*Purpose: Reimbursement for surgical procedures has been declining across surgical disciplines. CMS is one of the largest payers for abdominal transplant services, and changes in reimbursement could impact patients, transplant surgeons, and hospitals. However, comprehensive economic analysis of reimbursement trends in abdominal transplantation have not been performed.

*Methods: We utilized publicly-available Medicare fee schedule data (2000-2021) to assess inflation-adjusted trends in Medicare reimbursement over time for abdominal transplant procedures CPT codes (liver transplantation (LT), kidney transplantation (KT), and pancreas transplantation (PT)(Table 1). Reimbursement rates were adjusted for inflation to 2021 US dollars using consumer price index data to assess overall changes in reimbursement, year-over-year changes for the total study period, year-over-year changes for 2016-2021, and the compound annual growth rate (CAGR) for transplant procedures.

*Results: From 2000-2021, inflation-adjusted reimbursement fell for liver, kidney, and pancreas transplant procedures (% Change: LT = -32.4%, KT = -24.2%, PT = -15.2%, all p<0.05). Overall average yearly change for LT, KT with and without nephrectomy, and PT were -1.54%, -1.15%, -1.15%, and -0.72%, respectively. For these respective groups, from 2016-2021, the annual change averaged -2.69%, -2.35%, -2.64%, and -2.43%. The overall grand average CAGR for these transplant procedures was -1.27%.

*Conclusions: Reimbursement is decelerating rapidly for abdominal transplant procedures. Transplant surgeons, centers, and professional advocacy groups should engage and advocate for sustainable surgical fee reimbursement policies to ensure continued access to transplant services for patients, stability of the transplant workforce stability, and contribution margin to hospitals.

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