Kumar, Jayanth

Abstract Total wrist arthroplasty (TWA) is a motion-sparing surgical alternative to wrist arthrodesis for patients with radiocarpal arthritis, but prior reports have indicated that its utilization remains limited. This study aimed to quantify Medicare and Medicaid reimbursement for TWA, along with utilization trends for the procedure using Medicare data. Medicare and Medicaid reimbursement rates for three TWA Current Procedural Terminology (CPT) codes—25446 (TWA), 25332 (TWA with interposition), and 25449 (revision TWA)—were collected for all states except Tennessee for the year 2024 and compared with each other. Prior Medicare rates from 2000 to 2023 were also obtained, adjusted for inflation to represent 2024 dollars, and analyzed for reimbursement trends with a two-tailed t-test between average inflation-adjusted 2000 and 2024 reimbursement. Utilization data from 2000 to 2022 were obtained from the Medicare Part B database. Medicaid reimbursement averaged 16.8% less than Medicare across the three TWA codes, with high variability between states. Inflation-adjusted Medicare reimbursement decreased by an average of 44.2% from 2000 to 2024, with the greatest decline seen in CPT 25446 (TWA) with a 45.1% decrease. Reimbursement for all three codes had decreased significantly from 2000 to 2024 via the two-tailed t-test. Besides an initial dramatic fall from 2000 to 2021 for revision TWA, Medicare utilization gradually increased, with 25332 (TWA with interposition) being the most commonly billed code. TWA reimbursement has decreased significantly over the past two decades for Medicare. Current Medicaid reimbursement is substantially less than Medicare. Although utilization has increased modestly, low reimbursement, along with a variety of other factors, may contribute to a limited adoption of TWA. Addressing these disincentives may encourage further innovation and technological development in TWA.

Background: Total wrist arthrodesis is a well-established procedure providing pain relief and stability for patients with symptomatic radiocarpal arthritis refractory to nonoperative measures. Little research exists on reimbursement and utilization trends for this procedure. This study aimed to characterize Medicare reimbursement trends for total wrist arthrodesis, along with trends in Medicare utilization and comparison with Medicaid reimbursement. Methods: Medicare reimbursement for Current Procedural Terminology codes 25800, 25805, and 25810 were collected from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule from 2000 to 2025. Rates were inflation-adjusted to 2025 dollars, and percentage changes were calculated. Medicare utilization trends from 2000 to 2022 were analyzed using CMS Part B data. Most recent Medicaid reimbursement was collected from online state fee schedules and compared with 2025 Medicare rates, with additional analyses of variability and adjustment for work Relative Value Units. Results: Inflation-adjusted Medicare reimbursement for total wrist arthrodesis decreased by 49.1% from 2000 to 2025 ( P < .0001), averaging a 1.96% annual decline. Utilization trends remained stable, with wrist arthrodesis with iliac or other autograft (CPT 25810) being the most commonly billed procedure. Medicaid reimbursed 13.6% less than Medicare on average, with substantial state variability, ranging from 44.7% (New Hampshire) to 135.4% (Alaska) of Medicare reimbursement. Conclusion: Reimbursement for total wrist arthrodesis has declined significantly despite stable utilization in the Medicare population. Medicaid reimbursement is consistently lower and highly variable by state, potentially impacting access to care. Given the effectiveness of wrist arthrodesis, policymakers should advocate for equitable reimbursement for this procedure.

Abstract External coxa saltans, or lateral snapping hip arises from the abnormal movement of the iliotibial band (ITB) over the greater trochanter. The ITB has two major muscular components: the tensor fascia lata and the gluteus maximus. Thickening of the posterior aspect of the ITB or the anterior aspect of the gluteus maximus as it traverses over the greater trochanter perpetuates the snapping phenomenon. Several open and endoscopic techniques have been described to successfully treat external coxa saltans, with release of the iliotibial band being the accepted treatment approach. This case report presents a previously undescribed etiology of coxa saltans externa whereby trochanteric enthesopathy in the setting of chronic abductor tendinopathy and tendon tearing resulted in pathologic snapping of the iliotibial band over the enthesopathic prominences on the greater trochanter (Video 1). This novel etiology required a novel approach to address the pathologic snapping. Rather than iliotibial band release, the appropriate treatment in this case required resection of the trochanteric enthesopathy with abductor tendon repair followed by complete closure of the iliotibial band which resulted in the resolution of the patient’s symptoms (Figure 1, Video 2). Patient reported outcomes measures (pre/post) including HOOS, PROMIS pain interference, PROMIS physical function and global pain scores demonstrated significant improvement 33 months post-surgery. Recognition of this unique etiology of external coxa saltans ensures the appropriate treatment is employed to address the underlying pathology. The ITB is an important stabilizer of the hip and the tensor fascia lata an important accessory abductor of the hip. Release of the iliotibial band in the setting of underlying abductor dysfunction could potentially lead to further dysfunction and ongoing mechanical symptoms. When patients present with external coxa saltans in the setting of underlying abductor dysfunction and trochanteric enthesopathy, consideration should be given to resection of the enthesophytes with abductor tendon repair as opposed to open or endoscopic ITB release alone.