Reimbursement for ultrasound-guided procedures in a private practice group?

[PMRBro]

I've had an position offered to me to function purely as a proceduralist performing ultrasound-guided injections. The procedure referrals would come from a large internal referral system in a physician-owned private practice.

I'm looking for information from others on what this type of set-up could look like from an insurance reimbursement/financial standpoint? Where/how is the best way to determine this if I know the type and total number of procedures I would be doing?

---

Members don't see this ad.

 

[Iamnew2]

I've had an position offered to me to function purely as a proceduralist performing ultrasound-guided injections. The procedure referrals would come from a large internal referral system in a physician-owned private practice.

I'm looking for information from others on what this type of set-up could look like from an insurance reimbursement/financial standpoint? Where/how is the best way to determine this if I know the type and total number of procedures I would be doing?

Sketchy. US in general does not reimburse much. It seems that the expectation is that you would build up this US clinic, with no base salary but rather eat what you kill? I wouldn't take a job like that. There would need to be a solid base as you build up volume, and some time to determine whether the volume is reasonable or not to make a reasonable living.

 

[Dr. Ice]

Regen + ultrasound could be solid. Totally depends on your patient demographics. Stand alone ultrasound injections for glut med, rtc, Achilles, major joints won’t pay the bills. Don’t be a cowboy and try to do spine injections with US.

 

[PMRBro]

Sketchy. US in general does not reimburse much. It seems that the expectation is that you would build up this US clinic, with no base salary but rather eat what you kill? I wouldn't take a job like that. There would need to be a solid base as you build up volume, and some time to determine whether the volume is reasonable or not to make a reasonable living.

The practice volume is already there - no need to build the clinic up, 15 - 20 injections per day. I have access to fluoro with the position which obviously reimburses more, but I'm interested in learning more from those with ultrasound-guided injection reimbursement. You're correct about the eat what you kill model. I have a separate practice from this.

 

[PMRBro]

Regen + ultrasound could be solid. Totally depends on your patient demographics. Stand alone ultrasound injections for glut med, rtc, Achilles, major joints won’t pay the bills. Don’t be a cowboy and try to do spine injections with US.

Can you expand on what you mean by "could be solid" and pending patient demographics?

 

[Iamnew2]

The practice volume is already there - no need to build the clinic up, 15 - 20 injections per day. I have access to fluoro with the position which obviously reimburses more, but I'm interested in learning more from those with ultrasound-guided injection reimbursement. You're correct about the eat what you kill model. I have a separate practice from this.

Ok if you have a separate practice from this then that's a different story. What the other poster means in terms of patient demographics is that certain things like regen med are not favorable for all demographics. For example where I practice most people wouldn't be able to afford those kinds of procedures so it would fail. if you practice in a more affluent area where people have lots of disposable cash then practice will be successful. The regen practices in Colorado for example do very well, I believe standard price is about $5k per procedure.

 

[PMRBro]

Ok if you have a separate practice from this then that's a different story. What the other poster means in terms of patient demographics is that certain things like regen med are not favorable for all demographics. For example where I practice most people wouldn't be able to afford those kinds of procedures so it would fail. if you practice in a more affluent area where people have lots of disposable cash then practice will be successful. The regen practices in Colorado for example do very well, I believe standard price is about $5k per procedure.

Yea there is regen medicine opportunities. What about typical US-guided peripheral joints though?

 

[Iamnew2]

Yea there is regen medicine opportunities. What about typical US-guided peripheral joints though?

The US part doesn't pay enough - I am not sure what the exact charges are, but I know US reimbursement has been cut significantly. I'm sure there is a fee list somewhere floating around. sorry I can't be of more help.

 

[timisdaman]

Injections are fun but I believe they are a net loss $$$ compared to just regular clinic visits.

 

[Bostonspine]

Injections are fun but I believe they are a net loss $$$ compared to just regular clinic visits.

So an ultrasound guide hip pays less that a 99213-4, btw 15-20 use injects are usually done in a half day. My understanding is less than outpatient Fluro spine stuff, more than Asc or hospital spine, more than clinic time.

 

[j4pac]

What if your payment model? Collections? RVUs? SALARY?

