Commercial Insurers Paid an Average of $167 Less Per Procedure on Female Anatomy in 2025 Claims Versus $124 Under Medicare

AUSTIN, Texas, Nov. 5, 2026 /PRNewswire/ — Jiro Health, a public benefit corporation that turns healthcare data into actionable intelligence, released Anatomy of a Payment Gap, a new analysis of how Medicare and commercial insurers pay for matched surgical procedures on male and female anatomy. Comparing 55 matched procedure pairs using Medicare’s 2025 physician fees for facility settings, the analysis found that Medicare pays 14% less for the female-anatomy procedure in the median matched pair, and that commercial insurers carry that gap over rather than correcting it.

Jiro Health reconstructed a 2025 study in the Journal of Women’s Health using Medicare’s fee schedule files and reproduced the original study’s $75.73 average gap found in 2023 Medicare physician fees for facility settings. It then went further than the original to track how the gap has changed through 2026 and whether private insurers follow the same pattern, using commercial insurers’ published rates and 2025 claims data.

“Women’s health has finally become a national interest, but closing the disparity will take more than new private investment. It means looking honestly at how we pay for women’s healthcare,” said Greg Field, Co-Founder and CEO of Jiro Health. “CMS set these rates and created the gap, and commercial insurers ended up mirroring Medicare’s gap instead of correcting it. CMS and commercial payers set these rates every year, and they should be able to explain what justifies these differences. Clinicians and policymakers now have the evidence to ask.”

“Reimbursement is a signal of what our health system values, and this data shows that surgical care for women is still less valued than care for men,” said Liora Rodill, MD, Vice President of Intelligence Products at Jiro Health. “Three years later, women’s procedures are paid no closer to parity with men’s. That’s the test for the 2027 fee schedule, and every one after it: not whether payments rise or fall, but whether the gap actually closes.”

Key findings from Anatomy of a Payment Gap include:

• Medicare pays less for procedures on female anatomy. Across all 55 matched procedure pairs in Medicare’s 2025 physician fee schedule, female-anatomy procedures were reimbursed a median of 14% less than their male-anatomy counterparts.
• The gap isn’t closing on its own. The average Medicare fee gap widened from 2023 to 2025. It narrowed in 2026, when Medicare cut fees for all 92 study codes still on the schedule.
• Private insurers mirror Medicare’s pattern. In 2025 commercial claims for 29 matched procedure pairs with sufficient volume, female-anatomy procedures were reimbursed a median of 26% less, showing commercial payment follows Medicare’s pattern rather than correcting it.
• Assigned operating time may be part of the story. Medicare assigns male-anatomy procedures more operating time, 107 minutes on average versus 84, and classifies female-anatomy procedures as “minor” nearly three times as often. These minutes come from surgeon surveys, not recorded operating times.

The analysis compares Medicare physician fees, insurers’ posted rates and allowed amounts on claims. It does not determine why the differences exist or measure their effects on access to care, patient outcomes or physician earnings. Jiro Health also reviewed a 2024 study of more closely matched procedures by the American Urological Association and the American College of Obstetricians and Gynecologists, and flagged 15 of the original study’s 55 procedure pairs as questionable. The average difference was higher in 2025 than in 2023 even when all 15 flagged pairs were excluded.

The full analysis, including methodology, is available at https://jirohealth.com/womens-health-payment-gap.

About Jiro Health

Jiro Health is a public benefit corporation on a mission to put the power of healthcare data back in the hands of those who deliver care. Its platform helps clinicians make better-informed treatment decisions, healthcare organizations improve financial and operational performance, and researchers move faster from question to publication-ready findings.

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SOURCE Jiro Health