American Society for Peripheral Nerve
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Undervalued Physician Reimbursement in Brachial Plexus Nerve Transfer Surgery
Mitchel Seruya, MD1; Robin Babadjouni, MD2
1Cedars-Sinai Medical Center, Los Angeles, CA; 2Cedars Sinai Medical Center, Los Angeles, CA

Introduction: Brachial plexus reconstruction is an advancing field within peripheral nerve surgery. The complexity of this surgery is requires extensive knowledge of functional anatomy and skill with microsurgical expertise. However, physician reimbursement rates for such procedures are not well defined. Reimbursement rates do not always correlate to the complexity of surgery and as such it makes it challenging to recruit and retain surgeons who perform these vital motion regenerating surgeries.
Materials and Methods: Current Procedural Terminology (CPT) codes from the following surgical procedures; brachial plexus decompression (BPD) and brachial plexus decompression with associated nerve transfer surgery (BPD + NT) were collected between October 2020 to May 2022 for a single surgeon at a single tertiary institution. The top 8 insurance providers were analyzed. Charges, reimbursement, relative value units (RVUs) and RVUs per hour earned between CPT codes were analyzed comparing BPD to BPD + NT.
Results: A total of 19 and 9 patients were analyzed for BPD and BPD + NT, respectively. Average percent of reimbursement, among the top 8 insurance providers, for BPR was 32% compared to 27% for BPD + NT. Average sum of payments was $2275 for BPD and $3401 for BPD + NT. RVU per CPT code were an average of 26 RVUs for BPD and 47 RVUs for BPD + NT. However, when average RVUs per hour were considered, BPD resulted in 9 RVU/hour compared to 9 RVU/hour with BPD + NT.
Conclusions: Peripheral nerve surgeons hold the unique surgical and anatomical expertise to perform brachial plexus decompressions safely and effectively. Already, reimbursement rates for such a procedure do not adequately reflect compensation. When the complexity of peripheral nerve transfer is added to a BPD there is no change in RVU/hour, even though the surgical complexity is elevated. Attempts should be made in influencing the billing process in order to maximize surgeon retention and innovation in a burgeoning field.


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