The 2023 Imms Admin RVU Changes Should Have Real Impact

HRH Dr. Suzanne Berman shared the great and interesting news that the AAP has lobbied successfully to get the RVU valuations for immunization admins corrected. [I've written about this in the past.]  You can read the gory details at on pages 189-192.

Because you are unlikely to do that, let me share with you an executive summary provided by Dr. Berman:

  • The current total RVU for 90460 is 0.49. In the newly proposed CMS Final Rule for 2023, CMS has proposed 0.65 for 2023.
  • The current total RVU for 90461 is 0.37. CMS has proposed 0.30 for 2023 (basically, they took away the practice expense, which should never have been part of 90461 to begin with.)
  • The current total RVU for 90471 is 0.49. CMS has proposed 0.58 for 2023.
  • The current total RVU for 90472 is 0.37. CMS proposed 0.42 for 2023.

These figures make it easy to measure the per-procedure RVU impact:

CPT Difference
90460 + 32.7%
90461 -18.9%
90471 +18.4%
90472 +13.5%

Three hits and a strike - but how does that translate in real life?  You don't do the same number of each of those admins and a 32% increase in a larger-RVU procedure surely offsets an 18.9% loss in a smaller one...right?

Let's find out.

Using all of PCC as measure, our clients' vaccine admins were distributed as shown below. [Ignoring the 90473/4 because their impact is miniscule.]

CPT Code Overall As Primary
90460 55% 87%
90461 37%  
90471 7% 11%
90472 1% 2%

So, for every 1000 vaccines given throughout 2021, the CPT volume would look something like this:

CPT Volume
90460 868
90461 589
90471 112
90472 20

For what it's worth, most pediatricians personally do somewhere between 1500 and 2500 vaccines a year. I'd call 1700-2000 a sweet spot. A practice will often do a but more 90471/2s as a result of flu clinics, etc.

Using just the RVU changes, the implication is that - at least for fee schedules tied to the RVUs - When you do the math, it represents a 15.4% overall RVU increase. Given how important and common these procedures are, that's a BIG deal. How does this translate to dollars?

I grabbed a sample from a random pediatrician's imms admins for 2021 and this is what it looks like:

CPT Volume Distribution AVG Pmt 2022 Revenue 2023 Revenue
[if RVU-based]
90460 1842 62.95% $20.50 $37,761 $50,091
90461 1025 35.03% $13.00 $13,325 $10,804
90471 49 1.67% $20.00 $900 $1,160
90472 10 0.34% $21.00 $210 $238
TOTAL       $52,276 $62,293

By implication, this physician would receive $10,000 more in 2023 if the pay for his or her admins increase based on the RVU changes. You'll note that this doctor has a very high 90460:90471 ratio, so that $10K estimate is likely high. My napkin math says that it works out, on average, to $5-6K per FTE pediatrician. That is real money, as none of this work increases your overhead, it should all flow right to you.

NOTE: for the practices who see more Medicaid AND the local Medicaid programs don't accept 90461 admins (which is true for many of them), then there's a hidden math bonus. Ultimately, the one code the feds downgraded is the one that you weren't using or getting paid for anyway (i.e., 80% of $13 is better than 100% of $0)! And, further and importantly, when/if the Strengthening the Vaccines for Children Program Act gets passed, then those of you who give VFC vaccines have just been queued up for a very, very real improvement for vaccinating the most vulnerable children in our communities.

Another example of how your AAP dues can be dwarfed by the return you get.  Now we need to yell at the payors to stop pretending the 2021 and 2022 RVU changes didn't happen.