Underrepresentation of Pediatric Operations in the Relative Value Unit Updating Process

Background: The Relative Value Unit (RVU) system was designed and implemented by Medicare to standardize physician payments for a given CPT code. Because Medicare primarily cares for older adults, RVU assignments and updates may not consider pediatric-specific procedures, despite the fact that private insurers and Medicaid often base their payments on these RVU valuations.

Methods: The CPT codes of index pediatric operations were retrieved from the ACGME. We categorized these procedures into "Peds-specific" (eg, inguinal hernia < 6 months) versus those that could be performed in both children and adults, or "Non-specific" (eg, fundoplication). We merged these codes with RVU information from publicly available CMS files and the Resource-based Relative Value Scale Data Manager. Variables included were the date of last RVU update and the vignette used by survey respondents when asked to update the RVU valuation.

Results: Eighty-four CPT codes were identified with approximately half (49%) having never been updated. Three-quarters (75%) of the 84 procedures were Peds-specific. Compared to Non-specific CPT codes, Peds-specific CPT codes were less likely to have ever been updated (38% vs. 90%, p<0.001) and, among those that were updated, were updated more remotely (median year 2000 vs. 2005, p=0.03). Among updated Non-specific CPT codes, the vignette written to justify the valuation was based on an adult patient in 83% of cases (Table).

Conclusions: Pediatric-specific CPT codes have either never been updated or have not been updated in decades. CPT codes performed in both children and adults have been updated more often and more recently, but the vignette on which this valuation is based on is typically an adult patient. In order to remain relevant and reimburse pediatric surgeons accurately, the RVUs for pediatric procedures need to also be prioritized for revision and updating.