Our healthcare system reimburses the same surgery up to 34% less when the patient is a woman. This double standard is why millions of women can't access safe and timely gynecologic surgeries.
This short video breaks down the policies that have led to serious downstream effects for women accessing surgical care for gynecologic disease.
Equivalent surgical procedures performed on female patients reimburse up to 34% less than when performed on male patients. This is not accidental—it is structural.
For equivalent surgical procedures, Medicare—and the private insurers who follow its lead—reimburse work performed on a female patient up to 34% less than the same work performed on a male patient.
Source: Penn et al., “Price and Prejudice: Reimbursement of Surgical Care on Male Versus Female Anatomies,” Journal of Women’s Health (2025).
CMS pays for surgeries and relies on the AMA's secretive RUC committee to set Relative Value Units—using junk science surveys with self-interested, biased responses rather than objective measures. Private insurers follow suit.
The RUC surveys physicians to self-report time per procedure. Male-dominated specialties report inflated estimates. Gynecology has fewer advocates at the table.
Insurers reimburse GYN procedures at lower rates. Surgeons earn less for the same work. Few physicians pursue advanced gynecologic fellowship training.
GYN surgeries are performed by low-volume non-specialists. Patients suffer preventable injuries—chronic pain, incontinence, and repeat surgeries.
Several institutions bear responsibility for this structural inequity. Understanding their roles is essential to understanding the path to reform.
Centers for Medicare & Medicaid Services. The federal agency that sets reimbursement rates the entire healthcare market follows.
Department of Health and Human Services. The Secretary of HHS has authority to reject or override the RUC's recommendations.
The American Medical Association's Relative Value Update Committee. Develops RVU recommendations behind closed doors with known conflicts of interest.
American College of Obstetricians and Gynecologists. Has a seat at the RUC table but has not effectively challenged the undervaluation of GYN surgery.
Holds the power to lift the payment cap and require evidence-based, sex-equitable reimbursement—but has made federal payment rates unreviewable by the courts, even when they are illegal.
Follow the federal government's lead, adopting the same discriminatory rates. In doing so, they may share liability for perpetuating the disparity.
At the end of this chain are the people it harms most. Roughly four million Americans undergo gynecologic surgery every year—including some 600,000 hysterectomies—and too many suffer avoidable, lifelong injuries because the system that pays for their care values it less.
When an entire field of surgery is chronically underpaid, the harms compound—and patients bear them.
Lower pay steers skilled surgeons away from gynecologic specialization.
Undervalued procedures lose out when OR time is scarce.
Fewer specialists and less OR access mean longer waits for surgery.
Underfunding means less investment in the staff and equipment these surgeries demand.
Low-volume, under-resourced surgery drives preventable, lifelong injuries.
The Surgical Parity Project is grounded in published research documenting structural discrimination in surgical reimbursement and its consequences for patient safety.
Significant disparities in surgical reimbursement by patient sex have been documented for decades, although debate exists regarding their cause, and studies have approached the issue with different methodologies, arriving at seemingly divergent conclusions. In our analysis, we have found that the preponderance of the literature, including the most comprehensive studies, supports a conclusion that there are real payment disparities at the work relative value unit (RVU) level for gynecologic care. Disparities in funding and reimbursement result in differing health care resource allocation and access and ultimately systemic and persistent devaluation of female bodies. We advocate for robust interventions to promote equity rather than a limited approach focused on revising a handful of Current Procedural Terminology codes. Reforms should include broader RVU reassessment, specialty compensation parity, and rigorous yet inclusive comparisons of sex-specific procedures.
Background: Gender bias is a pervasive issue in health care, contributing to poorer health outcomes for women compared with men. In the United States, studies have shown a slowly improving, but persistent, disparity exists for gender-specific procedures' relative value units (RVUs). This study aims to build on existing literature and conduct a large-scale analysis examining comparable gender-specific surgical procedures to determine whether there remains a disparity in RVUs/reimbursements for care provided to female patients.
Methods: Using 110 CPT codes, we compared work RVU and reimbursement rates for facility and nonfacility procedures within the 2023 dataset for anatomically similar gender-specific procedures, verified by a group of gynecologists and urologists. We analyzed the procedures over a 20-year period with RVUs from 2003 to 2023 to determine how the difference between the gender-specific procedures was changing over time. We also used the same design and 22 current procedural terminology (CPT) codes as Goff (1997) and Benoit (2015) to compare RVUs between 1997, 2015, and 2023.
