Comparing Otolaryngology Subspecialties' Changes in Medicare Reimbursement From 2013 to 2024

Abstract

Objective

Identify differences in Medicare reimbursement changes for general otolaryngology, pediatric otolaryngology, head and neck oncology, laryngology, rhinology, otology, facial plastic and reconstructive surgery, and sleep surgery subspecialties from 2013 to 2024.

Methods

Subspecialty‐based procedures' facility prices and relative value units (RVUs) were sourced from the Centers for Medicare & Medicaid Services' Physician Fee Schedule. Prices were adjusted for inflation, and the average percent change in facility price and RVUs for each subspecialty was calculated. Each subspecialty's average inflation‐adjusted, facility price change was compared to general otolaryngology using t‐tests, and differences between subspecialties were assessed using Dunn's test.

Results

From 2013 to 2024, general otolaryngology's average percent change was −29.9% and significantly differed from facial plastic and reconstructive surgery (−26.4% [−5.5 to −0.7%]; p = 0.011) and sleep surgery (−23.7% [−19.2 to −2.2%]; p = 0.016). Rhinology (−32.5% [−1.3 to 6.1%]), otology (−30.2% [−6.5 to 7.6%]), laryngology (−29.3 [−4.2 to 2.1%]), head and neck (−27.4% [−5.7 to 0.2%]), and pediatric otolaryngology (−25.8% [−14.6 to 3.8%]) also decreased drastically but were not significantly different from general otolaryngology. For the multiple comparisons test, rhinology was statistically different from sleep surgery and facial plastic and reconstructive surgery.

Conclusion

General otolaryngology and rhinology were more negatively affected due to changes in work and practice expense RVUs. Universal decreases were due to inflation and legislative reductions to the conversion factor. Medicare's budget constraints, potential effects on access to otolaryngology services, and continuing inflation warrant lobbying efforts to address these changes to maintain financial viability.

Level of Evidence

NA Laryngoscope, 135:1950–1957, 2025

From 2013 to 2024, all otolaryngology subspecialties experienced drastic declines in Medicare inflation‐adjusted facility price with general otolaryngology, rhinology, and otology being the most negatively impacted. Relative differences between subspecialties were due to changes in relative value units for certain procedures. As Medicare budget cuts continue, lobbying for viable payment is essential for financial sustainability.

INTRODUCTION

Physician Medicare reimbursement has faced drastic cuts in spending despite physician and clinician services only comprising 20% of all national health expenditures (NHE) in 2021.^{1, 2} Changing Medicare's fee schedule disrupts physician payment nationally because Medicare reimbursement rates, based on relative value units (RVUs), set a standard for Medicaid and private insurers' payments to physicians. ³ Reimbursement for a given Current Procedural Terminology (CPT) code is the sum of work RVUs (wRVUs), malpractice RVUs (mRVUs), and practice expense RVUs (peRVUs). ⁴ Additionally, the peRVUs are classified based on Place of Service (POS) as designated by Medicare (facility vs. non‐facility). The facility price has a lower peRVUs component because when the POS is classified as a facility, this entity bills separately with an Outpatient Prospective Payment System facility fee. ⁵ Almost all CPT codes have a facility price, but not all have a non‐facility price due to surgical procedures necessitating a facility (i.e., hospital or ambulatory surgical center). The Centers for Medicare and Medicaid Services (CMS) further adjusts these RVUs geographically using a Geographic Practice Cost Index as reported on the Physician Fee Schedule (PFS). After adjustments, the sum of RVUs is multiplied by an established conversion factor which was $33.29 in March 2024. ⁶ The Relative Value Scale update committee (RUC) assesses RVUs for procedures (mainly wRVUs) after which CMS makes the final decision on their recommendations. ⁷

Many studies have examined changes in Medicare reimbursement, reporting a universal decline in physician specialties after adjusting for inflation. Otolaryngology Medicare reimbursement research has already examined the change in reimbursement for various otolaryngology subspecialties including pediatric otolaryngology, partially for general otolaryngology, head and neck oncology, laryngology, rhinology, and otology.^{8, 9, 10, 11, 12, 13, 14} Research in facial plastic and reconstructive surgery has been extensively studied for facial fracture procedures, and a study on plastic and reconstructive surgery subspecialties did not disclose specific procedures to represent craniofacial surgery.^{15, 16, 17} Overall, facial plastic and reconstructive surgery still lacks a comprehensive study. Studies in sleep surgery have focused on reimbursement for soft palate, lingual, and hyoid procedures, but sleep surgery also lacks a comprehensive overview and several other procedures.^{14, 18} Additionally, no previous research has compared otolaryngology subspecialties' changes in Medicare reimbursement relative to one another.

