Want to understand what's coming down the line for professionals who specialize in urodynamics? Don't just look to new diagnostic technologies or evolving caregiving practice standards. Urodynamics reimbursement rates are also a great bellwether of practice viability.
On January 20th of this year, Joe Biden was sworn in as the United States of America’s 46th president. Like any new leader of a country, this change in the White House meant many different things for various people, businesses, and entire industries.
The new administration is a tremendous shift from the previous one, changing the nation’s landscape across the board.
No more are these changes evident than in healthcare. Biden and his administration’s approach - even at first glance - is a totally different beast than former President Trump’s. With that said, how will this impact private practices across the US?
This blog will explore the above question and then delve into urology practices, specifically.
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.