Below are CPT™ procedures that have the highest Site of Service Differential in the Medicare PFSRVU 2020 database. In other words, if the procedure is performed in the office the Non-Facility RVUs are significantly higher than other procedures. These are extreme examples. However, they illustrate that complex procedures, that may rarely, if ever be performed in an office setting include reimbursement for the office surgical suite.
| CPT | Description | Global | NON FAC PE RVU | FAC PE RVU | RVU DIFF | RVU % DIFF | WORK RVU | MALPR | TOT NON FAC RVU | TOT FAC RVU | Office Reimb. |
| 53860 | Transurethral rf treatment | 90 | 55.34 | 2.02 | 53.32 | 2639.6% | 3.97 | 0.46 | 59.77 | 6.45 | $2,157.10 |
| 55873 | Cryoablate prostate | 90 | 160.37 | 6.9 | 153.47 | 2224.2% | 13.6 | 1.56 | 175.53 | 22.06 | $6,334.88 |
| 21127 | Augmentation lower jaw bone | 90 | 101.66 | 9.39 | 92.27 | 982.6% | 12.44 | 1.05 | 115.15 | 22.88 | $4,155.76 |
| 53854 | Trurl dstrj prst8 tiss rf wv | 90 | 44.6 | 4.23 | 40.37 | 954.4% | 5.93 | 0.65 | 51.18 | 10.81 | $1,847.09 |
| 21215 | Lower jaw bone graft | 90 | 104.02 | 9.95 | 94.07 | 945.4% | 12.23 | 1.05 | 117.3 | 23.23 | $4,233.36 |
| 53850 | Prostatic microwave thermotx | 90 | 38.3 | 4.06 | 34.24 | 843.3% | 5.42 | 0.62 | 44.34 | 10.1 | $1,600.23 |
| 58565 | Hysteroscopy sterilization | 90 | 43.4 | 4.72 | 38.68 | 819.5% | 7.12 | 1.13 | 51.65 | 12.97 | $1,864.05 |
| 65785 | Impltj ntrstrml crnl rng seg | 90 | 61.65 | 6.71 | 54.94 | 818.8% | 5.39 | 0.41 | 67.45 | 12.51 | $2,434.27 |
| 53852 | Prostatic rf thermotx | 90 | 36.41 | 4.23 | 32.18 | 760.8% | 5.93 | 0.66 | 43 | 10.82 | $1,551.87 |
| 21125 | Augmentation lower jaw bone | 90 | 69.18 | 8.17 | 61.01 | 746.8% | 10.8 | 0.91 | 80.89 | 19.88 | $2,919.32 |
| 52647 | Laser surgery of prostate | 90 | 33.77 | 6.11 | 27.66 | 452.7% | 11.3 | 1.28 | 46.35 | 18.69 | $1,672.77 |
| 52648 | Laser surgery of prostate | 90 | 34.28 | 6.4 | 27.88 | 435.6% | 12.15 | 1.39 | 47.82 | 19.94 | $1,725.82 |
| 21210 | Face bone graft | 90 | 43.82 | 9.66 | 34.16 | 353.6% | 11.69 | 1.01 | 56.52 | 22.36 | $2,039.81 |
| 30117 | Removal of intranasal lesion | 90 | 22.77 | 5.77 | 17 | 294.6% | 3.26 | 0.44 | 26.47 | 9.47 | $955.30 |
| 21208 | Augmentation of facial bones | 90 | 36.31 | 9.32 | 26.99 | 289.6% | 11.42 | 0.99 | 48.72 | 21.73 | $1,758.30 |
The highest is code 55873: Cryoablate prostate at $6,334.88. Note that in the Medicare PFSRVU database only truncated CPT names are used. That is not the complete name in the CPT manual.
So the question with the specific procedures above is why is the office-based surgery Site of Service Differential so high? Are the risks to the patient or the anesthesia needs minimal enough to warrant their status as office or facility? Numerous factors go into the RVU equation from the specialty societies, experts, the AMA and Medicare analysts.