ACOG Successful in Efforts to Increase Value of Maternity Services

Two years after a comprehensive review of the value of physician work for maternity services, CMS accepted most recommendations made by the RBRVS Update Committee (RUC), resulting in 2012 increases of up to 17% over the previous values.

The RUC traditionally uses a survey to help determine the correct relative value of services, but the maternity codes had never previously been surveyed because of the unusual nature of the global ob codes.  CMS asked that ACOG, with the American Academy of Family Physicians (AAFP), develop a special survey instrument and develop value recommendations. Recommendations were presented at the October 2009 RUC meeting.  The RUC rarely accepts the values recommended by specialty societies.  However, the final RUC recommendations to CMS that came out of that meeting were significantly higher than the values that had been previously assigned.

The RUC recommendations were delivered too late in 2009 to be included in the 2010 physician fee schedule. When CMS published the final 2011 fee schedule, ACOG was surprised and dismayed that CMS had applied a .8922 multiplier to the values, effectively eliminating the increases that were recommended by the RUC.  ACOG and the AAFP immediately went to work to get CMS to reverse that decision.

Letters were written to the CMS Administrator.  ACOG and the AAFP had a face-to-face meeting with CMS staff, and ACOG had a follow-up teleconference to further explain the rationale for the increased values.  In November 2011, more than two years after ACOG had surveyed and first presented the codes, CMS published the fee schedule that showed they had finally accepted nearly all of the RUC recommendations.

Special thanks to ACOG physicians Sandra Reed, George Hill, and Gregory DeMeo, and to AAFP physician Tom Weida for all of their hard work on this effort.

 

Maternity Code Physician Work Values from 2010 to 2012

 

CPT
code
Descriptor CMS
2010
Value
 CMS
Interim
Value
2011
CMS
Final
2012
Value 
 
59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care 27.48 28.69 32.16
59409 Vaginal delivery only (with or without episiotomy and/or forceps); 13.48 12.82 14.37
59410 Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care 15.37 16.07 18.01
59412 External cephalic version, with or without tocolysis 1.71 1.53 1.71
59414 Delivery of placenta 1.61 1.44 1.61
59425 Antepartum care only; 4-6 visits 6.50 5.63 6.31
59426 Antepartum care only; 7 or more visits 11.57 9.96 11.16
59430 Postpartum care only 2.13 2.20 2.47
59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care 31.07 31.80 35.64
59514 Cesarean delivery only; 15.95 14.39 16.13
59515 Cesarean delivery only; including postpartum care 18.39 19.15 21.47
59610 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery 28.86 30.22 33.87
59612 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); 15.04 14.35 16.09
59614 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care 16.64 17.60 19.73
59618 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery 32.51 32.26 36.16
59620 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; 17.50 14.86 16.66
59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care 19.83 19.63 22.00

Contact:

Donna Tyler
Manager, Coding Education
dtyler@acog.org

Keisha Sutton
Coding Specialist
ksutton@acog.org