# Examining Medicare Reimbursement Differences for Cochlear Implant Surgery

## TL;DR

This study compares Medicare reimbursement amounts for cochlear implant surgery in hospital outpatient settings versus ambulatory surgery centers and finds significant differences.

## Contribution

The study reveals significant Medicare reimbursement disparities for cochlear implant surgery between hospital and ASC settings over three years.

## Key findings

- Outpatient hospitals received significantly higher Medicare reimbursements for cochlear implant surgery than ASCs in all three years studied.
- Reimbursement amounts increased over time in both settings, but the gap between hospital and ASC reimbursements remained significant.
- Statistical analysis confirmed the differences were highly significant (p < 0.0001) in all years.

## Abstract

Objectives

This study aims to investigate discrepancies in Medicare reimbursements for cochlear implant surgery between the hospital setting and ambulatory surgery centers (ASCs), which provide a convenient alternative to hospital-based outpatient procedures by offering same-day surgical healthcare.

Study design

A retrospective analysis of Medicare claims data from 2019 to 2021 was conducted, including 358 otolaryngology and ASC providers. The study evaluated average Medicare reimbursement for cochlear implantation procedures performed in ASCs using Current Procedural Terminology (CPT) code 69930 and compared these with reimbursements for the same procedure in outpatient hospital settings using Ambulatory Payment Classification (APC) code 5166.

Methods

The primary outcome variable was the average Medicare reimbursement amount for each provider location (ASCs vs. outpatient hospital setting) for each code associated with cochlear implant surgery. Unpaired two-tailed t-tests (p <0.05) were used to compare average reimbursement amounts between the two groups. Additionally, box-and-whisker plots were utilized to illustrate the distribution of reimbursement amounts between each provider group.

Results

Outpatient hospital settings received significantly greater reimbursements for cochlear implant surgery between 2019 and 2021 (for 2019, mean = 29595.58, SD = 3934.898; for 2020, mean = 31464.87, SD = 4177.054; for 2021, mean = 32549.87, SD = 4402.242) compared with ASCs(for 2019, mean = 23202.01, SD = 2242.805, p < 0.0001; for 2020, mean = 24986.88, p < 0.001, SD = 3367.238; for 2021, mean = 26028.86, SD = 3184.769, p < 0.0001).

Conclusions

Identifying discrepancies in Medicare reimbursement for cochlear implant surgery between ASC surgeons and outpatient settings is crucial for understanding treatment selection. This study investigates current reimbursement practices and highlights areas for potential improvement within the Medicare system. Further research may explore reasons for reimbursement variations and their impact on patients needing cochlear implants.