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SIR 2026

Educational Exhibit

Office-Based Lab (OBL) and Ambulatory Surgery Center (ASC) Procedures

Session: Educational Exhibit Presentations - General IR Potpourri

728 - Maximizing IR Clinic Value: Modeled Impact of MDM-Based Coding and Premium Payer Consults on RVU Capture and Revenue

Monday, April 13, 2026
5:33 PM - 5:39 PM ET
Learning Objectives: Participants will be able to: (1) evaluate the impact of MDM-based coding on RVU and revenue capture in Interventional Radiology (IR) clinics, (2) apply payer mix modeling to quantify financial outcomes across Medicare, commercial, and premium contracts, and (3) recognize the profitability potential when commercial payers reimburse consult codes (99244, 99245).

Background: IR clinics are critical for longitudinal care, yet historically are undervalued due to under-coding. The 2021 transition to MDM-based coding enables better recognition of clinical complexity. Evaluating RVU and revenue implications across payers provides strategic insight into maintaining and expanding IR clinics.

Clinical Findings/Procedure Details: A modeled cohort of 1,000 clinic visits was constructed using 12 representative types (e.g., PAD consultation, Y-90 workup, venous insufficiency, UFE, dialysis access). Each encounter was coded two ways: (1) conservative, reflecting legacy under-coding, and (2) MDM-based per 2021 CMS rules. CPT assignments were mapped to 2024 non-facility RVUs, with estimates via the 2025 Medicare conversion factor ($32.35). A payer mix was applied (Medicare 35%, Commercial 45% at 1.4×, Medicaid 5% at 0.75×, VA/Tricare 4% at 0.9×, Self-pay 1% at 0×, Premium Commercial 10% at 1.8×). In the premium subgroup, appropriate consults were modeled as 99244 (4.82 RVUs) and 99245 (6.27 RVUs).

Conclusion and/or Teaching Points: MDM-based coding increased modeled RVU capture by 40% (2,380 vs 3,340 RVUs) and revenue by 41% at Medicare rates ($76,800 vs $108,200). When applied to a realistic blended payer mix, revenue per encounter rose from $127 to $178, yielding an additional $51,000 across 1,000 encounters. In premium commercial contracts, consult recognition provided an incremental gain of 2.3 RVUs and $58 per eligible encounter, with complex PAD and oncology consults frequently qualifying as 99215 or 99245. These findings reinforce that IR clinic encounters, when coded accurately, appropriately value the cognitive complexity and decision-making central to the specialty. Teaching point: accurate MDM-based coding and recognition of consult codes where permitted are essential strategies to maximize the financial sustainability of IR clinics while accurately valuing physician cognitive work.