RT Journal Article SR Electronic T1 Procedural, workforce, and reimbursement trends in neuroendovascular procedures JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP jnis-2022-019297 DO 10.1136/jnis-2022-019297 A1 Kyle Steiger A1 Rohin Singh A1 W Christopher Fox A1 Stefan Koester A1 Nolan Brown A1 Shane Shahrestani A1 David A Miller A1 Naresh P Patel A1 Joshua S Catapano A1 Visish M Srinivasan A1 James F Meschia A1 Young Erben YR 2022 UL http://jnis.bmj.com/content/early/2022/08/11/jnis-2022-019297.abstract AB Background This study aims to define the proportion of Medicare neuroendovascular procedures performed by different specialists from 2013 to 2019, map the geographic distribution of these specialists, and trend reimbursement for these procedures.Methods The Medicare Provider Utilization Database was queried for recognized neuroendovascular procedures. Data on specialists and their geographic distribution were tabulated. Reimbursement data were gathered using the Physician Fee Schedule Look-Up Tool and adjusted for inflation using the United States Bureau of Labor Statistics’ Consumer Price Index Inflation calculator.Results The neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46% vs 44%), neurosurgeons (45% vs 35%), and neurologists (9% vs 21%). Neurologists increased proportionally (p=0.03). Overall procedure numbers increased across each specialty: radiology (360%; p=0.02), neurosurgery (270%; p<0.01), and neurology (1070%; p=0.03). Neuroendovascular revascularization (CPT 61645) increased in all fields: radiology (170%; p<0.01), neurosurgery (280%; p<0.01), neurology (240%; p<0.01); central nervous system (CNS) permanent occlusion/embolization (CPT61624) in neurosurgery (67%; p=0.03); endovascular temporary balloon artery occlusion (CPT61623) in neurology (29%; p=0.04). In 2019, radiologists were the most common neuroendovascular specialists everywhere except in the Northeast where neurosurgeons predominated. Inflation adjusted reimbursement decreased for endovascular temporary balloon occlusion (CPT61623, −13%; p=0.01), CNS transcatheter permanent occlusion or embolization (CPT61624, −13%; p=0.02), non-CNS transcatheter permanent occlusion or embolization (CPT61626, −12%; p<0.01), and intracranial stent placement (CPT61635, −12%; p=0.05).Conclusions The number of neuroendovascular procedures and specialists increased, with neurologists becoming more predominant. Reimbursement decreased. Coordination among neuroendovascular specialists in terms of training and practice location may maximize access to acute care.Data are available in a public, open access repository. All data for this study were obtained from free and publicly available datasets cited within the article. Additionally, we provide supplementary tables that should allow others to independently replicate and critique our statistical analysis.