Results: For the 55 gender-specific procedures, 41 (75%) had lower RVUs for procedures on female patients in 2023. RVUs for procedures on male patients were 30% higher on average. For facility reimbursement, 35 (64%) were higher for procedures on male patients—with a 25.6% higher reimbursement on average, correlating to an average reimbursement of $75.73 more for male procedures. For nonfacility reimbursements, male procedures were reimbursed 20% higher on average. Between 2003 and 2023, there were no statistically significant improvements in the reimbursement disparities for male versus female procedures, with male procedures consistently having an average RVU 31–34% higher. The disparity narrowed minimally between 1997, 2015, and 2023.
Conclusion: There remain significant disparities between gender-specific procedures, with lower RVUs/reimbursements for procedures on female patients and minimal change over the past three decades. Addressing these disparities is crucial for achieving gender equity in health care and ensuring equally valued medical services.
Keywords: gynecology; health disparities; reproductive health; urogynecology.
The nearly four million Americans who undergo gynecological surgeries each year suffer avoidable lifelong, painful, and disabling injuries. This Article diagnoses the root cause in our legal framework for healthcare finance and identifies legal solutions.
America's public-private system for reimbursing healthcare pays for procedures rather than outcomes, and it pays substantially more for work on male rather than female anatomies. This disparity is due to the federal government's reliance on a secretive industry committee to set those rates, and the committee's reliance on junk science surveys, allowing self-interested and gender-biased responses, contrary to objective measures.
As payors disvalue the bodies of those needing gynecological care, the medical profession has organized accordingly. Surgical training for Obstetrician Gynecologists (OBGYNs) is truncated as compared to other surgical disciplines. They are incentivized to pursue a mix of better-paid work, rather than pursue the advanced training and specialized experience necessary to perform surgery consistently. Instead, most OBGYNs may perform particular surgeries only a few times per year, a context shown to magnify the risk of preventable injuries.
Traditional approaches, under informed consent and medical malpractice laws, take for granted the fundamental economic structure that sets aggregate levels of risk. A range of laws, including a provision in the Affordable Care Act, do promise equal treatment. Close analysis, however, reveals a range of barriers to redress. Congress has made federal payment rates unreviewable by courts, even if illegal. Notwithstanding the federal government's ironic immunity from its own laws, this Article suggests that private health insurers may be held liable for going along with the federal government's discrimination, but it is difficult for individual patients to assert their interests in reorganizing the medical profession.
There are narrow and uncertain paths for legal accountability, but the political economy of this problem is no less daunting. Presently, overall Medicare payments are conceived as a zero-sum game, pitting patients against each other. Nonetheless, Constitutional litigation under the Equal Protection Clause may give voice to those working for the health of women in America.
The wage gap in gynecologic surgery presents what we have described as “double discrimination”—lower pay in an area of surgery that boasts of the largest proportion of female surgeons, and potentially lower quality care with fewer resources for the field's exclusively female patients. This article expounds on this premise and describes how this pay gap translates to fewer resources and less training for gynecologic surgery residents. Solutions and ways forward toward reform and equity are proposed.
In this commentary, we describe historical and other influences that drive "double discrimination" in gynecologic surgery—lower pay in the area of surgery that boasts the largest proportion of female surgeons and is focused on female patients—and explore how it results in potentially lower quality care. Insurers reimburse procedures for women at a lower rate than similar procedures for men, although there is no medically justifiable reason for this disparity. The wage gap created by lower reimbursement rates disproportionately affects female surgeons, who are disproportionately represented among gynecologic surgeons. This contributes to a large wage gap in surgery for women. Finally, poor reimbursement for gynecologic surgery pushes many obstetrics and gynecology surgeons to preferentially perform obstetric services, resulting in a high prevalence of low-volume gynecologic surgeons, a metric that is closely tied to higher complication rates. Creating equity in reimbursement for gynecologic surgery is one important and ethically required step forward to gender equity in medicine for patients and surgeons.
The fight for surgical parity is gaining ground—but significant roadblocks remain.
