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50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
May 1 - 3, 2025 | Orlando, Florida
6799
MEDICARE PAYMENT TRENDS FOR PERIPHERAL NERVE BLOCKS FOR ACUTE POSTOPERATIVE PAIN MANAGEMENT
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Scientific Abstracts > Regional Anesthesia
Medicare Payment Trends for Peripheral Nerve Blocks for Acute Postoperative Pain Management
Christopher Deeble, MD; Caleb Ting, BS; Edward Mariano, MD, MAS, FASA, FASRA; Eric Sun, MD, PhD; Richard Kim, MD, MSc
Introduction:
•The Centers for Medicare and Medicaid Services (CMS) projects a 5.6% annual growth in national healthcare expenditures over the next decade.
•Despite this growth, physician payments across specialties have declined.
•This study analyzes Medicare payment trends for peripheral nerve blocks (PNB) for postoperative analgesia relative to inflation.
Methods:
•PSPS datasets from 2010 through 2023, examining Medicare payments and frequency for 11 performed PNB procedures, identified by CPT® codes.
•Filtered with primary modifier 59 (distinct procedural service, performed by anesthesiologists, professional charges of ultrasound guidance, and locations of inpatient hospitals, on-campus outpatient hospitals, and ambulatory surgical centers.
•To account for inflation, CPI-U was used to convert to 2023 USD .
•Work RVU and CF based on the CMS Physician Fee Schedule were examined
•Specific focus was also on 2020 wRVUs to confirm the ASA update about changes to certain nerve block codes.
•CAGR was calculated as a reliable measure of annual change.
Results:
•Unadjusted payment increases were seen for 5 of 11 PNBs from 2010 through 2023.
•When adjusting for inflation, all PNBs exhibited payment decreases, as well as negative adjusted CAGR (Table 1, Figure 1).
•8 of 11 CPT codes showed >20% decrease in adjusted payments
•CPT code 76942 (ultrasound guidance) had an unadjusted average payment from $25 to $20 from 2010 through 2023.
•For select codes, bundling of ultrasound guidance started in 2023; modest increases in wRVU for certain codes were seen at this time.
•The conversion factor from 2010 through 2023 decreased 7.1%, compared to an increase in CPI-U by 43.8%.
Discussion:
•Overall payments from Medicare for 11 common peripheral nerve blocks decreased from 2010 to 2023 when accounting for inflation.
•Primary factors for decreased payments include a continuously decreasing CF and changes to wRVUs.
•Limitations include the exclusion of non-laterality secondary modifiers and exclusion of follow-up eval and management codes.