Medicare Dermatology Pay Falls 29% Since 2007, Widening Access Gaps for Skin Cancer Care

The University at Buffalo study examined publicly available Medicare physician fee schedule files for common dermatologic procedures including biopsies, excisions, and Mohs surgery. Lead author Joshua Kent and co-authors tracked the conversion factor and procedure-specific payments, revealing consistent erosion beyond the 4.8% drop reported in earlier 2007-2021 analyses. The 2021-2026 period accounted for most of the loss as inflation outpaced modest congressional adjustments to the conversion factor.

This trend directly affects access because dermatology is procedure-heavy and Medicare covers a large share of skin cancer patients over 65. Lower payments reduce the financial viability of maintaining high-volume procedural practices, particularly in rural and underserved urban areas where private insurance mixes are thinner. Practices may limit new Medicare patients, shift to cosmetic services, or consolidate, patterns already documented in orthopedic and ophthalmology specialties facing similar cuts.

Related studies in JAMA and Health Affairs show that specialties with steeper reimbursement declines experience measurable increases in appointment wait times and referral backlogs for Medicare beneficiaries. The current analysis stops short of linking payment data to patient-level outcomes or practice closure rates, leaving open the question of how much further erosion would trigger measurable reductions in early skin cancer detection.

Next steps require linkage of reimbursement trends to claims-based measures of biopsy volume, stage at diagnosis, and geographic distribution of accepting providers, ideally through CMS data or a longitudinal cohort study.