What’s changing with reimbursement for cystoscopy packs

Regarding your article on the Medicare proposed fee schedule rules for 2025,¹ can you further explain how the practice expense (PE) relative value unit (RVU) is changing for the cystoscopy? I’m not familiar with the cystoscopy packs that are mentioned in the article or how they affect an in-office cystoscopy.

Jonathan Rubenstein, MD

In the article you are referring to, we stated that several urology codes will see their PE valuation change due to updates in supply valuation. A practitioner is reimbursed by the total RVU of a procedure, which consists of the sum of the work RVU, the PE RVU, and the malpractice RVU. In the case of cystoscopy procedures, the work RVU is unchanged. However, the Centers for Medicare & Medicaid Services (CMS) felt that the reimbursement for some of the supplies and equipment involved in some cystoscopy procedures was incorrectly valued. Many cystoscopy procedures have PE valuation that includes either drapes for cystoscopy (supply code SA045) or a full cystoscopy kit (supply

Mark Painter

code SA058), which includes several items such as drapes and other equipment necessary for the procedure to be performed. Medicare felt that the cost and, therefore, reimbursement of these packs was greater than the sum of its components. Therefore, with the help of the Relative Value Update Committee (RUC), these packs were revalued, with the SA045 dropping from $17.33 to $14.99 and SA058 dropping from $113.70 to $37.63. These updates will result in a reduction in the PE RVU portion of the total RVU; therefore, the reimbursement for the procedure will similarly be reduced. Please note that in the Medicare final rule, it was determined that SA058 changes would be phased in over 4 years to allow practices to adjust to the changes. As a result of the changes and the programmed phase-in of the changes, the cystoscopy code total RVU for the office setting will be 8% lower in 2025 than the current value. It is important to note that the kit packs and their corresponding numbers are not reported to Medicare separately and instead are used by CMS and the RUC in the process of developing the RVUs for these procedures.

Send coding and reimbursement questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology Times®, at UTeditors@mjhlifesciences.com.

The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.