A-224 Relatively Undervalued: Comparing the Work Relative Value Units of Neuropsychological Evaluation to Other Services

Abstract Objective: The work relative value units (wRVUs) assigned to current procedural technology (CPT) codes reflect the time, technical skill, effort, judgment, and stress involved in the procedures. This project compared the work RVUs for CPT codes used by neuropsychologists to codes used by other healthcare providers. Method: CPT codes were collected for evaluation and management (E&M) services (99202 to 99215), psychological evaluation (PE; 90791, 96130/1, 96136/7, 90785), psychotherapy (THER; 90791, 90832 to 90837, 90785), and neuropsychological evaluation (NPE; 96116, 96132/3, 96136/7). The CMS physician fee schedule look-up tool was used to gather the wRVUs for each CPT code. Results: E&M wRVUs vary by complexity from straightforward (0.7-0.93) to highly complex (2.8-3.5) cases. Per unit wRVUs showed a wide range in the other procedure groups: PE (0.45-3.84), THER (1.7-3.84), and NPE (0.45-2.56). PE and NPE codes are comparable except for greater wRVUs for the interview (3.84 versus 1.86). With the complexity modifier, PE and THER wRVUs increase (2.03-4.17). Conclusions: E&M code wRVUs increase with case complexity reflecting greater demands on time, skill, effort, and judgment. Similarly, a modifier to PE and THER codes captures additional effort required for complex cases. In contrast, NPE codes lack a complexity modifier, and NPE wRVUs are lower than those of THER codes, which can be billed by master’s level therapists in many states. It is unclear why wRVUs for NPE are not higher than those for PE given the greater training requirements in neuropsychology and the higher level of specialized knowledge, effort, and technical complexity involved in competent NPE.