---
title: Impact of 2024 RVUs on Pediatricians
description: I dig into the real-world impact of the 2024 RBRVS on pediatricians.  What do the 2024 RVUs look like in the ambulatory pediatric space?
image: https://chipsblog.pcc.com/hubfs/Screenshot%20from%202023-12-16%2016-40-06.png
---

# Impact of 2024 RVUs on Pediatricians

December 16, 2023

[coding](https://chipsblog.pcc.com/tag/coding), [insurance](https://chipsblog.pcc.com/tag/insurance), [practice management](https://chipsblog.pcc.com/tag/practice-management), [rvu](https://chipsblog.pcc.com/tag/rvu), [benchmarks](https://chipsblog.pcc.com/tag/benchmarks)

Just last week, the Feds finally posted the 2024 RVUs in the [official spot I like to retrieve them from](https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files/rvu24a) - I don't know why they were so late, we even had to write to them to see what the delay was.  No response, yet, but POOF! they appeared.

Every year, I analyze the impact of the RVU changes on pediatricians. Why? Because what the Feds do each year has a profound, downstream effect on pediatricians.  Going through this process is also [how I figured out what was happening with immunization administration codes](https://chipsblog.pcc.com/the-negative-impact-of-the-2019-rbrvs-on-pediatricians) in 2018,  and helps me counsel many practices working on fee schedule offers from the payers.

The results going back the last few years have been a mixed bag  for pediatricians, but we have a little good news for 2024.  Before we begin, though, it's important to recognize what a watershed moment [2021](https://chipsblog.pcc.com/impact-of-2021-rvus-on-pediatricians) was for pediatricians and primary care in general.  The Feds moved so much value into primary care RVUs (namely through massive improvements to E&M valuation) that you really can't talk about RVUs broadly without knowing whether you're referring to pre- or post-2021.

However, pediatricians have largely been isolated from these improvements - why?  Because pediatricians don't take Medicare and commercial payors know that a move to 2021 RVU values for pediatricians represents a serious payment improvement.  But they can't avoid it forever.

Maybe the interesting news in 2024 will make a difference.  Let's look.

First, a review of my methodology:

- I start by grabbing the full CPT utilization of our customers to determine which RVU-valid codes (i.e., codes with RVU values) have real impact on pediatric revenue. I want to know how these changes will affect a *typical pediatrician.  *I used 2023 CPT volumes because we're so late in the season I figured it wouldn't change the relative volumes too much. (because I can't use 2022, yet).  Our clients recorded just under 500 RVU-valid CPT codes, but we need only 60 CPT codes to address 99% of pediatric revenue. Our sample crossed the billion dollar threshold a few years back, so it's a decent data set.  Remember, this doesn't include ~30% of the work that doesn't have RVU values (immunizations, labs, after-hours codes, etc.).
- Using mildly proprietary math, I distribute those codes based on what I'd consider to be the most typical FTE arrangement. In other words, imagine a pediatrician with about 4000 visits a year - how many 99213s would that be, how many screenings, etc.? Every practice and every pediatrician is different, of course, but it is helpful to have a baseline from which to predict.  
- I then plugged in the 2024 RVU data, using a neutral GPCI and 100% of Medicare rates, and compared it to 2024 data. Which codes change the most - and which codes, by virtue of their pediatric volume - have the biggest impact? Where do we land?  

