Purpose:

Lumbar fusions are among the most commonly performed spinal procedures. Despite this, there remains a paucity of publicly available information of lumbar fusion procedural and monetary data. The purpose of this study is to evaluate the trends in utilization and reimbursement for Medicare patients from 2000-2019.

Methods:

The Medicare National Summary Data Files were utilized. Data was collected for true physician reimbursements and procedural rates for Posterolateral Interbody Fusion (PLF), Anterior Lumbar Interbody Fusion (ALIF), Posterior Lumbar Interbody Fusion (PLIF), and Combined PLIF and PLF (CPPIF) from 2000 to 2019. Reimbursement was adjusted to inflation utilizing the 2019 Consumer Price Index.

Results:

A total of 1,266,942 lumbar fusion procedures were billed to Medicare Part B from 2000 to 2019. The annual number of lumbar interbody fusion procedures increased by 57,740 procedures (+95%) from 61,017 in 2000 to 118,757 in 2019. This change in annual volume varied by procedure type, with PLF increasing from 24,873 procedures in 2000 to 45,665 procedures in 2019 (+20,792, +83.59%), ALIF increasing from 4,227 in 2000 to 29,285 procedures in 2019 (+25,058, 592.81%), PLIF increasing from 5,579 procedures in 2000 to 5,628 procedures in 2019 (+49, +0.88%), and CPPIF increasing from 26,338 procedures in 2012 to 38,179 procedures in 2019 (+11,841, +44.96%). The mean inflation-adjusted reimbursement to decreased for PLF from $1,662.96 to $1,245.85 (-$417.11, -25.08%), ALIF from $1,159.45 to $750.33 (-$409.12, -35.29%), PLIF from $1,225.02 to $1223.72 (-$1.3, -0.11%), and with CPPIF from $1541.59 per procedure in 2012 to $1467.08 per procedure in 2019.

Conclusion:

Overall, lumbar fusions have been increasingly performed in the last two decades, although reimbursement for all procedures has decreased. These trends are important to assure adequate resource allocation to surgeons as treating lumbar pathologies becomes more common among the aging Medicare population.