Also, what is the patient population? GOV insurances, affluent population? Will you have a patient population willing and capable to pay cash? Are you a generalist? Or SM/Pain?

 

[PMR2008]

U/S pays decent. I would recommend that you evaluate the patients your self versus be a needle jockey

Average rates /2022
Office new 99204 - 172
office follow up 99214 - 132
complete ultrasound exam 76881 - 68. limited is 57
20611 - Major joint with u/s 110
20606 - intermediate joint with u/s 90
20604 - small joint with u/s 80
20550-51 (tendon) + 76942 (guidance) = 58+59 = 117
20526 (Carpal tunnel) + 76942 = 83+59 = 142
64405 (Occipital nerve block) + 76942 = 77+59 = 136
64450 (other nerves) + 76942 = 81 + 59 = 140
76942 - guidance - 59

https://asipp.org/wp-content/uploads/Table-1.-2022-Physician-Proposed-Payment-Rates.pdf

https://assets.website-files.com/5a0cbe08f1138d000147a9d4/60995033bcba10f0a93783eb_2021-05_MSK%20Campaign_Reimbursement%20Guide.pdf

If doing nothing but injections you can do a u/s guided knee in 10-15 minutes. 4 an hour = 440
if doing 1 an hour than obviously not worth it.
In my practice I do the initial eval, decide if a patient needs a procedure and do the injection during the follow up. I also discuss with patient the pro/cons of regen med. Some decide to start with viscosupplementation and than might consider PRP/Stem cell. You do what is the best for the patient. My clinic is low overhead and "low volume". About 15 a day. Do what's best for the patient. The income will follow.

 

[Dr. Ice]

Regen is currently all over the map. IMHO if you are charging 5k for PRP/stem cell, you either don’t really believe in it or you are Greg lutz..lutz has the luxury of either believing in it or faning belief in it because he treats upper east side Manhattanites with money coming out their dinguses.

If you are gonna be an all ultrasound doc..you really better be extremely proficient at it if you wanna make a decent living. The fact is that the ultrasound code was crushed a few years ago. If you are proficient at scanning the anatomy, however, and can prove your worth, and can add regen at “reasonable” prices, you will do ok.

Doing ultrasound visco and cs shots will only get you so far. To make that work, you will need to be really high volume.

Much of this also depends on geography. If you plan to work in north or South Dakota and be the only game in town..well..you probably don’t even need an ultrasound machine. I’m a northeast guy, so my views are skewed. Seriously though, the coasts are saturated, Texas is getting saturated, middle of the country probably still a good option for what you wanna do.

 

[Iamnew2]

Regen is currently all over the map. IMHO if you are charging 5k for PRP/stem cell, you either don’t really believe in it or you are Greg lutz..lutz has the luxury of either believing in it or faning belief in it because he treats upper east side Manhattanites with money coming out their dinguses.

If you are gonna be an all ultrasound doc..you really better be extremely proficient at it if you wanna make a decent living. The fact is that the ultrasound code was crushed a few years ago. If you are proficient at scanning the anatomy, however, and can prove your worth, and can add regen at “reasonable” prices, you will do ok.

Doing ultrasound visco and cs shots will only get you so far. To make that work, you will need to be really high volume.

Much of this also depends on geography. If you plan to work in north or South Dakota and be the only game in town..well..you probably don’t even need an ultrasound machine. I’m a northeast guy, so my views are skewed. Seriously though, the coasts are saturated, Texas is getting saturated, middle of the country probably still a good option for what you wanna do.

Texas particularly Austin and Houston are super saturated. The 5k figure is something I mentioned that happens in Colorado - when I went to the Colorado Orthobiologics conference apparently that’s what they were charging if I remember correctly. I know other doctors that charge between $500 to $2500. As you mention though it’s very geography related - in my neck of the woods for example I’m one of the few pain and or PM&R docs in the area but demographically speaking while I would have plenty of volume I would likely starve if I were to do regen - the economics of the area simply don’t support it since it’s mostly cash based. It works in certain markets as you point out though.

