Uptick in Actinic Keratosis Lesion Removal but Decrease in Medicare Reimbursements

There is an escalating number of actinic keratosis lesions being treated, yet Medicare Part B payments for treatment procedures are declining, according to a study recently published in JAMA Dermatology.

Actinic keratosis is a scaly, rough patch of skin that can appear after many years of sun exposure. The condition typically affects aging adults over the age of 40 and can evolve into skin cancer. Common treatment practices are topical 5-fluorouracil and liquid nitrogen cryotherapy. According to the study’s principal investigator Howa Yeung, MD, in dermatology practices, actinic keratosis is the most popular diagnosis for patients 45 years and older.

Researchers from Emory School of Medicine in Atlanta found that the number of actinic keratosis lesions treated jumped from 30 million in 2007 to 35 million in 2015, an approximate 17 percent increase. These rising rates also corresponded with the rise in independent nurse practitioners and physicians treating the condition — from 4 percent in 2007 to 13.5 percent in 2015.

Initially, medicare reimbursements for lesion treatment grew as demand to remove the lesions increased. In 2007, Medicare distributed $522 million in reimbursements and that number shot up to $610 million in 2014. However, payments took a nose dive to $511 in 2015 after the government program cut reimbursement rates. According to the researchers, the average inflation-adjusted payments per 1,000 Medicare Part B fee-for-service subscribers dropped from $11,749 to $10,942. Despite the decrease in payments, the removal of actinic keratosis lesions accounts for around 15 percent of the $2.5 billion Medicare Part B dermatology spending in 2015.