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Quality and Safety

Trends in Utilization and Physician Payments for Dialysis Arteriovenous Fistula and Graft Maintenance Procedures From 2019 to 2021 - An Update on Bundled Medicare Payments

Saturday, April 13, 2024
10:00 AM - 10:00 PM ET
Location: Foyer Kiosk

    First Author(s)

  • SM

    Sarah M. Myers, BS

    Medical Student
    University of Pittsburgh
    University of Pittsburgh
    Pittsburgh, Pennsylvania, United States

    • Co-Author(s)

  • RD

    Rajoo Dhangana, M.D.

    Assistant Professor
    University of Pittsburgh Medical Center, United States

  • RK

    Roger Kayaleh, Md

    Radiology resident
    University of Pittsburgh Medical center, United States

  • WL

    Will S. Lindquester, MD

    Assistant Professor
    Emory University School of Medicine, Division of Interventional Radiology and Image-guided Medicine, United States

Purpose: In 2017, bundled Current Procedural Terminology (CPT) codes were introduced to reduce duplicate payments for dialysis arteriovenous fistula and graft maintenance procedures. The purpose of this study was to provide an update on the trends in volume and payment of these procedures from 2019 to 2021 following the implementation of these bundled codes.

Methods/Materials: Using the CPT codes for arteriovenous fistula and graft maintenance procedures, claims from the Medicare Part B Physician/Supplier Procedure Summary Master File were collected from the years 2019 to 2021. Trends of the annual total volume of procedures and total physician payment were analyzed per specialty.

Results: From 2019 to 2021, the volume of dialysis maintenance procedures decreased from 483,780 to 354,124 (26.8%). This decrease was driven primarily by radiologists (31.0%), followed by a decrease by nephrologists (28.0%) and surgeons (23.4%). The total physician payment decreased from $414.6 million in 2019 to $311.4 million in 2021 (24.9%). This was driven by a decrease in the total payment for radiologists (55.0%) and surgeons (63.5%), however, there was an increase in payment for nephrologists (80.6%). There was a small change in average payment per procedure during the study period, ranging from $857 to $903. As compared to previously published data for 2018, the average per-procedure payment decreased by 15.2% ($1036 in 2018 to $879 in 2021) {1}.

Conclusions: Following the introduction of CPT bundle codes for dialysis arteriovenous fistula and graft maintenance procedures in 2017, there has been a decrease in the volume of procedures (26.8%) and total physician payment (24.9%) from 2019 to 2021. This data suggests that the bundle codes, designed to reduce redundant payments, correlated with a decrease in volume and total physician payment for dialysis procedures.