{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:08:46Z","timestamp":1789186126724,"version":"build-2803163510"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterize national trends in Medicare reimbursement for otologic\/neurotologic procedures from 2012 to 2024, quantify the relative contributions of service volume, procedural mix, and within\u2010code reimbursement to aggregate spending, and identify clusters of procedures with similar economic behavior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Medicare Part B claims data from 2012 to 2024 were utilized and financial data were inflation\u2010adjusted to 2024\u2009USD. National trends in volume, spending, and reimbursement per service were evaluated. A Shapley decomposition framework quantified the contributions of service volume, procedural mix, and within\u2010code reimbursement to changes in aggregate spending. Unsupervised clustering with principal component analysis, hierarchical clustering, and k\u2010means classified CPT codes by reimbursement growth, variability, and service volume. Geographic and rural\u2013urban reimbursement variation were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Annual otologic\/neurotologic procedural volume increased from 1.85 million to 2.15 million services, while inflation\u2010adjusted mean reimbursement per service declined from $80.47 to $57.07. Total inflation\u2010adjusted spending fell from $147.1 million in 2012 to $121.9 million in 2024. Decomposition showed that rising service volume increased spending by $20.0 million, but this was offset by adverse shifts in procedural mix (\u2212$7.7 million) and declining within\u2010code reimbursement (\u2212$37.5 million). Clustering identified three economic phenotypes: low\u2010volume stable codes, high\u2010volume moderate\u2010variability codes, and high\u2010cost volatile codes. Geographic analysis demonstrated widening interstate and rural\u2013urban reimbursement variation over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite growing demand for otologic\/neurotologic services, inflation\u2010adjusted Medicare reimbursement has steadily declined. Aggregate spending reductions were driven primarily by reimbursement erosion rather than reduced utilization, highlighting structural vulnerabilities in current fee\u2010schedule valuation for otologic\/neurotologic care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70652","type":"journal-article","created":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T02:30:52Z","timestamp":1780713052000},"page":"4444-4456","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spatiotemporal Medicare Reimbursement Trends and Economic Clusters in Otologic\/Neurotologic Surgery"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4841-6366","authenticated-orcid":false,"given":"Akshay","family":"Warrier","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Rutgers New Jersey Medical School  Newark New Jersey USA"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-3576","authenticated-orcid":false,"given":"Shahid","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8310-3544","authenticated-orcid":false,"given":"Ryan","family":"Bartholomew","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-4184-7_11"},{"key":"e_1_2_10_3_1","volume-title":"Otologic Surgery","author":"Brackmann D. 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