So the rationale for reducing the wRVUs on cone beam review to 0.7 from 0.85 with the switch from 77014 to 77387 is that you will also bill this code for kV review instead of G6002, which had a wRVU value of 0.39. So while you will be getting paid less for cone beam review, you will be getting paid more for kV review. From the ASTRO and ACRO discussion on youtube, it is claimed that this weight of 0.7 (which medicare is already proposing to reduce to 0.68 with the 2.5% cut to all pro codes, which is insane since it is a new code) represents the average weight of CBCT vs. kV use in the typical practice.
I just ran my most recent numbers. I was 91% CBCT and 9% kV (I don't treat a lot of breast and a lot of lung, prostate and H&N). If I were to use the new code at the new valuation, this would result in an 13.4% decrease in wRVUs. In other words, the proper valuation of 77387 should be 0.81, not 0.7, and definitely not 0.68. To get a value of 0.7, you would need a CBCT/kV ratio of 67% to 33%. Curious if anyone besides a breast subspecialist is actually anywhere close to this? Whoever advocated for this ratio on our behalf really screwed us.