Declining Reimbursement, Shifting Surgical Workforce, and Geographic Disparities in Lumbar Laminectomy: A Medicare Analysis, 2013 to 2023

Retrospective database study. To evaluate national and regional trends in lumbar laminectomy [Current Procedural Terminology (CPT) 63047] reimbursement, utilization, and patient population characteristics among Medicare fee-for-service beneficiaries from 2013 to 2023. Lumbar laminectomy is among the most commonly performed spinal decompression procedures in the United States. Despite its prevalence in the Medicare population, national trends in surgeon reimbursement, utilization, and patient characteristics across geographic areas and surgeon specialties have not been comprehensively characterized over the past decade. The CMS "Medicare Physician and Other Practitioners" database was queried for all billing episodes of lumbar laminectomy (CPT 63047) from 2013 to 2023 among neurosurgeons and orthopedic surgeons. Population-based utilization rates were calculated using CMS Monthly Enrollment data. Inflation-adjusted reimbursement, procedural volume, and patient characteristics were extracted and stratified by US Census region and rural-urban commuting area (RUCA) codes. The Kruskal-Wallis tests, Wilcoxon rank-sum tests, and linear regression analyses were performed. As this analysis was restricted to fee-for-service (FFS) claims, the reported trends reflect changes within the FFS-billed population and do not capture procedures performed on Medicare Advantage beneficiaries, whose enrollment grew substantially over the study period. Population-based utilization declined 18.1% [24.14-19.78 per 10,000 Medicare fee-for-service (FFS) beneficiaries], and inflation-adjusted surgeon reimbursement declined 17.0% ($783-$649). The number of performing surgeons declined 16.6% (3184-2657). Between 2019 and 2020, national lumbar laminectomy volume fell 21.1%, reflecting the impact of the COVID-19 pandemic. In 2023, the South demonstrated the highest utilization (21.48 per 10,000 FFS beneficiaries), and reimbursement did not differ significantly across Census regions ( P =0.067) or RUCA categories ( P =0.531). Orthopedic surgeons performed the majority of procedures by 2023 (51.5%), up from 46.0% in 2013. Surgeon specialty was the only significant predictor of reimbursement on regression analysis ( P =0.021). Lumbar laminectomy utilization and surgeon reimbursement declined substantially among Medicare FFS beneficiaries from 2013 to 2023, and geographic disparities in utilization persisted throughout the study period. These findings highlight ongoing workforce and access concerns in lumbar spine surgery. However, these findings reflect trends specific to the fee-for-service Medicare population and should not be interpreted as a decline in access to lumbar decompression among all Medicare beneficiaries, given the concurrent expansion of Medicare Advantage enrollment during the study period. Level III-retrospective database study.