How Medical Services Get Valued

Abstract

The mechanisms for Medicare payment to physicians are complicated and, in fee for service Medicare, the value of a procedure code explicitly determines the payment to the physician and the out-of-pocket cost to the beneficiary. These codes are created and then valued for payment through a complex but reproducible and transparent process that allows for physician and specialty society input. This article describes the process and its implications for interventional radiology.

Keywords

relative value unit - CPT - procedure code - interventional radiology - Medicare - RUC - CMS

Publication History

Article published online:
02 November 2023