Abstract：
BACKGROUND: Awareness of Medicare reimbursement is important for gender-affirming surgeons who treat transgender patients with Medicare. In 2014, Medicare began to provide coverage for medically necessary transition-related surgery. The purpose of this study was to analyze trends in Medicare reimbursement rates for gender-affirming surgery procedures from 2014 to 2022.
METHODS: The Medicare Physician Fee Schedule Look-Up Tool provided by the Centers for Medicare and Medicaid Services was used, and the Current Procedural Terminology codes for 43 gender-affirming surgery services were obtained. Monetary units, conversion factors, relative value units (RVUs) for work, facility, and malpractice costs for 30 transmasculine and 13 transfeminine procedures were analyzed. Descriptive statistics were performed to account for inflation and to determine the relative differences between 2014 and 2022.
RESULTS: For all gender-affirming surgery procedures covered by Medicare, the average relative difference of monetary units decreased by 2.99% between 2014 and 2022. On average, there was a 3.97% decrease of work-based RVU charges for transmasculine procedures and a 1.73% decrease of work-based RVU charges for transfeminine procedures. After adjusting for inflation, the average relative difference of monetary units for all gender-affirming surgery procedures decreased by 23.42% between 2014 and 2022.
CONCLUSIONS: Reimbursement rates for gender-affirming surgery procedures covered under Medicare have decreased over the observed period, and trends in reimbursement rates have not kept up with consumer price index inflation. Gender-affirming surgeons should be conscious of these changes in reimbursement rates and advocate for fairer compensation to promote medical care among an underserved population.
METHODS: The Medicare Physician Fee Schedule Look-Up Tool provided by the Centers for Medicare and Medicaid Services was used, and the Current Procedural Terminology codes for 43 gender-affirming surgery services were obtained. Monetary units, conversion factors, relative value units (RVUs) for work, facility, and malpractice costs for 30 transmasculine and 13 transfeminine procedures were analyzed. Descriptive statistics were performed to account for inflation and to determine the relative differences between 2014 and 2022.
RESULTS: For all gender-affirming surgery procedures covered by Medicare, the average relative difference of monetary units decreased by 2.99% between 2014 and 2022. On average, there was a 3.97% decrease of work-based RVU charges for transmasculine procedures and a 1.73% decrease of work-based RVU charges for transfeminine procedures. After adjusting for inflation, the average relative difference of monetary units for all gender-affirming surgery procedures decreased by 23.42% between 2014 and 2022.
CONCLUSIONS: Reimbursement rates for gender-affirming surgery procedures covered under Medicare have decreased over the observed period, and trends in reimbursement rates have not kept up with consumer price index inflation. Gender-affirming surgeons should be conscious of these changes in reimbursement rates and advocate for fairer compensation to promote medical care among an underserved population.
摘要：
背景：意识到医疗保险报销对于通过医疗保险治疗变性患者的确认性别的外科医生很重要。2014年，Medicare开始为医疗上必要的过渡相关手术提供保险。这项研究的目的是分析2014年至2022年性别确认外科手术的医疗保险报销率趋势。
方法：使用了Medicare和Medicaid服务中心提供的Medicare医师费用表查询工具，并获得了43项性别确认手术服务的当前程序术语代码。货币单位,转换因子，工作的相对值单位(RVU)，设施,分析了30例跨男性和13例跨女性手术的医疗事故成本。进行描述性统计以说明通货膨胀并确定2014年至2022年之间的相对差异。
结果：对于Medicare承保的所有性别确认手术程序，货币单位的平均相对差异在2014年至2022年期间下降了2.99%。平均而言,跨男性手术的基于工作的RVU费用减少了3.97％，跨女性手术的基于工作的RVU费用减少了1.73％。在调整通货膨胀后，在2014年至2022年期间,所有确认性别的外科手术的货币单位的平均相对差异下降了23.42%.
结论：在观察期间，Medicare所涵盖的性别确认手术程序的报销率有所下降，偿还率的趋势没有跟上消费物价指数的通货膨胀。确认性别的外科医生应意识到报销率的这些变化，并倡导更公平的补偿，以促进服务不足的人群的医疗保健。
方法：使用了Medicare和Medicaid服务中心提供的Medicare医师费用表查询工具，并获得了43项性别确认手术服务的当前程序术语代码。货币单位,转换因子，工作的相对值单位(RVU)，设施,分析了30例跨男性和13例跨女性手术的医疗事故成本。进行描述性统计以说明通货膨胀并确定2014年至2022年之间的相对差异。
结果：对于Medicare承保的所有性别确认手术程序，货币单位的平均相对差异在2014年至2022年期间下降了2.99%。平均而言,跨男性手术的基于工作的RVU费用减少了3.97％，跨女性手术的基于工作的RVU费用减少了1.73％。在调整通货膨胀后，在2014年至2022年期间,所有确认性别的外科手术的货币单位的平均相对差异下降了23.42%.
结论：在观察期间，Medicare所涵盖的性别确认手术程序的报销率有所下降，偿还率的趋势没有跟上消费物价指数的通货膨胀。确认性别的外科医生应意识到报销率的这些变化，并倡导更公平的补偿，以促进服务不足的人群的医疗保健。
