The Devaluation of Otolaryngology: An Evaluation of CMS' Involvement in Physician Reimbursement

To evaluate the rate at which the Relative Value Scale Update Committee (RUC) recommended relative value unit (RVU) values for otolaryngology procedures are accepted by the Centers for Medicare and Medicaid Services (CMS).

The Federal Register (https://www.federalregister.gov) was queried from 1995 to 2021 to identify the annual Medicare Final Rule. Within the Medicare Final Rule, all codes reviewed by the RUC were evaluated by two independent authors. Codes where the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) and/or the Triologic Society participated in the valuation were extracted.

From 1995 to 2021, 271 codes relating to otolaryngology were surveyed and valued by the RUC. In 201 (74%) of those codes, CMS did not alter the RUC recommended value. CMS did alter the RUC recommended value of 70 (26%) codes. From 1995 to 2008, 91 otolaryngology codes were valued. Eighty (88%) of those values were not altered by CMS. Eleven (12%) values were altered by CMS in the Medicare Final Rule. From 2009 to 2021, 180 otolaryngology codes were valued. One hundred twenty-one (67%) of those values were not altered by CMS. Fifty-nine (33%) of those values were altered by CMS. The difference between the two time periods was significant (p = 0.0002). The reduction by CMS throughout all codes ranged from 2% to 100%, with an average alteration of 5%.

CMS is taking an increasing role in altering RUC-approved values for otolaryngology procedures. This has implications for both otolaryngology and all medical societies in terms of how their procedures are valued.

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