Subject(s)
Health Care Costs , Health Expenditures , Medicare Access and CHIP Reauthorization Act of 2015/economics , Physician Incentive Plans/economics , Reimbursement, Incentive/economics , Vascular Surgical Procedures/economics , Government Regulation , Health Care Costs/legislation & jurisprudence , Health Expenditures/legislation & jurisprudence , Humans , Medicare Access and CHIP Reauthorization Act of 2015/legislation & jurisprudence , Physician Incentive Plans/legislation & jurisprudence , Policy Making , Reimbursement, Incentive/legislation & jurisprudence , United States , Vascular Surgical Procedures/legislation & jurisprudenceSubject(s)
Centers for Medicare and Medicaid Services, U.S./economics , Current Procedural Terminology , Health Care Costs , Medicare Access and CHIP Reauthorization Act of 2015/economics , Physician-Patient Relations , Quality Indicators, Health Care/economics , Centers for Medicare and Medicaid Services, U.S./standards , Cost Savings , Cost-Benefit Analysis , Health Care Costs/standards , Humans , Medicare Access and CHIP Reauthorization Act of 2015/standards , Quality Indicators, Health Care/standards , United StatesSubject(s)
Economics, Hospital/organization & administration , Health Expenditures , Quality Improvement/economics , Reimbursement, Incentive/economics , Humans , Medicare/economics , Medicare/organization & administration , Quality Improvement/organization & administration , Reimbursement, Incentive/standards , United StatesSubject(s)
Medicaid , Medicare , Reimbursement Mechanisms , United States , Vascular Surgical Procedures/economicsABSTRACT
In 2015, there was an 18% reduction in the Relative Value Units (RVUs) that the Center for Medicare and Medicaid Services (CMS) assigned to the Current Procedural Terminology (CPT) code 58571 (Laparoscopy, surgical, with total hysterectomy, for uterus 250g or less; with removal of tube(s) and/or ovary(s)âTLH+BSO). The other CPT codes for laparoscopic hysterectomy and laparoscopic supracervical hysterectomy (58541-58544 and 58570-58573) lost between 12 and 23% of their assigned RVUs. In 2016, the laparoscopic lymph node dissection codes 38570 (Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple), 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy), and 38572 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), single or multiple) lost between 5.5 and 16.3% of their RVU's. The goals of this article from the Society of Gynecologic Oncology (SGO) Task force on Coding and Reimbursement are 1) to inform the SGO members on why CMS identified these codes as a part of their misvalued services screening program and then finalized a reduction in their payment levels; and 2) outline the role individual providers have in CMS' methodology used to determine the reimbursement of a surgical procedure.
