The gap in what Medicare pays for matched surgical procedures on male and female anatomy grew from 2023 to 2025, even though CMS didn’t change the work value of any of the codes involved, according to an October industry analysis from Jiro Health.
Jiro rebuilt a 2025 Journal of Women’s Health study by Penn et al. The study compared 2023 Medicare physician fee schedule payments for 55 pairs of procedures, each matching an operation on male anatomy with its closest counterpart on female anatomy. Jiro reproduced the study’s five headline figures exactly, including a $75.73 average facility payment gap favoring male-anatomy procedures. It then applied the same method to later fee schedules.
Five findings:
- Across 54 pairs tracked each year, the average facility payment gap rose from $75.92 in 2023 to $78.40 in 2024 and $80.29 in 2025, an increase of 5.7%.
- Surgeon work didn’t drive the change. The gap in physician work relative value units was identical in all three years, and none of the 93 codes had its assigned operating time revised.
- Practice-expense RVUs accounted for almost all of the movement. Across all 55 pairs, facility practice-expense RVUs ran 0.1449 points in favor of the female-anatomy procedure in 2023. By 2025, they ran 0.0973 points in favor of the male-anatomy procedure. That swing of 0.2422 points exceeds the total gap change of 0.2380 points.
- The falling conversion factor hid part of the shift. Medicare’s conversion factor fell 4.5% over the period, from $33.8872 to $32.3465. In RVU points, the gap widened 10.7% and moved toward the male-anatomy procedure in 51 of 55 pairs.
- The trend held under narrower comparisons. Jiro flagged 15 of the study’s 55 pairs as clinically questionable. With all 15 removed, the average gap still rose 9.6%, though the median was essentially flat at −1.1%. Among 38 pairs where both procedures carry the same Medicare global period, the gap moved 7.47 toward the make-anatomy procedure, from 8.24 in 2023 to −$0.77 in 2025. In those pairs, the average still slightly favors the female-anatomy procedure.
Claims data pointed the same way. In Medicare allowed amounts, the gap widened 2.4 percentage points from 2022 to 2025 and grew in 20 of 28 pairs. The commercial gap moved 0.2 percentage points over the same period, a change Jiro said could not be distinguished from none.
The size of the gap is harder to pin down than the trend. Jiro found the original study’s $75.73 average gap was not statistically significant when tested pair by pair (p = 0.088). The full dollar difference sits in 17 pairs where Medicare classifies the two procedures differently. In 15 of those pairs, one procedure is classified as major surgery and the other as minor. In two, a full operation is set against an add-on code. Medicare classes 33% of the female-anatomy codes as minor, against 12% of the male-anatomy codes. A 2024 joint review by the American Urological Association and the American College of Obstetricians and Gynecologists, published in Urology Practice, found no significant work-value difference among 10 strictly comparable pairs.
The 2026 fee schedule narrowed the dollar gap, but not by valuing women’s procedures more. CMS cut all 92 codes with data, and the average dollar gap fell to $63.18. As a share of payment, the gap narrowed only from 25.9% to 24.8%. Jiro attributed the cuts to the 2.5% efficiency adjustment and a change to how facility practice-expense RVUs are calculated. These codes were cut an average of 7.99%, against 5.45% for all surgical codes.
The analysis did not examine why practice-expense values shifted between 2023 and 2025, and it did not measure effects on physician earnings, access or outcomes.
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