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Original Investigation |

Economic and Demographic Characteristics of Cerumen Extraction Claims to Medicare

Eleanor L. Yang, BA1; Tyler M. Macy, MD2; Kevin H. Wang, MD2; Megan L. Durr, MD2
[+] Author Affiliations
1University of California, San Francisco, School of Medicine, San Francisco
2Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California
JAMA Otolaryngol Head Neck Surg. 2016;142(2):157-161. doi:10.1001/jamaoto.2015.3129.
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Importance  Cerumen extractions are performed in a large portion of otolaryngology and head and neck surgery practices. The burden on the health care system of cerumen extractions is unknown and demographics have not been characterized at a population level.

Objective  To quantify the cost burden and health care burden of cerumen extraction among Medicare recipients in the United States.

Design, Setting, and Participants  A retrospective cross-sectional study was conducted of all cerumen disimpactions documented in the Centers for Medicare & Medicaid Services Provider Utilization and Payment database from January 1 to December 31, 2012. Data analysis was conducted from August 4, 2014, to July 24, 2015.

Exposure  Cerumen disimpaction.

Main Outcomes and Measures  Cerumen extractions were analyzed by state, medical or surgical specialty, reimbursement, and type of health care professional performing the extraction.

Results  The Centers for Medicare & Medicaid Services reimbursed $46.8 million for 1.3 million cerumen disimpactions in 2012 (mean, $35.38 per procedure). The mean reimbursement rate per cerumen disimpaction varied by state from $25.41 in Puerto Rico to to $40.24 in New Jersey. The percentage of Medicare beneficiaries receiving cerumen extractions per state ranged from 0.55% in Puerto Rico to 4.92% in New Jersey. California had the overall highest total number of cerumen disimpactions (n = 132 823). The majority of cerumen extractions were performed by otolaryngology-head and neck practitioners (67.60%), although internal medicine (32.66%) and family practice (33.87%) had a higher amount of practitioners performing the procedure. The majority of cerumen extractions are performed by physicians (90.53%).

Conclusions and Relevance  Cerumen extraction is one of the most common procedures performed by otolaryngology health care professionals. Practice patterns and reimbursement rates vary greatly across the country.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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