Understanding otolaryngology subspecialties' relative change in Medicare reimbursement is important because changes in Medicare standardize all other insurers' rates and thereby affect otolaryngologists' financial potential. ³ Additionally, Medicare's legislation has neglected to adjust for inflation and for rising input costs, which may impact Medicare patients' access. Therefore, this study explored differences in Medicare reimbursement changes for general otolaryngology, pediatric otolaryngology (pediatric), head and neck oncology (head‐neck), rhinology, otology, facial plastic and reconstructive surgery (plastics), and sleep surgery (sleep) subspecialties from 2013 to 2024.

METHODS

Identifying the Top Subspecialty Codes

This study did not require approval from the Texas Tech Health Sciences Center Institutional Review Board because publicly available and de‐identified data were used that did not involve human subjects. Patient visit codes were excluded to isolate procedural differences unique to each otolaryngology subspecialty. All subspecialties' CPT codes were completely or partially sourced from previous studies. Only facility rates were analyzed because not all surgical procedures have non‐facility prices, and a single variable would allow for a controlled comparison between subspecialty rates. Additionally, there is variability in case mix and place of service by subspecialty. Therefore, facility price, nominal price, and the RVU breakdown were subsequently analyzed to allow global comparison between the eight subspecialties. CPT codes not present during the entire 12‐year period were excluded.

For general otolaryngology, similar to Dominguez et al.'s methodology, the American Academy of Otolaryngology–Head and Neck Surgery (AAO‐HNS) Medicare facility and non‐facility top 100 codes datasets for 2022 were aggregated. ¹² By multiplying combined facility and non‐facility frequency by each procedure's 2024 facility rate, an annual gross revenue was used to identify financially impactful codes with ≥0.50% of summed gross revenue of all analyzed codes. Medicare data predominantly reports on the older adult population, which fails to include common pediatric procedures (i.e., tonsillectomy, adenoidectomy, tympanostomy, tympanoplasty, frenotomy, congenital cysts). An otolaryngologist, W.I., then reviewed and selected a total of 46 codes representative of general otolaryngology, adding common pediatric procedures not found in the Medicare data (Table S1).

The top 25 pediatric CPT codes were referenced from the study performed by Yaffe et al. that identified the most frequent procedures at their institution (Table S2). ¹¹ The top 35 head‐neck CPT codes were identified in the study by Quereshy et al. for the top procedures at their institution (Table S3). ¹⁰ The 22 rhinology CPT codes were identified with the code ranges used by Torabi et al. (Table S4). These code ranges included endoscopy (31231–31238), balloon ostial dilation (31295–31298), low‐RVU procedures (31239–31288; 61782), and high‐RVU procedures (31290–31294). ⁸ The 19 CPT codes as identified by Schartz et al. were used to represent otology (Table S5). ⁹ Similarly, the procedures identified by Xu et al. were used to identify the 31 top laryngology CPT codes (Table S6). ¹³

Facial plastics' CPT codes were identified using categories by a fellowship‐trained, facial plastic and reconstructive surgeon (J.D.). As a result, procedural categories as indicated by multiple sources were also used to select codes representative of plastics: myocutaneous flaps, dermabrasion, ¹⁹ blepharoplasty, ²⁰ microtia, ²¹ rhinoplasty, ²² lip, cheiloplasty/palatoplasty, ²³ facial reanimation procedures, ²⁴ cranioplasty, ²⁵ and facial fracture/reconstruction.^{15, 17} Procedural categories were excluded if they were not unique to plastics, including wound repair, tissue transfer, skin graft and relocation, and removal of skin growth. All cosmetic procedures that would not be routinely billed through insurance were excluded; e.g., rhytidectomy. To further assess the financial impact of these codes, the Medicare Part B National Summary Data File for 2013 to 2022 was used to query an inflation‐adjusted annual payment for each procedure. Only procedures with ≥$150,000 average yearly payment were included in the study unless they were primarily pediatric (e.g., microtia, cheiloplasty, palatoplasty). In total, 107 CPT codes were analyzed as reported in Table S7.

