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Comment and Controversy

Fair reimbursement would increase laparoscopic procedures

May 2006 · Vol. 18, No. 5
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In his February editorial, “Minimally invasive hysterectomy: We are at the tipping point,” Dr. Robert L. Barbieri asked for suggestions of ways to increase the percentage of laparoscopic and vaginal procedures and decrease the percentage of abdominal hysterectomies. I think laparoscopic hysterectomy rates would more than double if we were adequately compensated for our skill and time.

At present, Medicare compensation is about $900 to $1,400 for laparoscopic hysterectomy and about $1,000 for abdominal hysterectomy. Yet the laparoscopic approach takes about 38 minutes longer.1 Thus, Medicare actually penalizes us for choosing the laparoscopic route.

Despite the satisfaction of doing the right thing for the patient by performing laparoscopic hysterectomy, the lower reimbursement rate certainly remains a deterrent.

Daniel N. Sacks, MD
West Palm Beach, Fla


1. Wattiez A, Cohen SB, Selvaggi L. Laparoscopic hysterectomy. Curr Opin Obstet Gynecol. 2002;14:417-422.

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Vaginal hysterectomy 
with basic instrumentation