This study evaluates the Medicaid reimbursement rates in the USA to determine changes from 2022–2024. Common procedural terminology codes 92004 and 92014 were used to search Medicaid regarding rates for all but 5 states. For analysis, 46 states were included. In 2022, the mean rates for new and follow-up visits were $107.17 and $86.39, and for 2024, were $116.62 and $91.85 – a +3.81% and +4.98% change respectively. Highest rates were in Alaska, Montana and New Mexico for new visits. Increase in rates was noted for 21 states and a decrease for 8, 17 with no change. Highest rates for follow-up were in Montana, Virginia and North Dakota in 2022, and in Alaska, Montana and Virginia in 2024, with an increase for 21 states, decrease for 8 and no change for 16. The authors conclude low Medicaid reimbursement rates have led to many paediatric ophthalmologists limiting their intake of patients with this insurance. This directly limits access to paediatric eyecare. There is a need to raise awareness and increase provider motivation to raise rates at state level, reduce financial challenges and promote equitable care.
Economics of Medicaid reimbursement rates
Reviewed by Fiona Rowe
Revisiting Medicaid reimbursements and their effects on the economics of pediatric ophthalmology 2 years later.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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