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).
I recently attended a statewide gastroenterology conference in Mississippi. I got to meet all types of interesting people, including accomplished doctors and their staffs. For this conference I compiled some data on anorectal manometry (ARM) reimbursement rates. Given gastroenterologist use of colonoscopies, I thought it would be useful to compare ARM reimbursements (CPT Codes 91120, 91122, and 51784) to screening colonoscopy reimbursements (CPT Code 45378). I was aware that ARM reimbursed at a better rate, but I was not aware it was substantially better. When looking only at National Medicare reimbursements, anorectal manometry reimburses at a 93% higher rate than a screening colonoscopy. In the chart below you'll see the trend of reimbursements rates both nationally and within the state of Mississippi over the last decade. As you can see, and as every gastroenterologist knows, colonoscopy reimbursement rates have fallen quite significantly and are expected to fall more in coming years. However, ARM shows a more stable reimbursement rate, especially in recent years.