Declining Reimbursement Rates for Obstructive Sleep Apnea Surgery: A 25-year Medicare Analysis

Introduction: Recent research suggests that Medicare reimbursement rates for otolaryngologic procedures have declined over time. This study assessed reimbursement trends for obstructive sleep apnea (OSA) surgical procedures from 2000-2025 with adjustment for inflation.

Methods: A retrospective study using the Physician Fee Schedule as provided by the Centers for Medicare and Medicaid Services was performed. Annual reports for Current Procedural Terminology (CPT) codes for sleep surgery procedures with data available for 2000 through 2025 were obtained. Procedures included septoplasty (CPT 30520), turbinectomy (CPT 30130, 30140), pharyngoplasty (CPT 42145), tonsillectomy (CPT 42826), uvulectomy (CPT 42140), and tracheostomy (CPT 31600). Physician professional fees were collected by Medicare Administrative Contractor localities per CPT code. Mean locality fee values per code were adjusted for inflation using January 2025 dollars per the Bureau of Labor Statistics. Statistical significance was defined as p < 0.05.

Results: Over the 25-year period, mean inflation-adjusted procedural fee reimbursement decreased for septoplasty by 19.4% ($670.60 vs. $832.20, p < 0.0001), decreased for turbinectomy by 36.1% ($296.60 vs. $464.40, p < 0.0001), decreased for pharyngoplasty by 40.7% ($685.70 vs. $1156.00, p < 0.0001), decreased for tonsillectomy by 48.3% ($258.30 vs. $499.20, p < 0.0001), decreased for uvulectomy by 36.3% ($165.30 vs. $259.70, p < 0.0001), and decreased for tracheostomy by 37.9% ($296.10 vs. $476.70, p < 0.0001).

Conclusions: Inflation-adjusted professional fee reimbursement for OSA surgical procedures has substantially declined since 2000. This may adversely impact access to care for Medicare patients with OSA, necessitating attention from healthcare policymakers.