597 - Trends in the State-Level Utilization of Percutaneous Kyphoplasty Among Medicare Part B Beneficiaries from 2015–2023

Purpose: Percutaneous kyphoplasty is widely used to manage vertebral compression fractures, yet little is known about its state-level utilization patterns. This study aimed to evaluate state-level utilization trends of percutaneous kyphoplasty among Medicare Part B beneficiaries from 2015 to 2023.

Materials and Methods: The CMS "Medicare Physician & Other Practitioners - by Geography and Service" dataset (2015–2023) was queried {1}. Percutaneous kyphoplasty procedures were identified using Current Procedural Terminology (CPT) codes 22513 and 22514. The variable Tot_Bene_Day_Srvcs was used to quantify the number of distinct services, combining facility and non-facility counts where applicable. Counts were standardized as services per 1,000,000 residents aged ≥65 years in each state, using state-level population data obtained from the Annie E. Casey Foundation {2}. Median values across the study period were calculated, and state-level trends were analyzed to identify highest- and lowest-utilization states.

Results: By median gross number of distinct services, the highest-utilization states were Florida (5851.0), Texas (4311.0), California (2968.0), North Carolina (1976.0), and Virginia (1970.0). The lowest were Alaska (23.0), Wyoming (41.0), Vermont (41.5), Hawaii (61.0), and Montana (74.0). When standardized per 1,000,000 residents aged ≥65 years, the highest medians were observed in Oklahoma (2374.31), Kansas (2184.63), Mississippi (1831.46), Arkansas (1708.08), and Indiana (1606.89), with Oklahoma and Kansas consistently ranking at the top. The lowest adjusted medians were seen in Hawaii (211.36), Minnesota (223.14), Oregon (239.19), Alaska (240.37), and New Mexico (349.64). Most states exhibited flat or declining adjusted utilization rates over the study period, with exceptions such as Arizona (537.57–780.49), Utah (946.44–1285.77), and North Dakota (691.16–911.58), where rates increased.

Conclusion: State-level analysis revealed wide variation in percutaneous kyphoplasty utilization among Medicare Part B beneficiaries, with most states demonstrating flat or declining trends from 2015 to 2023. A small number of states exhibited persistent increases, suggesting regional practice differences. These disparities may reflect variations in patient demographics, fracture epidemiology, provider availability, or reimbursement practices. Further investigation into these drivers is warranted.