Jiro Health | Industry Analysis · November 2026
Medicare pays 14% less for surgeries on female anatomy.
Across 55 matched procedure pairs, Medicare pays 14% less for the female-anatomy procedure in the median pair. Commercial insurers mirror the gap rather than correcting it, paying $167 less per procedure in 2025 claims versus $124 under Medicare.
Download ReportLess paid by Medicare for the female-anatomy procedure in the median of 55 matched pairs. The gap widened from 2023 to 2025.
Average commercial gap per procedure on female anatomy in 2025 claims, versus $124 under Medicare. Insurers mirror the gap rather than correct it.
Operating minutes Medicare credits, male against female. Operating time may be part of the story.
2026 fee schedule
The 2026 narrowing is a cut, not a correction.
On paper, the average gap shrinks from $80.29 to $63.18 in 2026. That isn’t because women’s procedures were valued more. Medicare cut every one of the 92 codes in these pairs and raised none. Male-side procedures are priced higher, so the same percentage cut takes more dollars off them.
Practice-cost cut on female-anatomy codes
Practice-cost cut on male-anatomy codes
The gap widened through 2025, then shrank because CMS cut everything
Average Medicare facility payment gap per matched pair
Source: CMS Physician Fee Schedule RVU files, CY2023–CY2026, national rates; 54 pairs held constant.
Procedure by procedure
Matched operations, priced differently depending on the anatomy.
Both procedures in each pair are classified as major surgery. The largest gap is a subtotal prostatectomy against an abdominal trachelectomy. The finding is a consistent tilt, not a uniform rule: across all 55 pairs in 2025, 19 pay more for the female-anatomy procedure.
Medicare pays for a subtotal prostatectomy
Medicare pays for an abdominal trachelectomy
The eight largest gaps favoring male anatomy, and the four largest favoring female
Medicare facility payment per procedure in each matched pair, CY2025
Each row is one matched pair: the upper label is the male-anatomy procedure, the lower the female. Excludes the 15 pairs judged clinically questionable. Source: CMS Physician Fee Schedule CY2025, national rates.
For practices
A posted price isn’t what you’ll be paid.
Insurers’ published rates for the same procedure vary more than eight-fold, and the amounts actually allowed on claims sit near the bottom of that range. A practice modeling revenue should start from its own claims, by payer and setting, rather than from a price file.
Typical spread in posted rates for one procedure (10th to 90th percentile)
Of codes where the amount allowed on claims fell below the posted median
About the report
Anatomy of a Payment Gap reconstructs a 2025 Journal of Women’s Health study, tracks the gap through the 2026 fee schedule, and tests whether commercial insurers follow the same pattern using their published rates and 2025 claims. It covers why 2026’s narrowing came from cutting every fee rather than valuing women’s procedures more, plus full methodology and limitations.
Medicare and commercial reimbursement for matched male- and female-anatomy procedures, 2023–2026.
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