Effect of 2009 RVU Changes on Pediatrics

OK, overdue, but done.  Here’s what I did…I took the top 40 RVU-valid CPT codes that our clients have performed over the last 12 months and fit them into an overall model comparing the 2008 Transitioned Non-Facility Rates to the 2009 Transitioned Non-Facility rates (someone check my logic).  With the help of Siouxsie, I made sure to map things like the 99431, which doesn’t exist in 2009, to the 99460, etc.

Here’s the bottom line: pediatricians should expect the 2009 RVUs to reduce their average reimbursement (on those procedures) by 3.5%, not accounting for GPCI changes.  This does not address any of those non-RVU codes related to immunizations, after-hours codes, etc.  The implication of this reduction, however, is that pediatric codes will actually increase about 2.3% over last year, as Medicare will implementing an overall 5.6% cut across the board.

What are the big winners and losers this year?

CPT Code Description Difference (’08-’09)
92587 Evoked Auditory Test -43.2%
92567 Tympanometry -20.4%
95117 Immunotherapy Injections -17.1%
86580 TB Intradermal test -10.0%
99211 Office visit, est -3.8%
94760 Measure blood oxygen level +8.2%
92551 Pure tone hearing test, air +10.3%
90772 Ther/proph/diag inj, sc/im +12.5%

Tomorrow, I’ll have an overdue second GPCI review, but this is the important piece today. -3.5%. Could be worse, but could be a lot better.

Thanks to Siouxse who also provided this important review of the code changes.  I need to help get this out to the world.

2009 CPT Renumbering.pdf

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