For the sleep subspecialty, UpToDate was used to identify procedural categories used to correct obstructive sleep apnea (OSA). ²⁶ Corresponding CPT codes representative of otolaryngology were then found for each procedural group: turbinate reduction, septoplasty, nasal valve surgery, functional rhinoplasty, endoscopic procedures, uvulopalatopharyngoplasty, tonsillectomy, adenoidectomy, hyoid suspension, tongue suspension, and tracheotomy. Uvulectomy and pharyngoplasty were added as indicated by a study on soft‐palate procedures for OSA. ¹⁸ The 24 CPT codes were then verified by an otolaryngologist who routinely performs OSA‐based procedures (W.I.) as reported in Table S8.

Factoring Changes in Medicare Reimbursement

For 2013 to 2024, the selected CPT codes were queried for their corresponding reimbursement variables: facility price, wRVUs, peRVUs, and mRVUs. Facility prices were then adjusted for inflation using each year's January Consumer Price Index from the U.S. Bureau of Labor Statistics. ²⁷ A total percent change for each reimbursement variable was calculated for each year of the study period by taking the CPT code variable for a given year (y), dividing by the 2013 variable, subtracting by 1, and multiplying by 100%:

$$\text{Total Percent Change}=\left[\left(\frac{\mathrm{CPT}{\text{Code Variable}}_y}{\mathrm{CPT}{\text{Code Variable}}_{2013}}\right)-1\right]\times 100\%$$

The average total percent change was then determined for each subspecialty's unique mix of CPT codes' reimbursement variables. This specialty‐specific average total percent change was plotted via line graphs from 2013 to 2024 for nominal (Fig. 1) and inflation‐adjusted facility price (Fig. 2), wRVUs (Fig. 3), peRVUs (Fig. 4), and mRVUs (Fig. 5). Analyses of the nominal facility price, wRVUs, peRVUs, and mRVUs were descriptive studies without statistical comparisons. For each subspecialty, the average total percent change for the inflation‐adjusted facility prices from 2013 to 2024, which will be referred to as average inflation‐adjusted facility price change, was calculated and used for statistical comparisons.

Figure 1.

Nominal facility price change. The line chart shows the unadjusted, average total facility price change for each otolaryngology subspecialty's unique mix of procedural codes. The percent change is a running proportional difference to 2013.

Figure 2.

Inflation‐adjusted facility price change. The line chart exhibits inflation‐adjusted, average total facility price change for each subspecialty's unique mix of procedural codes. The percent change is a running proportional difference to 2013.

Figure 3.

Work relative value units change. The line chart displays the average total change in work relative value units (RVUs) for each subspecialty's unique mix of procedural codes. The percent change is a running proportional difference to 2013.

Figure 4.

Facility practice expense relative value units change. The line chart presents the average total change in facility‐based, practice expense relative value units (RVUs) for each subspecialty's unique mix of procedural codes. The percent change is a running proportional difference to 2013.

Figure 5.

Malpractice relative value units change. The line chart shows the average total change in malpractice relative value units (RVUs) for each subspecialty's unique mix of procedural codes. The percent change is a running proportional difference to 2013.

Statistical Comparisons

The first aim was to understand how each subspecialty's average inflation‐adjusted facility price change compared to the baseline of general otolaryngology over the 12‐year period. An α of 0.05 was chosen to represent statistical significance. An unequal variances, two‐tailed, independent samples t‐test was used to compare subspecialties to general otolaryngology. CPT codes were excluded from both general otolaryngology and each individually compared subspecialty if there was overlap. Descriptive statistics were also reported for the mean, standard deviation, and median. In comparison to general otolaryngology (ref.), the 95% confidence interval and p‐value were also reported.

For the second aim, each subspecialty (excluding general otolaryngology) was compared via a multiple comparisons test. The Kruskal–Wallis test determined the presence of one or more differences between all subspecialties' average inflation‐adjusted facility price change (p < 0.001). For each individual comparison between subspecialties, the overlapping CPT codes for both subspecialties were excluded. The Dunn's test for multiple comparisons was then used to identify statistical differences between subspecialties, and each p‐value was adjusted by the Bonferroni correction for multiple tests. Each subspecialty was graphed in the boxplot with data points plotted as an overlay and statistical differences indicated with bars and p‐values (Fig. 6). Both statistical analyses were performed in SPSS Statistics by IBM (version 29.0.1.0), and the boxplot was generated in R (version 4.3.1).

Figure 6.

