Abstract
INTRODUCTION Medicare reimburses physicians on a resource-based relative value scale. In this system, payment is based on the perceived costs of resources needed to deliver the service. A volunteer group of 31 physicians comprise the Relative Value Update Committee (RVUC) which determines changes to procedural Relative Value Units (RVU) every year. Changes to RVUs can have significant impacts on physicians compensation and practice, and is therefore imperative to understand the trends in these assigned values. METHODS Data was obtained through the Center for Medicare Services Website through the Physician Fee Schedule Search tool. The codes 61312, 61510, 61512, 61520 represent the most billed cranial procedures, and codes 22558, 22612, 22630, 63030, and 63047 represent the most bill spinal procedures. Data was collected for every year from 2000 to 2020. RESULTS Cranial codes on average had higher RVUs, and larger increases than spinal codes. Cranial code 61312 (evacuation of hematoma) displayed the largest increase of 5.6 RVU, from 24.57 RVUs in 2000 to 30.17 RVUs in 2020. Cranial code 61512 (craniectomy) displayed the smallest increase of 2.05, from 35.09 to 37.14 RVUs. Spinal code 22612 (posterior arthrodesis) displayed the largest increase of the spinal codes with 2.53, from 21 to 23.53 RVUs. Spinal code 63047 (single level laminectomy), displayed the smallest increase of 0.76, from 14.61 to 15.37 RVUs. Of note, both cranial and spinal RVUs were largely stagnant and saw their largest increase from 2006 to 2007. CONCLUSION Overall, cranial codes have higher RVUs than spinal codes and see a larger increase over time. Interestingly, both cranial and spinal codes follow similar trends of periods of stagnation followed by a large increase in 2007. For most codes, this was the only year there was any change. This could perhaps reflect the appointment of an outspoken neurosurgical representative to the RVUC, or broader changes in how RVUs were calculated. Future studies are warranted into the factors leading to these trends, and how it affects the practice of neurosurgery.