Reimbursement is always a hot topic in urologic care, especially with regards to specific procedures. While individual payors may vary with regards to what they pay for specific evaluation and management (E&M) and procedures (CPT codes), almost all reimbursement is ultimately driven by what rates Medicare will pay and/or how many Relative Value Units (RVU’s) Medicare will assign to a specific E&M or CPT code. This post will review reimbursement trends for urodynamics in 2020 (UDS).
Foremost, the Center for Medicare Services (CMS), is allowing a 1% increase in allowable charges for all urologic practice expenses in 2020 and there is no change to work RVU’s for the specialty. As a whole, this means there will be a slight increase in allowable billing for charges related to all practice/facility related expenditures and no cuts to the RVU’s for any procedure, including UDS. There were no specific changes to RVU’s for any specific component of performing and interpreting a UDS procedure; however, there were some changes to two codes that are possibly relevant to providers who handle a large volume of voiding dysfunction. Regarding the placement of a test sacral-nerve stimulation lead, the proposed CMS rule was felt to underpay the facility fee associated with the equipment to place a test lead and the final rule accounted for this change. Secondly, CMS adopted the American Urologic Association’s (AUA)suggested RVU level for biofeedback training, which may apply to providers who perform UDS and especially physician extenders that they may work with. Additional detail is in the AUA’s blog post listed below.
Finally, Laborie has published 2019 CMS rates for multiple components of a UDS study in their blog post as listed below. There are geographic variations in what Medicare pays, in addition to changes associated with modifiers, thus each provider may need to consult CMS’s website directly for complete pricing data. That being said, there do not appear to be any dramatic changes to the applicable reimbursement rates for UDS in 2020, with Medicare as the payor. Overall, providers performing UDS and associated treatments can expect 2020 to have comparable reimbursement for UDS as in 2019.
References:
https://www.laborie.com/reimbursement