Otolaryngology subspecialty comparison. A boxplot comparing the inflation‐adjusted, total percent change in facility price for each subspecialty's procedural codes. Each procedure's percent change is dot‐plotted as a scatter overlay. Dunn's test identified significant differences between subspecialties, which were then adjusted with the Bonferroni correction (*p < .05; **p < .01; ***p < .001).

RESULTS

All subspecialties experienced drastic decreases in average inflation‐adjusted facility price change (Table I). Comparing each subspecialty's average inflation‐adjusted facility price change to general otolaryngology (−29.9%) demonstrated significant differences for plastics (−26.4% [−5.5 to −0.7%]; p = 0.011) and sleep (−23.7% [−19.2 to −2.2%]; p = 0.016). However, head and neck (−27.4% [−5.7 to 0.2%]; p = 0.066), pediatric (−25.8% [−14.6 to 3.8%]; p = 0.239), rhinology (−32.5% [−1.3 to 6.1%]; p = 0.201), laryngology (−29.3% [−4.2 to 2.1%]; p = 0.512), and otology (−30.2% [−6.5 to 7.6%]; p = 0.880) were not statistically different from general otolaryngology (Table I). When subspecialties (excluding general otolaryngology) were compared to one another using Dunn's test, rhinology was significantly different from sleep (p < 0.001) and plastics (p = 0.009) as shown in Figure 6. Sleep surgery's average inflation‐adjusted facility price change was significantly different from laryngology (p = 0.022) and additionally, displayed an unadjusted p‐value of 0.003 when compared to otology. Bonferroni's correction for 21 comparisons adjusts the α to 0.00238 to reduce the family‐wise error rate. When not using the Bonferroni correction, sleep was significantly different from head and neck and plastics (unadjusted p < 0.05), while rhinology was significantly different from pediatrics and head and neck (unadjusted p < 0.05).

TABLE I.

Otolaryngology Subspecialties to General Otolaryngology Comparison.

Subspecialty	CPT Codes	Mean % (S.D.)	Median	95% C.I.	p‐Value
General	46	−29.9% (8.8)	−27.4%	ref.	ref.
Rhinology	22	−32.5% (5.3)	−33.7%	−1.3 to 6.1%	0.201
Otology	19	−30.2% (9.0)	−27.5%	−6.5 to 7.6%	0.880
Laryngology	31	−29.3% (4.6)	−27.4%	−4.2 to 2.1%	0.512
Head‐Neck	35	−27.4% (1.6)	−27.4%	−5.7 to 0.2%	0.066
Plastics	107	−26.4% (8.2)	−27.2%	−5.5 to −0.7%	0.011
Pediatric	25	−25.8% (12.8)	−27.4%	−14.6 to 3.8%	0.239
Sleep	24	−23.7% (16.1)	−25.1%	−19.2 to −2.2%	0.016

Each subspecialty's Current Procedural Terminology (CPT) codes' average total percent change inflation‐adjusted, facility price was calculated and compared to general otolaryngology (ref.), using a two‐tailed, t‐test (bolded if p < 0.05). Overlapping codes between general otolaryngology and each subspecialty were excluded for statistical comparisons but not for counts, mean (S.D.), and median.

C.I. = confidence interval; ref. = reference group.

Each subspecialty's average inflation‐adjusted facility price change was plotted from 2013 to 2024 relative to the starting year 2013 in Figure 2, demonstrating general otolaryngology's, rhinology's, and otology's dramatic declines relative to all other subspecialties. General otolaryngology's and rhinology's declines are further explained by the 2018 devaluation in wRVUs and peRVUs portrayed in Figures 3 and 4 as a running average total percent change, respectively. This devaluation in wRVUs and peRVUs led to rhinology's significant difference from some subspecialties for the Dunn's test (Fig. 6).

The most‐affected rhinology nasal/sinus endoscopy procedures included: epistaxis control (CPT code: 31238; total percent change: −37.2%); dacryocystorhinostomy (31239; −35.9%); total ethmoidectomy, anterior and posterior (31255; −40.5%); frontal sinus exploration with tissue removal (31276; −44.8%); sphenoidotomy (31287; −35.2%); sphenoidotomy with sphenoid sinus tissue removal (31288; −36.4%); and dilation of sphenoid sinus ostium (31297; −35.9%). General otolaryngology overlapped with rhinology's CPT code 31276, and general otolaryngology also exhibited decreases for submucous resection inferior turbinate, partial or complete (30140; −70.7%); laryngoscopy with stroboscopy (31579; −38.0%); planned tracheotomy (31600; −43.6%); clean out mastoid cavity (69220; −39.8%); and maxillofacial CT scan without dye (70846; −45.9%).

