Comparison of radical hysterectomy with pelvic lymphadenectomy and radical prostatectomy with lymphadenectomy: Medicare reimbursement 2010-2019

Objectives: To investigate differences in Medicare reimbursement between hysterectomy and prostatectomy (with lymphadenectomy) between Gynecology and Urology Methods: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid was utilized to extract reimbursement data for the two CPT codes representing open radical hysterectomy with lymphadenectomy and laparoscopic radical hysterectomy with lymphadenectomy. Likewise, the CPT code representing open radical prostatectomy with lymphadenectomy and the two CPT codes representing laparoscopic radical prostatectomy and lymphadenectomy was also collected. There is no code that combines laparoscopic prostatectomy and lymphadenectomy, so the values were combined. Average annual and total percent change in reimbursement was calculated for each hysterectomy with lymphadenectomy and prostatectomy with lymphadenectomy. Results: Reimbursement for the open hysterectomy with lymphadenectomy decreased by an average of 13.72%, and for the open prostatectomy with lymphadenectomy by 27.88% from 2010 to 2019 with R-squared values of 0.98 and 0.92, respectively. Reimbursement rates from 2010 to 2019 for open procedures averaged $1,828.59 and $1,649.44, respectively. Reimbursement for laparoscopic hysterectomy with lymphadenectomy decreased by an average of 13.72% with an R-value of 0.98 and by 34.99% with an R-value of 0.94 for the laparoscopic prostatectomy with lymphadenectomy procedure. Reimbursement rates for laparoscopic procedures from 2010 to 2019 averaged $1,860.22 and $2,722.99, respectively. Conclusions: This study provides an analysis of trends in procedural Medicare reimbursement for oncologic procedures performed by gynecologic and urologic surgeons. Findings suggest that urologists are reimbursed slightly less for open radical prostatectomy with lymphadenectomy compared to their gynecology counterparts, while being reimbursed more for laparoscopic prostatectomy with lymphadenectomy compared to their gynecology counterparts. This is an area of concern since minimally invasive procedures have become the industry standard. Results suggest continuing disparities surrounding Medicare reimbursements for sex-specific procedures