction patients to ORL physicians and APPs, which may reflect a decreasing interest and/or comfort among general physicians in treating simple ORL complaints, a trend with implications for the healthcare burden on ORL physicians. Despite this, general physicians may be filling a need in the rural setting, where there are fewer ORLs practicing.”