RVUs for otology and head‐neck were also negatively devaluated in 2018, although to a lesser degree than general otolaryngology, laryngology, and rhinology. Otology has experienced a sustained decrease since 2021 as observed in the nominal changes (Fig. 1). Pediatric, plastics, sleep, and head and neck were positively evaluated by CMS, which coincides with individual subspecialty's changes in wRVUs (Fig. 3), peRVUs (Fig. 4), and mRVUs (Fig. 5). This positive change is summarized in the nominal facility price, which demonstrated that sleep, pediatric, plastics, and head‐neck subspecialties' positive evaluation stabilized the nominal rate until CMS decreased the conversion factor for 2023 and 2024 (Fig. 1).

Each subspecialty had varying periods of increases and decreases when looking at the RVU components. Universally, general otolaryngology, rhinology, and otology were more negatively affected for all RVU distributions, including mRVUs (Fig. 5). All subspecialties have been devaluated significantly when looking at peRVUs, although sleep, plastics, and pediatric recovered from 2020 to 2024 (Fig. 4). The mRVUs played a minor positive adjustment for all subspecialties, including general otolaryngology and rhinology from 2015 to 2024 (Fig. 5). Looking at nominal facility price in Figure 1 provides a summary of the weighted impact of relative changes in RVU components. Overall, each subspecialty has varied in impact from RVU evaluations, but all subspecialties had drastic losses in recent years due to both nominal decreases in the conversion factor and heightened inflation.

DISCUSSION

This Medicare reimbursement study found differences in average inflation‐adjusted facility price change when comparing general otolaryngology, pediatric otolaryngology, head‐neck, rhinology, otology, plastics, and sleep subspecialties from 2013 to 2024. On average, general otolaryngology declined more than most subspecialties and was significantly different from plastics and sleep. The multiple comparisons test revealed that some otolaryngology subspecialties do differ in their Medicare rate changes. These differences in otolaryngology subspecialties are due to positive and negative revisions of CPT codes' wRVUs and peRVUs.

Previous Medicare reimbursement research found similar results for otolaryngology subspecialties.^{8, 9, 10, 11, 12} Torabi et al. speculated that rhinology's drastic decreases may be due to increasing utilization. ⁸ In two separate studies, Calixto et al. and Koester et al. identified increasing utilization of sinus procedures for Medicare patients.^{28, 29} Both Calixto et al. and Koester et al. attributed the rise in balloon sinuplasty secondary to relatively high‐value RVUs and the ability to perform procedures in an office setting. These observations coincide with the RUC committee and CMS targeting of rhinology‐based codes in 2018 due to increasing utilization, procedural pairings, and decreased procedural time as demonstrated by changes in wRVUs (Fig. 3) and peRVUs (Fig. 4). ³⁰ The changes observed in RVU components have historically been adjusted for improvements in surgical efficiency, technology, and equipment as observed in other specialties. ³¹

These declines in Medicare reimbursement are due to economic and political forces. Despite a growing Medicare population, the Sustainable Growth Rate (SGR) legislation prevented Medicare's budget to grow with the rising costs to provide care for Medicare beneficiaries. In 2015, the SGR was replaced with Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA), under which reimbursement was temporarily increased by 0.5% every year from 2015 to 2019. ³² Despite subsequent efforts to temporarily maintain the conversion factor from 2020 to 2024, supportive legislation failed to prevent the budget cuts to the nominal conversion factor rate, effectively reducing physician reimbursement. ³³

On March 9, 2024, the authorized 3.39% decrease to the 2024 conversion factor (relative to 2023) was replaced with a 1.77% decrease to the 2024 conversion factor through the Consolidated Appropriations Act. ³⁴ These lobbying efforts are commendable, providing temporary relief, but ultimately lack the ability to address the root cause of Medicare's budget constraints which fails to consider economic factors such as adjustments for inflation and a growing Medicare population. At the time of this study, CMS is expected to decrease the conversion factor by another 2.83% for the 2025 Medicare fee schedule.

