Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
UPJ INSIGHT Changes in Billing and Reimbursement for Urology Office Visits Before and After Medicare Payment Reforms
By: Austin J. Lee, MD, University of Rochester Medical Center, New York; Aaron Saxton, MD, University of Rochester Medical Center, New York; Stephen Hassig, MD, MBA, University of Rochester Medical Center, New York; Scott O. Quarrier, MD, University of Rochester Medical Center, New York; Jathin Bandari, MD, University of Rochester Medical Center, New York | Posted on: 27 Jun 2023
Lee AJ, Saxton A, Hassig S, Quarrier SO, Bandari J. Changes in billing and reimbursement for urology office visits before and after Medicare payment reforms. Urol Pract. 2023;10(3):220-228.
Study Need and Importance
The medical system faces ongoing financial pressures from changes in reimbursement through Medicare. The impact of these Medicare reimbursement changes on urology office visit reimbursements has not been fully examined. This study aims to analyze the impact of urology office visit Medicare reimbursements from 2010-2021, with a focus on 2021 Medicare payment reforms.
What We Found
The 2021 mean visit reimbursement was $110.95, up from $99.42 in 2020 and $94.44 in 2010 (both P < .001). From 2010 to 2020, all Current Procedural Terminology (CPT) codes except for 99211 had a decrease in mean reimbursement. From 2020 to 2021, there was an increase in mean reimbursement for CPT codes 99205 and 99212-99215, and decreases in 99202, 99204, and 99211 (P < .001). New and established patient urology office visits had significant migration of billing codes from 2010 to 2021 (P < .001). New patient visits were most commonly as 99204, which increased from 47% in 2010 to 65% in 2021 (P < .001). The most commonly billed established patient urology visit was 99213 until 2021 when 99214 became the most common at 46% (P < .001).
Limitations
These data are limited to Medicare beneficiaries and may not be generalizable of all urology patients and billing practices. Second, these findings must be taken in the context of changes in billing guidelines in 2021, and long-term trends on the new billing system cannot be examined at this time. Lastly, most recent data must take into consideration the impact of the COVID-19 pandemic on the medical system and practice patterns.
Interpretation for Patient Care
Urologists have seen increases in mean real reimbursements for office visits both before and after 2021 Medicare payment reform. Contributing factors consisted of increased established patient visit reimbursements, decreased new patient visit reimbursements, and generally higher levels of CPT code billings. Practice patterns may have also changed, with urologists billing for more time per patient visit in the office.
advertisement
advertisement