Trends in Medicare Utilization and Reimbursement for Spinal Cord Stimulators

The number of percutaneous and open procedures as well as reimbursement per procedure have progressively expanded from 2000 to 2019, according to a recent study (World Neurosurg. 2022; S1878-8750(22)01023-3. doi:10.1016/j.wneu.2022.07.075).

“Spinal cord stimulators (SCS) allow spine surgeons to provide relief for patients who suffer from chronic pain due to several disorders, such as failed back surgery syndrome, complex regional pain syndrome, and neuropathy,” wrote Marcus Romaniuk, MD, Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona and colleagues, adding, “Despite this, there remains a paucity of data regarding the utilization and reimbursement of SCS.”

This study aimed to assess the monetary and procedural trends of spinal cord stimulators among the Medicare database from 2000 to 2019.

The researchers utilized publicly available Medicare Part B National Summary Data files from 2000–2019 on all services billed to Medicare within that time frame.

Each service is assigned a Current Procedural Terminology (CPT) code and the number of times that service was performed, as well as the total physician Medicare charges and reimbursements for each service annually are incorporated in that data set.

The CPT codes for percutaneous and open placement of spinal cord stimulators were identified: 63,650 and 63,655, respectively. The total allowed services allowed charges and actual payments were separated from the data set for each year for each CPT code.

The total allowed charges and actual payments for the year were then divided by the total allowed services to find and trend the allowed charges and actual payment for each individual service performed for both percutaneous and open placement of spinal cord stimulators.

From 2000 to 2019, there were 992,372 Medicare-approved total percutaneous spinal cord stimulator operations and 99,736 Medicare-approved total open spinal cord stimulator operations.

Medicare paid $1.02 billion (2019 US dollars) in reimbursement to physicians for percutaneous spinal cord stimulator operations and approximately $145 million (2019 US dollars) in reimbursement to physicians for open spinal cord stimulator operations.

From the years 2000 to 2019, annually, there was an average 21.9% increase in Medicare-approved percutaneous spinal stimulator placement operations and a 18.4% increase annually in Medicare-approved open spinal stimulator placement operations.

From 2000 to 2019, there was also an average 8.7% increase annually in Medicare reimbursement per each percutaneous spinal stimulator placement operation. Per each open spinal stimulator placement operation, there was a 9.1% increase annually in Medicare reimbursement.

“The results of this study show that the number of percutaneous and open procedures have steadily increased from 2000 to 2019," wrote Dr Romaniuk and colleagues, adding, “Reimbursement per procedure has also increased steadily over this time.” Researchers concluded that, “Identifying these trends is important to promote research into costs of these surgeries and ensure adequate resource allocation.”