Medicare volume and reimbursement trends in lingual and hyoid procedures for obstructive sleep apnea

Sina J Torabi; Cynthia Tsang; Rahul A Patel; Theodore V Nguyen; R Peter Manes; Edward C Kuan; Douglas K Trask

doi:10.1016/j.amjoto.2024.104361

Medicare volume and reimbursement trends in lingual and hyoid procedures for obstructive sleep apnea

Am J Otolaryngol. 2024 Apr 29;45(4):104361. doi: 10.1016/j.amjoto.2024.104361. Online ahead of print.

Authors

Sina J Torabi¹, Cynthia Tsang², Rahul A Patel³, Theodore V Nguyen², R Peter Manes⁴, Edward C Kuan¹, Douglas K Trask⁵

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.
² School of Medicine, University of California, Irvine, Orange, CA, USA.
³ Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, CT, USA.
⁴ Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA. Electronic address: dtrask@hs.uci.edu.

PMID: 38729015
DOI: 10.1016/j.amjoto.2024.104361

Abstract

Objectives: This study aims to analyze utilization and reimbursement trends in lingual and hyoid surgery for obstructive sleep apnea (OSA).

Methods: Annual retrospective data on lingual and hyoid OSA surgeries was obtained from the 2000-2021 Medicare Part B National Summary Datafiles. Current Procedural Terminology (CPT) codes utilized included 21,685 (hyoid myotomy and suspension [HMS]), 41,512 (tongue base suspension [TBS]), 41,530 (radiofrequency ablation of the tongue [RFT]) and 42,870 (lingual tonsillectomy [LT]).

Results: The number of lingual and hyoid OSA surgeries rose 2777 % from 121 in 2000 to 3481 in 2015, before falling 82.9 % to 594 in 2021. Accordingly, Medicare payments rose 17,899 % from an inflation-adjusted $46,958 in 2000 to $8.45 million in 2015, before falling drastically to $341,011 in 2021. As the number of HMSs (2000: 91; 2015: 84; 2021: 165), TBS (2009: 48; 2015: 31; 2021: 16), and LTs (2000: 121; 2015: 261; 2021: 234) only experienced modest changes in utilization, this change was largely driven by RFT (2009: 340; 2015: 3105; 2021: 179). Average Medicare payments for RFT rose from $1110 in 2009 to $2994 in 2015, before falling drastically to $737 in 2021.

Conclusion: Lingual and hyoid surgery for OSA has overall fallen in utilization among the Medicare population from 2000 to 2021. However, there was a brief spike in usage, peaking in 2015, driven by the adoption (and then quick dismissal) of RFT. The rise and fall in RFT use coincide with the rise and fall in reimbursement.

Keywords: Hyoid myotomy and suspension; Lingual tonsillectomy; Medicare; Obstructive sleep apnea; Radiofrequency ablation of tongue; Reimbursement; Tongue base suspension; Volume.