Uh oh. 2019 RVUs are going to be a challenge for pediatricians.
Executive summary: even with the mild increase in the Medicare Multiplier (from $35.99 to $36.04), the overall impact of the 2019 RBRVS on typical pediatricians will be a 1.45% REDUCTION in revenue.
CMS has targeted the lifeblood of pediatrics, the most important service in all of medicine: vaccine administration. They have also targeted screening of all kinds - developmental, hearing, behavioral. Yes, the Interprofessional Consult codes (99446-52) are now payable by Medicare, which could have a profound impact on pediatric offices...but we know that these codes are going to be unpaid, sent to patient deductible, or bundled by the private payors.
In exchange, the values of some codes have been improved - nutritional counseling, TB test, even the tympanometry. E&M codes have been lightly, but impactfully, increased. But overall, it doesn't bode well. A 1.5% decrease translates to a ~$3,000-$10,000 decrease in a pediatrician's actual take home pay.
Let's look at the data. To understand the impact on a typical pediatrician, I grab all of the "RVU valid" procedures our clients have performed for a year's sample - there are about 600 (you may not have performed a 65205 - Fb removal, eye - but some practices did). I then match the CPTs to the 2018 and 2019 RVU values and weight them based on that real-world distribution. Here's the impact on the top 30 codes, based on volume:
| 2018 RVUs |
2019 RVUs |
2018 Fee |
2019 Fee |
Diff | |
| 90460 | 0.58 | 0.47 | $20.88 | $16.94 | -18.9% |
| 99213 | 2.06 | 2.09 | $74.16 | $75.32 | 1.6% |
| 90461 | 0.36 | 0.36 | $12.96 | $12.97 | 0.1% |
| 99214 | 3.04 | 3.06 | $109.44 | $110.28 | 0.8% |
| 99392 | 3 | 3.01 | $108.00 | $108.48 | 0.4% |
| 96110 | 0.29 | 0.28 | $10.44 | $10.09 | -3.3% |
| 99391 | 2.81 | 2.82 | $101.16 | $101.63 | 0.5% |
| 99173 | 0.09 | 0.08 | $3.24 | $2.88 | -11.0% |
| 99393 | 2.99 | 3 | $107.64 | $108.12 | 0.4% |
| 96127 | 0.18 | 0.15 | $6.48 | $5.41 | -16.6% |
| 90471 | 0.58 | 0.47 | $20.88 | $16.94 | -18.9% |
| 99394 | 3.28 | 3.29 | $118.08 | $118.57 | 0.4% |
| 92551 | 0.35 | 0.33 | $12.60 | $11.89 | -5.6% |
| 94760 | 0.08 | 0.07 | $2.88 | $2.52 | -12.4% |
| 96160 | 0.11 | 0.09 | $3.96 | $3.24 | -18.1% |
| 92552 | 0.9 | 0.89 | $32.40 | $32.07 | -1.0% |
| 99212 | 1.24 | 1.27 | $44.64 | $45.77 | 2.5% |
| 92587 | 0.61 | 0.62 | $21.96 | $22.34 | 1.8% |
| 90472 | 0.36 | 0.36 | $12.96 | $12.97 | 0.1% |
| 96161 | 0.11 | 0.09 | $3.96 | $3.24 | -18.1% |
| 94640 | 0.53 | 0.51 | $19.08 | $18.38 | -3.7% |
| 99395 | 3.35 | 3.36 | $120.60 | $121.09 | 0.4% |
| 99215 | 4.1 | 4.1 | $147.60 | $147.76 | 0.1% |
| G0447 | 0.73 | 0.73 | $26.28 | $26.31 | 0.1% |
| 99460 | 2.71 | 2.71 | $97.56 | $97.67 | 0.1% |
| 99238 | 2.07 | 2.06 | $74.52 | $74.24 | -0.4% |
| 97802 | 0.98 | 1.05 | $35.28 | $37.84 | 7.3% |
| 95004 | 0.15 | 0.12 | $5.40 | $4.32 | -19.9% |
| 99203 | 3.05 | 3.05 | $109.80 | $109.92 | 0.1% |
| 99381 | 3.13 | 3.13 | $112.68 | $112.80 | 0.1% |
I was prepared to show a lot more data, but everything after this has such a small impact on the budget it's only interesting from curiosity impact. Ultimately, it boils down to one thing: the almost 20% cut to the 90460, the most common code performed in pediatrics.
I have more to say and the 2019 RVU Calculator will be due out soon for those interested.