When gynecologic surgery is reimbursed fairly, more physicians will specialize, volumes will increase, and patient safety will improve. Getting there requires action on multiple fronts.
The Secretary of HHS can reject the AMA RUC's recommendations and set fair rates. CMS can eliminate sex-specific codes, replace self-reported surveys with objective measurement, and require sex-equity audits of all RVU reviews.
Congress needs to lift the cap and make these adjustments—amending the Social Security Act to require evidence-based reimbursement methods, mandate sex-equity reviews, and impose transparency requirements on the RUC process. This is fundamentally a patient safety issue with bipartisan appeal.
Legal challenges can target discriminatory reimbursement under existing civil rights statutes, including Title IX, the Equal Protection Clause, and Section 1557 of the Affordable Care Act. The research base now provides the evidentiary foundation.
Medical societies, hospital systems, and training programs can advocate internally—pushing ACOG to prioritize parity, supporting fellowship training in GYN surgery, and building coalitions across specialties.
The reimbursement gap doesn't only affect surgeons and patients. When procedures for women are systematically undervalued, the ripple effects reach across the entire women's health economy—chilling investment in FemTech and medical devices, slowing R&D for better surgical tools, and narrowing the pipeline of innovation in a field that already draws a fraction of the funding directed elsewhere. Undervaluing women's surgical care today means fewer breakthroughs in women's health tomorrow.
When insurers pay less for gynecologic procedures, device companies invest less in developing better tools—leaving the R&D pipeline for women’s surgical health a fraction of what it could be.
The Secretary of HHS can reject the AMA committee's recommendations and set fair reimbursement rates today. CMS can eliminate sex-specific codes and replace unreliable surveys with objective measures—but they need to hear from you.
Comments are open now—through September 14, 2026—on the CY2027 Medicare Physician Fee Schedule (CMS-1848-P), the annual rule that sets the work RVUs behind every surgical reimbursement. This cycle even revisits how surgical global-period work is paid, making it a pivotal moment to press for sex-equity in how procedures are valued.
Click the link to go directly to the CMS public comment portal.
Use or adapt the template on the right. Personal stories make comments more impactful.
Submit before the deadline. Comment periods are strictly time-limited—see the countdown above.
Dear Administrator,
I am writing to urge CMS to address the well-documented sex-based disparities in surgical reimbursement rates. Peer-reviewed research has demonstrated that identical procedures performed on female patients are reimbursed at rates up to 34% lower than the same procedures performed on male patients.
This disparity undermines the financial viability of gynecologic surgical specialization, reduces the supply of fellowship-trained surgeons, and directly contributes to higher rates of preventable complications.
I respectfully request that CMS: (1) conduct a comprehensive sex-equity audit of current RVU valuations; (2) adopt objective, evidence-based methods for determining physician work values; and (3) eliminate sex-specific procedure codes where the underlying surgical work is equivalent.
[Your name, credentials, and personal experience]
Through our partner Women's Health Advocates (WHA), you can write to your representatives in just a few minutes. Their letter-writing tool finds your elected officials automatically and gives you a ready-to-send message urging Congress to close the surgical reimbursement gap—you simply add your name and any personal note.
Congress has the power to require evidence-based, sex-equitable reimbursement. The more constituents who speak up, the harder this is to ignore.
Open the WHA Letter-Writing Tool →Behind every statistic is a person. Whether you're a surgeon who has watched the reimbursement gap distort care, a medical professional or trainee who has seen its effects firsthand, a patient who has lived through an avoidable complication, or a loved one who has walked beside someone who has—your story matters.
Sharing it helps us put a human face on the research and strengthen the case for change. The button below opens a private email to our team, and everything you share stays confidential—we'll never use your name or details without your explicit permission.
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Assistant Professor of Obstetrics and Gynecology
Northwestern University Feinberg School of Medicine
Assistant Professor, Obstetrics, Gynecology & Reproductive Sciences
UPMC Magee-Womens Hospital
University of Pittsburgh
Assistant Professor, Harvard Medical School
Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital
Lecturer, Boston University
Assistant Professor, Minimally Invasive Gynecologic Surgery
The University of North Carolina at Chapel Hill
N. Neal Pike Scholar and Professor of Law, Boston University School of Law
Institutions are listed for identification purposes only. We are working passionately, in our individual capacities.
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