CMS Hospital Outpatient Circumcision

I was making the point that CMS usually gives outpatient (APC) coding and pricing to any procedure, even if it is uncommon under Medicare.

54150 is circumcision, any age, clamp.  54160 is other method, <28d, and 54161 is other method, >28d.   These are coded in APC 5373, $1739, except for 54160, which is APC 5372, $562.

Leaving aside CMS, the AMA RVU for 54150 is $159 (office, $101 facility).  CMS utilization was 237 in 2017, 70% outpatient, 11% inpatient, 10% office.

AMA RVU for 54160 is $227 (office, $150 facility).  Recall this is "<28d" of age.  CMS utilization was 4 in 2017, having peaked at 17 in 2007.

54161 was by far the busiest code.  Payment is $205, facility only, with utilization in 2017 at 9,294.  85% were beneficiaries by age (15% by disability or ESRD).  The main diagnosis code was N47 (disorder of prepuce), and location was 72% outpatient, 18% ASC, 5% inpatient, 3% office.  98% of surgeons were urologists.

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I haven't research all the various L&D codes further, but code 59400 for antepartum care & normal L&D had 3,383 uses in CY2017.  RVU's tally $2177 for 739 minutes (12 hours) of MD time.  With antepartum care and cesarean, 54510, $2414, for 817 minutes, with 2,853 uses in CY2017.