title: Economic and Demographic Characteristics of Cerumen Extraction Claims to Medicare.
abstract: OBJECTIVE
  Cerumen extractions are performed in a large portion of otolaryngology and head and neck surgery practices. The burden on the health care system of cerumen extractions is unknown and demographics have not been characterized at a population level.
  
  
  OBJECTIVE
  To quantify the cost burden and health care burden of cerumen extraction among Medicare recipients in the United States.
  
  
  METHODS
  A retrospective cross-sectional study was conducted of all cerumen disimpactions documented in the Centers for Medicare & Medicaid Services Provider Utilization and Payment database from January 1 to December 31, 2012. Data analysis was conducted from August 4, 2014, to July 24, 2015.
  
  
  METHODS
  Cerumen disimpaction.
  
  
  METHODS
  Cerumen extractions were analyzed by state, medical or surgical specialty, reimbursement, and type of health care professional performing the extraction.
  
  
  RESULTS
  The Centers for Medicare & Medicaid Services reimbursed $46.8 million for 1.3 million cerumen disimpactions in 2012 (mean, $35.38 per procedure). The mean reimbursement rate per cerumen disimpaction varied by state from $25.41 in Puerto Rico to to $40.24 in New Jersey. The percentage of Medicare beneficiaries receiving cerumen extractions per state ranged from 0.55% in Puerto Rico to 4.92% in New Jersey. California had the overall highest total number of cerumen disimpactions (n = 132 823). The majority of cerumen extractions were performed by otolaryngology-head and neck practitioners (67.60%), although internal medicine (32.66%) and family practice (33.87%) had a higher amount of practitioners performing the procedure. The majority of cerumen extractions are performed by physicians (90.53%).
  
  
  CONCLUSIONS
  Cerumen extraction is one of the most common procedures performed by otolaryngology health care professionals. Practice patterns and reimbursement rates vary greatly across the country.
authors.affiliation: University of California, San Francisco, School of Medicine, San Francisco.
authors.forename: Eleanor L
authors.initials: EL
authors.lastname: Yang
authors.affiliation: Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Macy
authors.affiliation: Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Wang
authors.affiliation: Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Durr
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D002571:Cerumen; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D010036:Otolaryngology / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000191:economics; D014481:United States