**The results for 2023?**

- Headline: I estimate that 2024 will increase pediatric RVUs by about 1.4% over 2023 (which is probably about 18% over 2020!).   Payments, on the other hand,  tell a different story.  2024 payments would be 2.1% *lower* than 2023, marking the second straight annual decrease.   
  To summarize: when it comes to your contracts, 2024 is still markedly better than 2020 or any year before it, but not as good, overall, as 2021-2023 for dollars.  
- Wait, how can the RVUs in 2024 be higher than 2023 but the expected payments lower?  Because the annual Medicare Conversion Factor - the amount Medicare pays per-RVU - has dropped from $33.89 to $32.74.  This is required to keep the Medicare budget neutral, not some conspiracy to reduce payments.  The Feds shifted billions to primary care, but to do that they have take a little off the top everywhere else.  The medical universe has already complained about the ~3.4% drop, but the real impact needs to be calculated by estimating a weighted model of pediatric CPT codes to the results.  Sure, the CF dropped, but what about the RVU increases to the 90460 and 99213?
- Note: Don't forget to adjust by your GPCI!  I haven't done the 2024 numbers yet, so stay tuned.
- What I wrote last year remains true: the AAP's strong work to restore immunization administration values, especially in this pandemic era, has really paid off.  2023's 90460's RVUs are 168% of the 2020 values and the revenue is 153% of 2020 and the RVUs are even higher in 2024.  Similar, though more mild, improvements have been made for the 90471, 90472.  *However, *the 90461 has been cut considerably (more than 25% at this point, I believe), offsetting the 90460 improvement.  Don't panic, as the result is still quite net positive.  A practice with a typical 90460/90461/90471/90472 distribution would still see an overall revenue improvement of about 25%, which is fantastic.
- Other codes have met with serious RVU improvements, especially in the screening space.  96110 up 9.5%, 99173 up 11.1%, 96160 up 12.5%, 92551 up 5.6%, 99177 up 7.1%, 94760 up 14.3%, 92552 up 7.5%, 99174 up 5.6%, etc.  These codes have two major elements in common - first, I believe they are all dots on the [Bright Futures Periodicity Table](https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf), which means generally required payment.  Second, they're generally low dollar procedures (sad trombone).

The bottom line?  Practices working on their insurance contracts should heartily avoid RBRVS-based contracts based in years 2018-2020.  Anything from 2021 on looks good.   IMO, it doesn't matter which year you get after 2020. 

Let's see what the changes look like.  Below is a list of the top ~60 RVU-valid codes for pediatricians and what their changes look like for both RVUs and $$, comparing 2024 to both 2023 and 2020.   

