TOPLINE

Inflation-adjusted Medicare reimbursement for 15 categories of common dermatology procedures fell by an unweighted average of 28.9% between 2007 and 2026, with most of the reduction occurring after 2021.

METHODOLOGY

• Researchers conducted a cross-sectional study of 46 dermatologic procedure codes from 2007 using Medicare Physician Fee Schedule data from 2007 to 2026.
• Payment rates were calculated using nonfacility relative value units (RVUs) and the corresponding annual Medicare conversion factor, then adjusted to January 2026 dollars using the Consumer Price Index for All Urban Consumers.
• Service volume and Medicare-allowed charges were assessed using the Centers for Medicare & Medicaid Services’ Medicare Physician & Other Practitioners files for 2013–2024.
• The analysis included 15 procedure categories, spanning biopsies, lesion destruction, excisions, Mohs surgery, repairs, skin grafts, laser treatments, and phototherapy.

TAKEAWAY

• Across the 15 categories, the unweighted mean inflation-adjusted reimbursement declined by 8.5% through 2021 and by 28.9% over the full 2007-2026 period.
• From 2007 to 2026, the largest declines occurred in simple repairs (45.0%), followed by laser/phototherapy (40.5%), split-thickness grafting (37.8%), destruction of lesions (37.5%), and Mohs micrographic surgery (35.4%).
• Biopsy and shave-removal payments rose by 33.4% and 19.3%, respectively, through 2021, but subsequently declined. By 2026, biopsy payments were 1.0% below their 2007 level and shave-removal payments were 12.6% lower.
• Office-based procedure volume rose from 33.3 million services in 2013 to 41.3 million in 2024. Medicare-allowed charges totaled about $3.1 billion in 2024; applying inflation-adjusted 2007 rates to the same volume would have yielded roughly $1.2 billion more. The volume-weighted decline was 38.7%, largely reflecting destruction of premalignant lesions. The 2026 Medicare fee schedule also introduced a 2.5% reduction in work RVUs for non-time-based services, including most of the codes studied.

IN PRACTICE

"These findings are directly relevant to current proposals to index physician payment to the Medicare Economic Index," the authors wrote. 

SOURCE

The study was led by Joshua A. Kent, BA, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo Academic Health Center, Buffalo, New York. It was published online on October 7 in JAMA Dermatology.

LIMITATIONS

The analysis used national nonfacility payments and did not capture geographic variation or reimbursement from non-Medicare payers. Researchers averaged code ranges rather than weighting them by observed case mix, assumed that the distribution of multiple-procedure reductions remained stable, and had utilization data only through 2024. Evaluation and management services were excluded.

DISCLOSURES

The authors did not report any funding source. Kent reported receiving grants from the American Society of Hematology unrelated to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.