Changes in Billing and Reimbursement for Urology Office Visits Before and After Medicare Payment Reforms

Abstract

Introduction:The impact of 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 to 2021, with a focus on 2021 Medicare payment reforms.Methods:The Centers for Medicare and Medicaid Services Physician/Procedure Summary data from 2010-2021 were utilized to examine office visit CPT (Current Procedural Terminology) new patient visit codes 99201-99205 and established patient visit codes 99211-99215 by urologists. Mean office visit reimbursements (2021 USD), CPT specific reimbursements, and proportion of level of service were compared.Results: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 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, 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).Conclusions:Urologists have seen increases in mean reimbursements for office visits both before and after the 2021 Medicare payment reform. Contributing factors consist of increased established patient visit reimbursements despite decreased new patient visit reimbursements, and changes in level of CPT code billings.

Editorial Comment

“…Lee and colleagues have nicely summarized the shift in reimbursement trends for a slew of common procedures done by urologists, urologic advanced practice providers (APPs), and interventional radiologists (IR). 1 While many procedures have been performed by the same providers for years, such as antegrade stent placement by IR and prostate biopsies by radiologists, the largest shifts are suprapubic tube (SPT) placement, SPT change, and renal ablation.…”

Editorial Comment

“…Dr Lee and colleagues examined the changes in urology office visit reimbursement before and after the 2021 Medicare Payment Reform, a reform aimed at reducing documentation, simplifying CPT coding, and using time as a dominant metric for determining billing code. 2 This coding reform was hypothesized to increase reimbursements for urology office visits, although prior studies revealed decreased reimbursement across urological procedures over time. 3…”