 

[PMRBro]

btw 15-20 use injects are usually done in a half day. My understanding is less than outpatient Fluro spine stuff, more than Asc or hospital spine, more than clinic time.

Yea the procedures would be done in a half day of clinic throughout the week - separate from my own practice.

What if your payment model? Collections? RVUs? SALARY?

Also, what is the patient population? GOV insurances, affluent population? Will you have a patient population willing and capable to pay cash? Are you a generalist? Or SM/Pain?

That's what I'm waiting to hear. I think percentage of collections will be most likely/eat what you kill. What would you all expect to be reasonable % of collections if it was done this way? Alternatively, what would you argue for the best structure of reimbursement be?

The patient population is average to above average income, the practice has the lions share of the community/no competition, the practice is very well respected in the area. I'm generalist.

Average rates /2022
Office new 99204 - 172
office follow up 99214 - 132
complete ultrasound exam 76881 - 68. limited is 57
20611 - Major joint with u/s 110
20606 - intermediate joint with u/s 90
20604 - small joint with u/s 80
20550-51 (tendon) + 76942 (guidance) = 58+59 = 117
20526 (Carpal tunnel) + 76942 = 83+59 = 142
64405 (Occipital nerve block) + 76942 = 77+59 = 136
64450 (other nerves) + 76942 = 81 + 59 = 140
76942 - guidance - 59
https://asipp.org/wp-content/uploads/Table-1.-2022-Physician-Proposed-Payment-Rates.pdf
https://assets.website-files.com/5a0cbe08f1138d000147a9d4/60995033bcba10f0a93783eb_2021-05_MSK Campaign_Reimbursement Guide.pdf

If doing nothing but injections you can do a u/s guided knee in 10-15 minutes. 4 an hour = 440
if doing 1 an hour than obviously not worth it.

Thank you for the information! The procedures will be done every 10-15 minutes - it's an efficient practice.

I would recommend that you evaluate the patients your self versus be a needle jockey

I have thought about this, but have questions on this as well. Apart from just seeing initial clinic patients myself, what would be the best way to have this set-up from a practice standpoint? For basic example, say a patient has been seen by the orthopod initially, had XR completed, determined to have some hip OA so referred to me for US-guided hip injection. Apart from doing the procedure, what other changes to the practice model would you recommend to increase my reimbursement?

Much of this also depends on geography. If you plan to work in north or South Dakota and be the only game in town..well..you probably don’t even need an ultrasound machine. I’m a northeast guy, so my views are skewed. Seriously though, the coasts are saturated, Texas is getting saturated, middle of the country probably still a good option for what you wanna do.

It is located in a very non-saturated market, the practice has the monopoly of area. I forgot to mention, it is a orthopedics practice that has large internal referral system. Thanks for the insight everyone.

 

[PMR2008]

I have thought about this, but have questions on this as well. Apart from just seeing initial clinic patients myself, what would be the best way to have this set-up from a practice standpoint? For basic example, say a patient has been seen by the orthopod initially, had XR completed, determined to have some hip OA so referred to me for US-guided hip injection. Apart from doing the procedure, what other changes to the practice model would you recommend to increase my reimbursement?

DME/bracing and other joints that are causing pain (setup follow ups). I am not sure why an ortho would send you patients for injections. Typically in my area they just hire a PA who does the injections and keep the profit (unless you are employed by the group).

 

[runfastnow]

Echo a lot of the above - be wary of getting into a job that is 100% internal referrals just for injections with no other room for expansion (i.e. being told that no new outside referrals will come to you, no marketing about your arrival to PCPs, etc.).

If the practice is busy enough to refer 15+/day consideration for injection referrals to you (that way you can bill for office visit + injection) then you could be ok. But if you are sent patients solely for injection you are not supposed to bill office visit unless discuss other issues beyond the injection - which you could, but could slow you down significantly.

If the practice didn't care if you absorbed some of these patients as your own after injection then it would not be a bad way to start out and build up from there. I did similar when I came out of fellowship with spine patients (my practice never had spine/PMR person) and have built into a 60/40 spine/sports practice that is fairly well oiled machine between internal and external referrals for various US, fluoro, EMG, and random PMR stuff.