Additionally, the American Academy of Otolaryngology – Head and Neck Surgery reports that the Medicare Economic Index (MEI) weights undervalue peRVUs because CMS used data from 2006 to weight practice expense data. ³⁵ The peRVUs were already negatively evaluated for all otolaryngology subspecialties aside from sleep and plastics (Fig. 4), and basing these peRVUs on 2006 data further exacerbates the decreasing conversion factor. Supporting the American Medical Association's (AMA) efforts to research physician practice expenses could identify true gaps in MEI weights that undervalue peRVUs and correct for rising overhead costs. ³⁶

Although increasing peRVUs would ameliorate reimbursement for individual otolaryngology subspecialties, adjusting the conversion factor for inflation would be the most influential and legislatively strategic component to correct Medicare reimbursement. Revision to peRVUs is complex and varies across medical specialties, requiring more effort for specialty‐specific justification for individual codes than global economic updates to the conversion factor. ³⁷ Also, changes to the peRVUs would only improve reimbursement as a fractional component while changes to the conversion factor would serve as a direct multiplier to rates and allow adjustments for inflation. ⁴

As a result, in addition to supporting the AMA's efforts to research peRVUs, otolaryngologists should join forces with other organizations to support bipartisan bills that address Medicare's budget constraints, primarily to update the conversion factor. Despite the differences in Medicare rate changes between otolaryngology subspecialties observed in this study, unifying subspecialty efforts to address the greater problem of Medicare's budget cuts is paramount. Bipartisan bills should focus on updating Medicare's budget to adjust for inflation, accommodate for the growing Medicare population, and financing Medicare's budget expansion in an equitable way. Additionally, further research should explore the true impact of these budgetary cuts, compounded by inflation, on Medicare beneficiary access to otolaryngology services. Over time, physicians may observe increased pressure to limit government‐based payers by opting out of Medicare to maintain financial viability as seen for Medicaid patients. ³⁸

While the following study allows for a global comparison across all otolaryngology subspecialties, this approach is not without limitations. Using facility price allows comparisons across subspecialties because facility payment is not available for all procedures, but ultimately, facility price excludes important rate changes in peRVUs for clinic‐based procedures. Additionally, physician payment is nuanced due to modifiers, geographic adjustments, variability in practicing subspecialists' case mix and volume, proportional differences in facility versus non‐facility procedures, value‐based adjustments, and increased subspecialization within otolaryngology. The CPT codes used in this study were sourced from other works using institutionally derived codes that may not be fully generalizable. Therefore, discretion should be used when evaluating the application of these findings within specific practice settings.

CONCLUSION

From 2013 to 2024, all otolaryngology subspecialties experienced drastic declines in Medicare inflation‐adjusted, facility price with rhinology, general otolaryngology, and otology being the most negatively impacted. General otolaryngology declined more than most subspecialties and was significantly different from plastics and sleep. Both general otolaryngology's and rhinology's disproportionate decrease was due to an abrupt downgrade in facility price via devaluation in wRVUs and peRVUs. All subspecialties experienced alarming declines from 2021 to 2024, leading to the overall reduction seen across specialties. Financial pressures on otolaryngologists due to these changes in Medicare reimbursement and increases in practice expenses may be passed along to patients and limit access. Otolaryngologists lobbying for financially viable payment is essential for sustainability as Medicare budget cuts take effect.

Supporting information

Supplemental Table S1. General Otolaryngology CPT Codes. General Otolaryngology Current Procedural Terminology (CPT) codes were analyzed for total percent change from 2013 to 2024 for inflation‐adjusted facility rates (∆Adjusted), nominal facility rates (∆Nominal), and relative value units (RVUs) breakdown. RVUs breakdown includes total percent change from 2013 to 2014 for work RVUs (∆wRVUs), practice expense RVUs (∆peRVUs), and malpractice RVUs (∆mRVUs). The 2024 facility‐calculated annual payment (CMS 24’ PMT) was derived from Centers for Medicare and Medicaid Services procedure volume in 2022 on the AAO‐HNS' report of the top 100 facility and 100 non‐facility codes. Primarily pediatric‐based codes do not have reported CMS 24’ PMTs. CMS Short Descriptions were sourced from the 2024 CMS Physician Fee Schedule.

Supplemental Table S2. Pediatric Otolaryngology CPT Codes. Pediatric Otolaryngology Current Procedural Terminology (CPT) codes were analyzed for total percent change from 2013 to 2024 for inflation‐adjusted facility rates (∆Inflation‐adjusted), nominal facility rates (∆Nominal), and relative value units (RVUs) breakdown. RVUs breakdown includes total percent change from 2013 to 2014 for work RVUs (∆wRVUs), practice expense RVUs (∆peRVUs), and malpractice RVUs (∆mRVUs). Centers for Medicare and Medicaid Services (CMS) Short Descriptions were sourced from the 2024 CMS Physician Fee Schedule.

