Trends in Medicare utilization and reimbursement for hematology/oncology procedures.

person Julijana Zoran Conic Louisiana State University Health Sciences Center, New Orleans, LA info_outline Julijana Zoran Conic, Thomas Reske

Authors person Julijana Zoran Conic Louisiana State University Health Sciences Center, New Orleans, LA info_outline Julijana Zoran Conic, Thomas Reske Organizations Louisiana State University Health Sciences Center, New Orleans, LA Abstract Disclosures Research Funding No funding received None. Background: Medicare Part B pays for physician services such as office visits and procedures based on the Medicare Physician Fee Schedule which is re-evaluated annually to maintain budget neutrality. Moreover, national cancer-attributed medical care costs in 2015 were $183 billion and projected to increase 34% to $246 billion by 2030 (Green et al: J Clin Oncol, PMID: 31804856). The aim of this study is to evaluate trends in Medicare reimbursement for procedures in hematology/oncology between 2012-2022. Methods: The data analyzed were extracted from the Physician Fee Schedule Look-Up Tool. CPT Codes were obtained from the Medicare Coverage Database. The following CPT codes were extracted: antineoplastic chemotherapy administration (96405, 96406, 96401, 96409, 96411, 96413, 96415, 96416, 96417, 96420, 96422, 96423, 96425, 96440, 96446, 96450, 96542), antineoplastic hormone therapy administration (96402), non-chemotherapy infusion (96360, 96361, 96365, 96366, 96367, 96368, 96369, 96370, 96371, 96372, 96373, 96374, 96375, 96376 ), bone marrow sampling (38220, 38221, 38222), bone marrow harvest (38230, 38232) and bone marrow transplant (38240, 38241, 38242). Consumer Price Index (CPI) obtained from the U.S. Department of Labor's Bureau of Labor Statistics was used to adjust reimbursement rates for cumulative inflation to 2022 U.S. dollars. The T-test was used to compare the mean prices for each procedure. This research contains publicly available data and as such is exempt from the IRB according to the Institutional Review Board at LSU Health Sciences Center in New Orleans, Louisiana. Results: The procedure with the highest reimbursement rate in 2012 was bone marrow harvest and the procedure with the lowest reimbursement rate in the same year was antineoplastic hormone therapy administration. The procedure with the highest reimbursement rate in 2022 was bone marrow harvest. The procedure with the lowest reimbursement rate in 2022 was antineoplastic hormone therapy. All procedure reimbursement fell significantly (p value of <0.001) over the timer period studied. Conclusions: Between 2012 and 2022 the reimbursement rates for common hematology oncology services fell significantly when adjusted for inflation due to reforms in Medicare part B. T-test by procedure and year. Procedure Mean ± SD 2012 Mean ± SD 2022 P-value Chemotherapy administration 3130.24±3376.05 148.57±135.99 <0.001 Antineoplastic hormone therapy 677.11±68.20 35.08±3.48 <0.001 Non-chemotherapy infusion 972.00±937.00 40.11±37.77 <0.001 Bone marrow sampling 3266.76±312.93 175.21±18.41 <0.001 Bone marrow transplant 1912.36±528.01 189.66±51.20 <0.001 Bone marrow harvest 3690.37±289.88 206.38±15.82 <0.001