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American Association of Plastic Surgeons

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Variation In Payment Per Work Relative Value Unit For Breast Reconstruction And Non-Breast Microsurgical Reconstruction - An All-Payer Claims Database Analysis
Meghana Shamsunder, MPH1, Clifford Sheckter, MD2, Avraham Sheinin, BA3, David Rubin, BS3, Nicholas Berlin, MD, MPH4, Evan Matros, MD, MMSc., MPH1.
1Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA, USA, 3Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 4Section of Plastic Surgery, Department of Surgery, University of Michigan Health System,, Ann Arbor, MI, USA.

PURPOSE: Commercial payments for prosthetic breast reconstruction have increased within the past decade while reimbursements have stagnated for microsurgical techniques. Work Relative Value Units(wRVU) standardize reimbursement across a spectrum of procedures; however, the payment to wRVU ratio remains unknown for breast and non-breast microsurgical procedures. This study aims to characterize the physician payment-per-wRVU ratio for breast and non-breast microsurgical procedures.
METHODS: The Massachusetts All-Payer Claims Database was queried for microsurgical and breast reconstruction Current Procedural Terminology(CPT) codes. International Classification of Diseases(ICD) codes were used to categorize procedures by anatomic region including head and neck, breast, trunk, and extremities. Physician payments, for both commercial and governmental, were aggregated by anatomic region and CPT code. Payment distributions were described and compared for statistical significance.
RESULTS: Among 3,435 commercial claims, tissue expander breast reconstruction had the highest median payment-per-wRVU ratio, although this difference was not significant compared to other breast procedures. However, microsurgical breast procedures showed significantly greater commercial median payments-per-wRVU compared to microsurgery of the head/neck, trunk, and extremities(p=0.004). These differences were not significant when comparing claims from governmental payers(p=0.103).
CONCLUSION: The findings suggest that commercial insurance payments for common breast reconstruction procedures are largely driven by wRVU differences and contractual negotiations. The relatively greater payments for breast microsurgery compared to other anatomic areas may reflect a variety of factors including patient demand and elective nature.


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