Regulatory Affairs

1) Will the reimbursement for 99183 ('physician supervision of HBOT') change?

Answer: Yes

Code 99183 has never been valued by the American Medical Association Relative Value Update Committee (AMA RUC). It was given a value by CMS in 1994, and has remained unchanged since that time, with a work value of 2.34 RVUs (relative value units). This year, due to increased utilization (many more hyperbaric treatments being billed), 99183 was selected for review. The process of valuing a code includes a physician survey, a defining of the practice expense, and then a presentation in front of the RUC defending the request for keeping the value unchanged. The typical code that comes up for review is decreased about 20%. After much debate, the RVUs were determined to be 2.11. This represents approximately a 9% decrease in the payment for hyperbaric chamber supervision.

The reimbursement for physicians is comprised of three elements, work, indirect practice expense, and malpractice. When combined, the total RVUs for a facility based provider will be 3.13 RVUs. Those RVUs, multiplied by the conversion factor (CF) and your Geographic Price Index will give you the final amount. Nationally it should be in the range of $112.06. Currently the total RVUs for 99183 in a facility setting is 3.45 (CF $35.8228) for a national payment of $123.59.