| ** ** | **2023** | **2024** | **Difference** |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
| **CPT Code** | **2023 RVUs** | **2023 Price** | **2024 RVUs** | **2024 Price** | **RVU Difference** | **Revenue Difference** |
| **90460** | 0.67 | $22.71 | 0.69 | $22.59 | 103.0% | 99.5% |
| **99213** | 2.68 | $90.85 | 2.73 | $89.39 | 101.9% | 98.4% |
| **90461** | 0.30 | $10.17 | 0.26 | $8.51 | 86.7% | 83.7% |
| **99214** | 3.79 | $128.48 | 3.85 | $126.07 | 101.6% | 98.1% |
| **96127** | 0.14 | $4.75 | 0.14 | $4.58 | 100.0% | 96.6% |
| **96110** | 0.32 | $10.85 | 0.35 | $11.46 | 109.4% | 105.6% |
| **99392** | 3.10 | $105.09 | 3.13 | $102.49 | 101.0% | 97.5% |
| **99173** | 0.09 | $3.05 | 0.10 | $3.27 | 111.1% | 107.3% |
| **99391** | 2.90 | $98.31 | 2.94 | $96.27 | 101.4% | 97.9% |
| **99393** | 3.09 | $104.75 | 3.12 | $102.16 | 101.0% | 97.5% |
| **96160** | 0.08 | $2.71 | 0.09 | $2.95 | 112.5% | 108.7% |
| **92551** | 0.36 | $12.20 | 0.38 | $12.44 | 105.6% | 102.0% |
| **99394** | 3.37 | $114.24 | 3.41 | $111.66 | 101.2% | 97.7% |
| **90471** | 0.60 | $20.34 | 0.62 | $20.30 | 103.3% | 99.8% |
| **96161** | 0.08 | $2.71 | 0.09 | $2.95 | 112.5% | 108.7% |
| **99177** | 0.14 | $4.75 | 0.15 | $4.91 | 107.1% | 103.5% |
| **G0447** | 0.76 | $25.76 | 0.76 | $24.89 | 100.0% | 96.6% |
| **94760** | 0.07 | $2.37 | 0.08 | $2.62 | 114.3% | 110.4% |
| **99188** | 0.35 | $11.87 | 0.35 | $11.46 | 100.0% | 96.6% |
| **92552** | 1.06 | $35.93 | 1.14 | $37.33 | 107.5% | 103.9% |
| **92587** | 0.65 | $22.04 | 0.64 | $20.96 | 98.5% | 95.1% |
| **99212** | 1.68 | $56.95 | 1.70 | $55.67 | 101.2% | 97.7% |
| **99174** | 0.18 | $6.10 | 0.19 | $6.22 | 105.6% | 102.0% |
| **99395** | 3.45 | $116.96 | 3.49 | $114.28 | 101.2% | 97.7% |
| **97802** | 1.09 | $36.95 | 1.09 | $35.69 | 100.0% | 96.6% |
| **90472** | 0.43 | $14.58 | 0.44 | $14.41 | 102.3% | 98.8% |
| **99215** | 5.31 | $180.01 | 5.42 | $177.47 | 102.1% | 98.6% |
| **99381** | 3.23 | $109.50 | 3.27 | $107.07 | 101.2% | 97.8% |
| **95004** | 0.12 | $4.07 | 0.11 | $3.60 | 91.7% | 88.5% |
| **94640** | 0.27 | $9.15 | 0.24 | $7.86 | 88.9% | 85.9% |
| **96372** | 0.42 | $14.24 | 0.43 | $14.08 | 102.4% | 98.9% |
| **99401** | 1.15 | $38.99 | 1.15 | $37.66 | 100.0% | 96.6% |
| **99383** | 3.50 | $118.65 | 3.55 | $116.24 | 101.4% | 98.0% |
| **95165** | 0.45 | $15.26 | 0.44 | $14.41 | 97.8% | 94.4% |
| **99203** | 3.33 | $112.89 | 3.35 | $109.69 | 100.6% | 97.2% |
| **99460** | 2.74 | $92.89 | 2.75 | $90.05 | 100.4% | 96.9% |
| **99238** | 2.39 | $81.02 | 2.41 | $78.91 | 100.8% | 97.4% |
| **99211** | 0.69 | $23.39 | 0.70 | $22.92 | 101.4% | 98.0% |
| **69210** | 1.42 | $48.14 | 1.44 | $47.15 | 101.4% | 98.0% |
| **99382** | 3.37 | $114.24 | 3.42 | $111.99 | 101.5% | 98.0% |
| **99204** | 4.94 | $167.47 | 5.02 | $164.38 | 101.6% | 98.2% |
| **94664** | 0.51 | $17.29 | 0.54 | $17.68 | 105.9% | 102.3% |
| **92558** | 0.28 | $9.49 | 0.28 | $9.17 | 100.0% | 96.6% |
| **90473** | 0.49 | $16.61 | 0.50 | $16.37 | 102.0% | 98.6% |
| **97803** | 0.95 | $32.21 | 0.95 | $31.11 | 100.0% | 96.6% |
| **99384** | 3.94 | $133.57 | 3.98 | $130.32 | 101.0% | 97.6% |
| **G0444** | 0.55 | $18.65 | 0.57 | $18.66 | 103.6% | 100.1% |
| **99462** | 1.21 | $41.02 | 1.21 | $39.62 | 100.0% | 96.6% |
| **17110** | 3.41 | $115.60 | 3.43 | $112.31 | 100.6% | 97.2% |
| **92567** | 0.49 | $16.61 | 0.49 | $16.04 | 100.0% | 96.6% |
| **86580** | 0.30 | $10.17 | 0.31 | $10.15 | 103.3% | 99.8% |
| **90837** | 4.34 | $147.13 | 4.57 | $149.64 | 105.3% | 101.7% |
| **69209** | 0.46 | $15.59 | 0.48 | $15.72 | 104.3% | 100.8% |
| **17250** | 2.63 | $89.16 | 2.62 | $85.79 | 99.6% | 96.2% |
| **90474** | 0.35 | $11.87 | 0.36 | $11.79 | 102.9% | 99.4% |
| **95117** | 0.35 | $11.87 | 0.37 | $12.12 | 105.7% | 102.1% |
| **92583** | 1.62 | $54.92 | 1.71 | $55.99 | 105.6% | 102.0% |
| **94010** | 0.80 | $27.12 | 0.82 | $26.85 | 102.5% | 99.0% |
| **98966** | 0.39 | $13.22 | 0.39 | $12.77 | 100.0% | 96.6% |
| **54150** | 4.44 | $150.52 | 4.46 | $146.04 | 100.5% | 97.0% |

 

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