PRESTIGE

PRESTIGE® Cervical Disc | REIMBURSEMENT GUIDE 9
Section 3: Physician Reimbursement
Physician Coding and Payment
Current Procedural Terminology Codes
Physicians use Current Procedural Terminology (CPT®) codes to report all
their services. Under Medicare’s Resource-Based Relative Value Scale (RBRVS)
methodology for physician payment, each CPT code is assigned a point
value, known as the Relative Value Units (RVU), which is then multiplied by a
conversion factor to determine the physician payment. Many other payers use
Medicare’s RBRVS fee schedule or a variation of it. Industrial or work-related
injury cases are usually reimbursed according to the official fee schedule for
each state.
Use of CPT codes is governed by various coding guidelines published by the
American Medical Association (AMA) and other major sources such as physician
specialty societies. In addition, the National Correct Coding Initiative (NCCI), a
set of CPT coding edits created and maintained by the Centers for Medicare and
Medicaid Services (CMS), has become a national standard.
Medicare’s 2014 Relative Value Units (RVUs) and RBRVS payments are below:
Physician
Reimbursement
CPT Code Description Total RVUs
22856 Total disc arthroplasty (artificial disc), anterior
approach, including discectomy with end plate
preparation (includes osteophytectomy for
nerve root or spinal cord decompression and
microdissection), single interspace, cervical
Medicare
Payment
47.49 $1,701.22
Source: CY2014 Medicare Physician Fee Schedule. Federal Register, December 10, 2013. No geographic
adjustments. Updated with adjustments from the Pathway for SGR Reform Act of 2013.