Trends in Billing and Medicare Reimbursement for In-Office Cerumen Removal by Otolaryngologists and Other Providers

• Published in: Annals of otology, rhinology & laryngology Vol. 132; no. 4; pp. 410 - 416
• Main Authors: Patel, Rahul A., Torabi, Sina J., Kasle, David A., Kayastha, Darpan, Peter Manes, R.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-04-2023
• Subjects: Aged; Cerumen; Humans; Medicare; Otolaryngologists; Practice Patterns, Physicians; Retrospective Studies; United States; United States; cerumen removal; otolaryngology; otology; Medicare; outpatient; in-office
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/00034894221096980

Objectives:
To analyze trends in billing patterns, Medicare reimbursement, and practice-setting for otolaryngologists (ORLs) and other provider types performing in-office cerumen removal.
Methods:
This retrospective study included data on Medicare-billing providers from the Medicare Part B: Provider Utilization and Payment Datafiles (2012-2018). Number of providers performing in-office cerumen removal, total sums and medians for Medicare reimbursements and services, and services per patient were gathered along with geographic distributions.
Results:
There have been near linear declines in number of general physicians and other provider types performing cerumen extractions with 42.6% and 40.7% declines, respectively, and near linear growth in number of ORLs and advanced practice providers (APPs) with 9.7% and 51.1% growth, respectively. At the median, general physicians, APPs, and other provider types have been billing for a similar and constant number of cerumen extractions per provider, while ORLs have seen a 10.6% increase. Total Medicare reimbursement to general physicians and other provider types has fallen 45.0% and 32.5%, respectively, and to ORLs and APPs has grown 16.9% and 103.4%, respectively. Compared to non-ORLs, ORLs tend to bill for cerumen extraction out of an urban setting rather than a rural setting (P < .001).
Conclusions:
General physicians and other provider types are increasingly referring cerumen disimpaction patients to ORL physicians and allowing APPs to perform these procedures, indicating a change in landscape of medical practice among these providers. General physicians may be filling a need in the rural setting, where there are fewer ORLs practicing.