Supplemental Table S3. Head and Neck Otolaryngology CPT Codes. Head and Neck Otolaryngology Current Procedural Terminology (CPT) codes were analyzed for total percent change from 2013 to 2024 for inflation‐adjusted facility rates (∆Inflation‐adjusted), nominal facility rates (∆Nominal), and relative value units (RVUs) breakdown. RVUs breakdown includes total percent change from 2013 to 2014 for work RVUs (∆wRVUs), practice expense RVUs (∆peRVUs), and malpractice RVUs (∆mRVUs). Centers for Medicare and Medicaid Services (CMS). Short Descriptions were sourced from the 2024 CMS Physician Fee Schedule.

Supplemental Table S4. Rhinology CPT Codes. Rhinology Current Procedural Terminology (CPT) codes were analyzed for total percent changes from 2013 to 2024 in inflation‐adjusted facility rates (∆Inflation‐adjusted), nominal facility rates (∆Nominal), and relative value units (RVUs). RVUs breakdown includes total percent change from 2013 to 2014 for work RVUs (∆wRVUs), practice expense RVUs (∆peRVUs), and malpractice RVUs (∆mRVUs). Centers for Medicare and Medicaid Services (CMS) Short Descriptions were sourced from the 2024 CMS Physician Fee Schedule.

Supplemental Table S5. Otology CPT Codes. Otology Current Procedural Terminology (CPT) codes were analyzed for total percent change from 2013 to 2024 for inflation‐adjusted facility rates (∆Inflation‐adjusted), nominal facility rates (∆Nominal), and relative value units (RVUs) breakdown. RVUs breakdown includes total percent change from 2013 to 2014 for work RVUs (∆wRVUs), practice expense RVUs (∆peRVUs), and malpractice RVUs (∆mRVUs). Centers for Medicare and Medicaid Services (CMS) Short Descriptions were sourced from the 2024 CMS Physician Fee Schedule.

Supplemental Table S6. Laryngology CPT Codes. Laryngology Current Procedural Terminology (CPT) codes were analyzed for total percent change from 2013 to 2024 for inflation‐adjusted facility rates (∆Inflation‐adjusted), nominal facility rates (∆Nominal), and relative value units (RVUs) breakdown. RVUs breakdown includes total percent change from 2013 to 2014 for work RVUs (∆wRVUs), practice expense RVUs (∆peRVUs), and malpractice RVUs (∆mRVUs). Centers for Medicare and Medicaid Services (CMS) Short Descriptions were sourced from the 2024 CMS Physician Fee Schedule.

Supplemental Table S7. Sleep Surgery CPT Codes. Sleep Surgery Current Procedural Terminology (CPT) codes were analyzed for total percent change from 2013 to 2024 for inflation‐adjusted facility rates (∆Inflation‐adjusted), nominal facility rates (∆Nominal), and relative value units (RVUs) breakdown. RVUs breakdown included total percent change from 2013 to 2014 for work RVUs (∆wRVUs), practice expense RVUs (∆peRVUs), and malpractice RVUs (∆mRVUs). Centers for Medicare and Medicaid Services (CMS) Short Descriptions were sourced from the 2024 CMS Physician Fee Schedule.

Supplemental Table S8. Facial Plastic & Reconstructive Surgery CPT Codes. Facial Plastic and Reconstructive Surgery Current Procedural Terminology (CPT) codes, divided into procedural categories, were analyzed for total percent change from 2013 to 2024 for inflation‐adjusted facility rates (∆Adjusted), nominal facility rates (∆Nominal), and relative value units (RVUs) breakdown. RVUs breakdown included total percent change from 2013 to 2014 work RVUs (∆wRVUs), practice expense RVUs (∆peRVUs), and malpractice RVUs (∆mRVUs). The Centers for Medicare and Medicaid Services (CMS) Part B National Summary Data File was used to derive an average, inflation‐adjusted annual payment for each procedure from 2013 to 2022. Primarily pediatric‐based codes were not well‐represented or do not have payment data (i.e., cheiloplasty/palatoplasty, microtia). CMS Short Descriptions were sourced from the 2024 CMS Physician Fee Schedule.