Pediatricians may be paid more appropriately for immunizing patients in the future due to a proposed increase in the relative value unit (RVU) basis, which has been decreasing since 2017.
The Centers for Medicare & Medicaid Services (CMS) released the proposed change this week following strong advocacy from the AAP.
“Through AAP member advocacy and AAP leadership strategy, we were able to convince CMS that their methodology used to value the practice expense associated with immunizing children was flawed and directly impacting our efforts to combat vaccine-preventable disease,” said Margie C. Andreae, M.D., FAAP, AAP representative to the American Medical Association/Specialty Society Relative Value Scale Update Committee.
CMS bases the value of Current Procedural Terminology (CPT) codes for immunization administration on the Medicare Physician Fee Schedule (MPFS). For years, these codes, including 90460, have been linked to the value of a code for therapeutic injection. However, a drop in the value of the therapeutic injection code starting in 2018 meant pediatricians also were being paid less for vaccinating children, an essential service that takes place in about one-third of pediatric visits.
“We provide a public health service to this nation by immunizing children and to basically tie our hands behind our backs to make it almost more costly to do that than we get paid was just an intolerable situation,” Dr. Andreae said.
The AAP argued vaccine administration and counseling involves more work than a therapeutic injection and should not decrease in value. CMS agreed to change its method for valuing immunization administration and included the change in its proposed rule.
|
IA CPT Code |
2020 MPFS Work RVUs |
2020 MPFS NF PE RVUs |
2020 MPFS PLI RVUs |
2020 MPFS Total NF RVUs |
Proposed 2021 MPFS Work RVUs |
Proposed 2021 MPFS NF PE RVUs |
Proposed 2021 MPFS PLI RVUs |
Proposed 2021 MPFS Total NF RVUs |
|
90460 |
0.17 |
0.22 |
0.01 |
0.40 |
0.18 |
0.69 |
0.01 |
0.88 |
|
90461 |
0.15 |
0.20 |
0.01 |
0.36 |
0.09 |
0.35 |
0.01 |
0.45 |
|
90471 |
0.17 |
0.22 |
0.01 |
0.40 |
0.18 |
0.69 |
0.01 |
0.88 |
|
90472 |
0.15 |
0.20 |
0.01 |
0.36 |
0.09 |
0.35 |
0.01 |
0.45 |
|
90473 |
0.17 |
0.22 |
0.01 |
0.40 |
0.18 |
0.69 |
0.01 |
0.88 |
|
90474 |
0.15 |
0.20 |
0.01 |
0.36 |
0.09 |
0.35 |
0.01 |
0.45 |
IA = Immunization Administration; MPFS = Medicare Physician Fee Schedule; RVUs = Relative Value Units; NF = Non-Facility; PE = Practice Expense; PLI = Professional Liability Insurance
If finalized later this year, the changes will go into effect Jan. 1, 2021. Clinicians immunizing patients with Medicaid and private insurance likely will see benefit as non-Medicare payers typically adopt some Medicare policy in developing their own policy.
The AAP continues additional advocacy related to immunization administration coding and payment, including increasing Medicaid payment for immunization administration and allowing Medicaid programs to pay for add-on code 90461 for immunizations administered through the Vaccines for Children program.
