Wiki RVU for bilateral procedure

[shanamarie]

We pay our providers by the WRVU’s and the question has come up regarding bilateral procedures and Rvu’s. Ex: 6461250, we bill as 1 unit with a bilateral modifier. In our system we bill a higher dollar amount for bilateral, but it looks like the RVU’s are the same for bilateral and unilateral. Should we be increasing the RVU’s x 2 in this case? Or can you point me in the direction of where I can find this answer?

 

[sls314]

We pay our providers by the WRVU’s and the question has come up regarding bilateral procedures and Rvu’s. Ex: 6461250, we bill as 1 unit with a bilateral modifier. In our system we bill a higher dollar amount for bilateral, but it looks like the RVU’s are the same for bilateral and unilateral. Should we be increasing the RVU’s x 2 in this case? Or can you point me in the direction of where I can find this answer?

I would use 1.5 times the RVU.

Medicare reimburses 150% of the Medicare physician fee schedule for bilateral eligible procedures. This indicates that Medicare values the added work for the other side at 50% of the value for one side alone.

Of course, if this is how your practice negotiates compensation to your physicians, you can use whichever methodology the practice decides. They could agree to 2x the RVU. However, there is reasonable justification for 1.5x RVU as well.