Straight Talk Tuesday

Tuesdays in the month of June, I’m offering some straight talk about a few of the MANY ways in which payment for hyperbaric oxygen therapy is going to change and FAST.  Another issue is that of decreased payment of Physician Supervision for HBOT. The American Medical Association Relative Value Update Committee (AMA RUC) values the “relative work” and practice expense of CPT codes and makes recommendations to CMS.

PrintDuring their analysis, the RUC needed data on the co-morbid conditions of patients undergoing HBOT, the average number of medications they took and the frequency of HBOT “side effects”. The UHMS reached out to the wound center management companies for these data but got no response. Thankfully the US Wound Registry stepped up to the plate and provided the data in about 1 hour—in response to the RUCs urgent demand.

Care to know the Top 10 Co-morbid conditions for HBOT patients?

  1. Hypertension
  2. Peripheral arterial disease
  3. Hyperlipidemia
  4. Heart failure
  5. Diabetes (present in patients who are not being be treated for a DFU)
  6. End stage renal disease
  7. Coronary artery disease
  8. COPD
  9. Morbid obesity
  10. Atrial fibrillation

In 2014, the total RVUs for 99183 in a facility setting WAS 3.45 for a national payment of $123.59. After much debate by the RUC, the HBOT RVUs were determined to be 2.11. This represents approximately a 9% decrease in the payment for hyperbaric chamber supervision. Nationally, reimbursement should be in the range of $112.06 per HBOT treatment.

What’s your plan to make sure that payment for 99183 isn’t further reduced? If you are not participating in HBOT quality reporting with the USWR, then you don’t have a plan. The RUC will reevaluate 99183 “work value” again in 5 years. WE NEED DOCTORS TO UTILIZE THE USWR TO REPORT HBOT QUALITY MEASURES TO COLLECT THE NECESSARY DATA.