National Trends in Utilization, Reimbursement, and Patient Demographics for Arthroscopic Subacromial Decompression, Biceps Tenodesis, and Distal Clavicle Excision in the Medicare Population.

BACKGROUND: Subacromial decompression (SAD), biceps tenodesis (BT), and distal clavicle excision (DCE) are frequently performed concomitant arthroscopic shoulder procedures. Randomized controlled trials questioning the benefit of SAD, combined with growing evidence supporting biceps tenodesis over tenotomy, have shifted clinical practice recently. This study evaluated national and regional trends in utilization, inflation-adjusted reimbursement, and patient demographics for these procedures among Medicare beneficiaries from 2013 to 2023. We hypothesized that SAD utilization would decline, BT utilization would increase, reimbursement for all three procedures would decrease, and the South would demonstrate higher utilization and lower reimbursement.

METHODS: The Centers for Medicare and Medicaid Services (CMS) "Medicare Physician & Other Practitioners - by Provider and Service" dataset was queried for CPT codes 29826 (SAD), 29828 (BT), and 29824 (DCE) from 2013 to 2023. Reimbursement data were inflation-adjusted to 2023 US dollars. Surgeons were stratified by US Census region and rural-urban commuting area (RUCA) classification. Regional and rural-urban differences were assessed using Kruskal-Wallis tests. Univariable and multivariable linear regression analyses evaluated factors associated with physician reimbursement in 2023.

RESULTS: Over the study period, 498,400 SADs, 73,668 arthroscopic BTs, 214,015 DCEs, and 82,398 open subpectoral BTs (CPT 23430) were billed to Medicare by orthopedic surgeons. SAD utilization declined from 13.48 to 9.75 procedures per 10,000 Original Medicare fee-for-service (FFS) beneficiaries (-27.7%), and DCE from 5.87 to 3.78 per 10,000 (-35.6%). Biceps tenodesis utilization increased from 1.10 to 2.53 per 10,000 FFS beneficiaries (+130.0%), with performing surgeons increasing 127.0%. Inflation-adjusted reimbursement declined for all three procedures: SAD by 24.1%, BT by 24.7%, and DCE by 34.7%. The Northeast consistently demonstrated the highest reimbursement, and the South almost always demonstrated the highest utilization per 10,000 beneficiaries. Rural areas had significantly higher rates of dual Medicare-Medicaid eligibility. On multivariable regression, increasing average patient age was independently associated with higher reimbursement for all three procedures.

CONCLUSION: SAD and DCE utilization declined substantially in the Medicare FFS population between 2013 and 2023, while BT more than doubled. Inflation-adjusted reimbursement decreased for all three procedures, consistent with broader trends in orthopedic surgery. Geographic disparities persist in both reimbursement and utilization, and rural populations face barriers to access. These findings have implications for orthopedic workforce planning, healthcare policy, and ensuring equitable access to shoulder arthroscopy.

LEVEL OF EVIDENCE: Level IV; Descriptive Epidemiology Study.