Table 6.
Procedure | CPT code | Description | Work RVU | Work GPCI | PE RVU | PE GPCI | PLI RVU | PLI GPCI | Total RVU | |
---|---|---|---|---|---|---|---|---|---|---|
1. | Removal of ruptured implant | 19330 | Removal of implant material | 8.54 | 1.029 | 8.35 | 1.026 | 1.66 | 1.855 | 20.43 |
2. | Removal of ruptured implant and insert new implants in augmentation | 19325 | Enlarge breast with implant | 8.64 | 1.029 | 8.71 | 1.026 | 1.69 | 1.855 | 20.96 |
3. | Removal of ruptured implant and insert new implants in reconstruction | 19342 | Delayed breast prosthesis | 12.63 | 1.029 | 12.19 | 1.026 | 2.44 | 1.855 | 30.02 |
4. | Removal of ruptured implant and Mastopexy | 19316 | Suspension of breasts | 11.09 | 1.029 | 9.46 | 1.026 | 2.19 | 1.855 | 25.24 |
Total RVU = (Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (PLI RVU × PLI GPCI)
Medicare reimbursement = [Total RVU + (Anesthesia RVU × Anesthesia GPCI)] × fee schedule conversion factor
RVU-Relative Value Unit
GPCI- Geographic Practice Cost Index
PE RVU-Practice expense RVU
PLI RVU - Physician Liability RVU