Medicaid Reimbursement for Common Orthopaedic Foot and Ankle Procedures Is Highly Inconsistent Among States, Ranging from 37% to 324% of Medicare Reimbursement.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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 OF EVIDENCE

Level IV, economic analysis.