Medicare Paid Less for Female Surgical Procedures
Research revealed significant disparities in reimbursement rates between male and female-specific surgical procedures.
Updated on Oct. 9, 2026 in Men’s Health
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Should Medicare reimbursement rates for surgeries be adjusted to eliminate gender-based payment disparities?
A 2023 analysis of 55 surgical procedure pairs found that Medicare consistently provided lower reimbursement rates for female-specific surgeries compared to male-specific equivalents. This pay gap continues a trend first identified in 1997, where male-specific procedures received higher valuation.
Why it matters
The disparity in reimbursement values influences how hospitals prioritize operating room time and resources, often favoring higher-paying procedures. This funding structure, largely driven by self-reported surgeon surveys to the American Medical Association, contributes to systemic inequities in medical resource allocation.
In 2023, Medicare paid $121.32 for a penile biopsy compared to $65.74 for a vaginal biopsy. Across 55 studied procedure pairs, 75 percent carried lower relative value units for female procedures.
The players
American Medical Association
This professional association manages the committee that determines relative value units for medical procedures based on physician surveys.
Centers for Medicare and Medicaid Services
This federal agency administers the Medicare program and approves nearly 90 percent of the valuation recommendations provided by the AMA.
Michigan Medicine
This academic medical center conducted a study of over 900,000 surgeries that analyzed differences in surgical time reporting between specialties.
The details
The American Medical Association committee determines procedure valuations based on self-reported physician surveys, which CMS accepts nearly 90 percent of the time. Studies show that urologists often report longer operating times in these surveys, leading to higher valuations, while gynecologic subspecialists are underrepresented on the committee.
Timeline
Researchers first documented sex-specific surgical payment disparities in 1997.
A study evaluated 55 pairs of surgical procedures during 2023.
New CPT codes for maternity care billing are scheduled to take effect in 2027.
Health Landscape
This news follows the established Relative Value Scale Update Committee process, which critics argue lacks sufficient representation from gynecologic specialists. It underscores how administrative valuation methods can perpetuate long-term financial disparities in medical care.
These reimbursement disparities can influence whether local hospitals prioritize gynecologic surgeries, potentially affecting wait times and scheduling for patients. Understanding these financial structures helps patients recognize why certain surgical resources may be limited or harder to access.
The takeaway
The valuation of medical procedures is heavily influenced by physician-reported survey data rather than objective time measurements. Recognizing these financial biases is the first step toward advocating for more equitable resource allocation in surgical care.
What happens next
New CPT codes for maternity care billing are scheduled to take effect in 2027, which may alter existing reimbursement patterns.
Further reading
Learn more about broader healthcare policy in our Men’s Health section.
Source note: This article includes information reported by Becker's Hospital Review | Healthcare News & Analysis.
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Should Medicare reimbursement rates for surgeries be adjusted to eliminate gender-based payment disparities?
