Trends in Medicare Utilization and Reimbursement for Intertrochanteric Femur Fractures: A 21-Year Review

Sliding hip screw (SHS) and intramedullary (IMN) constructs are commonly utilized treatments for intertrochanteric (IT) femur fractures. The aim of this study was to assess the economic and utilization trends in the management of IT fractures among the Medicare population over the last 21 years.

A review of the publicly available Medicare Part B National Summary Data File for years 2000–2021 was performed. Collected data included true physician reimbursement and utilization numbers for all CPT codes pertaining to fixation of IT fractures with either SHS or IMN.

A total of 1,361,112 IMN implants and 739,032 SHS implants were billed to Medicare for intertrochanteric femur fractures during the studied timeline. In this 21-year span, utilization of IMN increased 695% (9648–76,667), while utilization of SHS decreased by 96% (94,223–4224). After adjusting for inflation, the average physician reimbursement for SHS decreased by 34%, while IMN decreased by 41%. Absolute physician reimbursement was found to be $943.36 for SHS and $999.88 for IMN constructs.

Intramedullary implants are being increasingly utilized while sliding hip screw, and intramedullary construct reimbursement continues to decrease for intertrochanteric femur fracture fixation. These trends suggest that opting for a sliding hip screw may be more cost-effective when the fracture pattern allows for either construct.