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Scientific Oral Presentation

Pediatric Otolaryngology

Declining Reimbursement for Pediatric Otolaryngology Procedures: A 25-year Medicare Analysis

Monday, October 19, 2026
8:54 AM - 9:00 AM PT
Location: 409AB

    Presenting Author(s)

  • Emma R. DeRavin, MD

    Otolaryngology Resident
    1) Department of Otolaryngology–Head and Neck Surgery, Sidney Kimmel Medical School/Sidney Kimmel Comprehensive Cancer Center at Thomas Jefferson University
    Philadelphia, PA, United States

    • Co-Author(s)

  • Sruti Tekumalla, MD

    Otolaryngology Resident
    Thomas Jefferson University
    Philadelphia , Pennsylvania, United States

  • Leonard E. Estephan, MD

    Otolaryngology Resident
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

    • Senior Author(s)

  • Nicole L. Aaronson, MD, MBA

    Chief, Pediatric Otolaryngology
    Nemours Children's Hospital of Delaware
    Wilmington, DE, United States

Disclosure(s):
Nicole L. Aaronson, MD, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Medicare reimbursement for otolaryngologic (ENT) procedures has declined over time, but long-term trends in pediatric ENT procedures are poorly characterized. This study evaluated 25-year trends in facility reimbursement and work relative value units (RVUs) for common pediatric ENT procedures.

Methods: A retrospective analysis of the CMS Physician Fee Schedule was performed for the 25 most common pediatric ENT CPT codes from 2000–2025, including nasal fracture repair, neck abscess drainage, frenulectomy, intubation, direct laryngoscopy and/or bronchoscopy, foreign body removal, tracheostomy (or trach tube change, tracheobronchoscopy), tonsillectomy and/or adenoidectomy, control of post-tonsillectomy hemorrhage, myringotomy ± tympanostomy tubes, myringoplasty, and tympanoplasty ± mastoidectomy. Facility fees and mean work RVUs were collected across localities and averaged annually per procedure. Fees were adjusted to January 2025 dollars using Bureau of Labor Statistics inflation data.

Results: Across all procedures, mean inflation-adjusted facility reimbursement declined from $443.60 in 2000 to $252.50 in 2025 (p < 0.001). This trend remained when stratified by procedure type (all p < 0.001). Mean work RVUs increased modestly overall from 3.35 to 3.55. Significant RVU increases were observed for tracheostomy and tonsillectomy/adenoidectomy (p < 0.05); RVU changes for other procedures were not statistically significant.

Conclusions: Despite stable or modestly increasing work RVUs, inflation-adjusted facility reimbursement for pediatric ENT procedures has declined substantially over the past 25 years. These trends may contribute to increasing financial strain on institutions providing pediatric ENT care and warrant consideration by healthcare systems and policymakers.