TY - JOUR T1 - The impending conversion factor crisis and neurointerventional practice JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 301 LP - 303 DO - 10.1136/neurintsurg-2020-017005 VL - 13 IS - 4 AU - Theresa H Nguyen AU - Joshua A Hirsch AU - Melissa M Chen AU - Lauren Golding AU - Thabele M Leslie-Mazwi AU - Greg N Nicola AU - Clemens M Schirmer AU - James M Milburn Y1 - 2021/04/01 UR - http://jnis.bmj.com/content/13/4/301.abstract N2 - On August 3, 2020, the Centers for Medicare and Medicaid Services (CMS) released the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule. The MPFS is used by CMS to calculate physician reimbursement, generating relative value unit (RVU) numbers that are adjusted for geography. The 2021 edition entailed reducing the RVU conversion factor (CF) from $36.09 to $32.26, (a -10.61% change). Due to budget neutrality requirements, the reduction is mainly due to increased expenditures for evaluation and management (E/M) services. Using neurosurgery and interventional radiology (IR) as predicates for NeuroInterventional (NI) practice, were the 2021 MPFS Proposed Rule to be implemented, we would predict reimbursement decreases of approximately 7%–9% from CMS. To understand why the 2021 CMS proposed rule results in this substantial decrease for neurointerventionalists, we must recognize how physicians are compensated by CMS and the impetuses for change in payment for office/outpatient services that have been brewing over the past few years.In brief, payment for physician services by the CMS is correlated to the number of RVUs allocated for that service, which takes into account physician work (professional component), practice expense (technical component), and professional liability insurance. The RVU is multiplied by a conversion factor, set by CMS to maintain budget neutrality, resulting in the eventual dollar amount paid for a service.1 To consistently describe medical services, a unique and billable Current Procedural Terminology (CPT) code are assigned. Codes are allocated RVUs by CMS based on input from the AMA Relative Value Scale Update Committee (RUC).2 3 CMS updates and publishes payment for physician services annually in the Medicare Physician Fee Schedule (MPFS). New codes are periodically added to the MPFS, and the number of RVUs assigned can also be adjusted to more accurately reflect the value of that service.4 5 The MPFS must be … ER -