(015) Medicare Reimbursement for Various Nasal Surgeries based on Geographical Location

Introduction: Medicare reimbursement for otolaryngologic surgery varies by geographic location through GPCIs. However, the relative valuation of specific nasal procedures has not been well characterized. This study quantifies geographic effects on reimbursement controlling for the cost of living based on state and evaluates whether procedure-specific payment disparities persisted across recent Medicare fee schedules.

Methods: We analyzed national Medicare fee schedule data for nasal surgery CPT codes 30400, 30410, 30420, 30430, 30435, 20450, 30460, 30462, 30465, and 30620 from 2023 - 2025, aggregating to state-year mean reimbursement for each code. We merged this data with a state‑level cost‑of‑living index derived from the MERIC cost-of-living index by state. For each CPT code and year, we used R 4.5.1 to fit linear regressions of state‑level mean reimbursement on cost of living across all states and calculated the residual reimbursement (observed minus Cost of Living Index (COLI)‑expected reimbursement).

Results: Across all nasal CPT codes and study years, the difference between the most over‑ and under‑reimbursed state in 2023 was 365 dollars per CPT-state-year after cost‑of‑living adjustment. When averaged across all nasal CPT codes and years, Vermont (mean residual -110 dollars), Maine (-72 dollars), and Arkansas (-57 dollars) were most under‑reimbursed relative to COLI, whereas Alaska (+112 dollars), Washington (+101 dollars), Florida (+100 dollars), Texas (+66 dollars), and Illinois (+93 dollars) were most over‑reimbursed. California’s reimbursements for nasal surgery were close to COLI‑expected levels overall, with an average residual of -11.9 dollars across all CPT codes and years and -9.4 dollars for CPT 30400 specifically, placing it near the middle of the national distribution. These patterns were consistent across 2023 - 2025.

Conclusions: Substantial interstate variation in Medicare reimbursement for nasal surgery persists after adjusting for regional cost of living, with some states systematically over‑ and others under‑reimbursed relative to COLI‑expected levels.