Henderson Adam P, Moore M Lane, Beckett Nathan C, Van Schuyver Paul R, Haglin Jack M, Brinkman Joseph C, Patel Karan A
Mayo Clinic Alix School of Medicine, Jacksonville, FL, USA.
Mayo Clinic Department of Orthopedic Surgery, Phoenix, AZ, USA.
Foot Ankle Orthop. 2025 Apr 15;10(2):24730114251330302. doi: 10.1177/24730114251330302. eCollection 2025 Apr.
Medicaid reimbursement to physicians is often perceived to be lower than Medicare, but little is known about orthopaedic foot and ankle reimbursement. This study sought to compare Medicare and Medicaid reimbursement for the 20 most common foot and ankle procedures.
Medicare reimbursement rates for common foot and ankle codes were obtained from the online Centers for Medicare & Medicaid fee schedule, while Medicaid rates were found from individual state fee schedule websites. Medicaid rates were compared by state and pooled to obtain national differences. The Medicare Wage Index was used to adjust Medicaid rates by state wages to ensure a more accurate comparison. Variability between states was measured using state percentages of Medicare and coefficient of variation values.
Medicaid reimbursed physicians higher than Medicare in 31 states overall, with average reimbursement ranging from 37% to 324% of Medicare. Nationally, Medicaid reimbursed 8.8% higher than Medicare, but Medicare reimbursed 3.7% higher when adjusted for the Medicare Wage Index. The () codes with the highest ratio of Medicaid to Medicare reimbursement were 28002 for incision and drainage of the foot (176.6%) and 28820 for toe amputation (167.6%). Five codes had lower relative Medicaid reimbursement on average: 27687 for repair procedures on the leg and ankle joint, 28810 for amputation procedures on the foot and toes, 28010 for toe tenotomy, 28005 for incision procedures on the foot and toes, and 28470 for closed treatment of a metatarsal fracture. The coefficient of variation values ranged from 0.34 to 0.84 in the Medicaid group and 0.40 to 0.78 in the adjusted group, indicating high variability between states and between procedures.
Medicaid reimbursement is highly inconsistent between states, ranging from 37% to 324% of Medicare. Medicaid reimbursed more than Medicare overall, which is in contrast with most published findings that tend to show higher reimbursement for Medicare when compared to Medicaid. When adjusting for wage differences between states, Medicare reimbursed slightly higher than Medicaid.
Level IV, economic analysis.
医疗补助计划（Medicaid）向医生支付的费用通常被认为低于医疗保险（Medicare），但对于骨科足踝疾病的报销情况却知之甚少。本研究旨在比较医疗保险和医疗补助计划对20种最常见的足踝手术的报销情况。
常见足踝疾病编码的医疗保险报销率来自医疗保险和医疗补助服务中心在线费用表，而医疗补助计划的费率则从各个州的费用表网站获取。按州对医疗补助计划的费率进行比较，并汇总以得出全国性差异。使用医疗保险工资指数根据各州工资水平对医疗补助计划的费率进行调整，以确保进行更准确的比较。使用医疗保险的州百分比和变异系数值来衡量各州之间的差异。
总体而言，在31个州中，医疗补助计划向医生支付的费用高于医疗保险，平均报销费用为医疗保险的37%至324%。在全国范围内，医疗补助计划的报销比医疗保险高8.8%，但根据医疗保险工资指数调整后，医疗保险的报销比医疗补助计划高3.7%。医疗补助计划与医疗保险报销率之比最高的（）编码是足部切开引流术（28002，176.6%）和脚趾截肢术（28820，167.6%）。有5个编码的医疗补助计划相对报销率平均较低：小腿和踝关节修复手术（27687）、足部和脚趾截肢手术（28810）、脚趾切断术（28010）、足部和脚趾切开手术（28005）以及跖骨骨折闭合治疗（28470）。医疗补助计划组的变异系数值范围为0.34至0.84，调整后组的变异系数值范围为0.40至0.78，表明各州之间以及各手术之间存在高度差异。
各州的医疗补助计划报销情况极不一致，为医疗保险报销的37%至324%。总体而言，医疗补助计划的报销高于医疗保险，这与大多数已发表的研究结果相反，那些研究往往表明医疗保险的报销高于医疗补助计划。在调整各州工资差异后，医疗保险的报销略高于医疗补助计划。
四级，经济分析。
