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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1437-1440

POLICY STATEMENT

Application of the Resource-Based Relative Value Scale System to Pediatrics

Committee on Coding and Nomenclature

In today's rapidly changing health care environment, it is crucial to understand the genesis and principles behind the Medicare Resource-Based Relative Value Scale (RBRVS) physician fee schedule. Many third-party payers, including state Medicaid programs, BlueCross BlueShield, and managed care organizations, use variations of the Medicare RBRVS to determine physician reimbursement and capitation rates. Because the RBRVS fee schedule was created originally for Medicare only, pediatric-specific Current Procedural Terminology (CPT) codes and pediatric practice expense calculations were not included. The American Academy of Pediatrics supports the use of CPT codes and the RBRVS physician fee schedule and continues to work to rectify certain inequities of the RBRVS system as they pertain to pediatrics.

Key Words: reimbursement • coding • RBRVS

Abbreviations: RBRVS, Resource-Based Relative Value Scale • CF, conversion factor • RVU, relative value unit • AAP, American Academy of Pediatrics • CPT, Current Procedural Terminology • AMA, American Medical Association • CMS, Centers for Medicare and Medicaid Services


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The following policy statement is a revision:

Application of the Resource-Based Relative Value Scale System to Pediatrics

Pediatrics 122: 1395-1400. [Full Text]

The following policy statement has been revised:

Issues in the Application of the Resource-Based Relative Value Scale System to Pediatrics: A Subject Review

Pediatrics 102: 996-998. [Full Text]



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