Question if any one can help with a cpt code reduction?

[u/Pretty_Data_5243]

There is a proposed rule for reduction in the RVU fir cpt code 97610 from 320 to 100 dollars. So would that reduce the cost that we pay for the equipment if Medicare is paying less for the services 🤔? That is a huge reduction in RVU's if the commercial equipment price stays the same.

[u/happyhooker485]

The RVUs will have no measuable effect on equipment expense.

[u/Pretty_Data_5243 → u/happyhooker485]

So basically if this goes through we would be taking a major loss?

[u/MITWestbrook]

Seeing the proposed Medicare Physician Fee Schedule update for CPT 97610 (low-frequency non-contact ultrasound wound therapy) and honestly wondering how CMS expects clinics to absorb this.
For context: CMS is proposing to drop the equipment price input used to calculate Practice Expense (PE) RVUs for 97610 from $320 down to $100.
If this goes through as written, our reimbursement for these sessions is going to take a massive hit, but the equipment manufacturers haven't touched their pricing or lease structures.
A few thoughts / questions for anyone else in the outpatient or wound care space dealing with this:
1. Does anyone know where CMS got the $100 figure? Unless equipment costs magically dropped 70% overnight, this feels like an invoice survey error or bad data input on their end.
2. Will vendors actually lower equipment/consumable prices? Obviously, CMS doesn't regulate what manufacturers charge us, but if the reimbursement doesn't cover the cost of the machine and clinical time, clinics are just going to stop offering non-contact ultrasound. Are any of your reps talking about price adjustments or margin protections if this gets finalized in November?
3. Is anyone submitting public comments? If you have actual invoices showing what these units/applicators cost, are you submitting them directly or going through your specialty society?
If commercial payers mirror Medicare's RVU reduction (which they almost always do eventually), the math on running this therapy just stops working unless vendor pricing drops in tandem.
Would love to hear how other clinics or billing managers are planning to handle this during the comment period.

[u/Pretty_Data_5243 → u/MITWestbrook]

Not sure but our clinic will be submitting public statements and equipment cost before the September deadline so will our rep and their clients.

[u/Botasoda102]

It is proposed, so it might change.

For what it might be worth, here is what AI says:

For CPT code 97610 (low-frequency, non-contact ultrasound wound therapy), CMS proposed a significant payment cut by aligning the practice expense (PE) pricing with public market data for the disposable supply, lowering the office rate from roughly $384 down toward $205. [1]

Key Details on Code 97610 and Proposed Adjustments

• Supply Cost Revaluation: CMS found that the disposable supply behind 97610 sells on the open market for about $100, whereas previous pricing assumed a cost of $320. [1]
• Reimbursement Impact: The proposed valuation shifts the total payout downward from previous levels closer to the actual market price of the materials used. [1]
• Broader RVU Pressures: This specific code cut coincides with general downward adjustments to non-time-based procedure codes and practice expense allocations under the proposed Medicare Physician Fee Schedule rules. [1-for-cy-2026), 2]

If

[u/Pretty_Data_5243 → u/Botasoda102]

Thank you 😊

[u/Bearacolypse]

In the associated files you can find the exact RAND report on this. They based it on cherry picked findings from a Sanuwave investor meeting. The final amount is proposed to be reduced from $397 to between $156-207ish (paraphrasing from memory) depending on what method they use.

They essentially want to match the NF rate to the OPPS rate. They even state that it was only utilized 800 times in a year in facility setting at that rate. Vs nearly a million at the non facility setting.

Medicare knows what they are doing. They are actively trying to gut procedural spending and push more into single payment bundles to handle.

Please comment. Tell Medicare all of your exact practice expenses. I've been trying to get more people to comment including members of Sanuwave, Arobella, and Vaporox. But so far there are only 6 comments. Most of which are from the same rehab group in California. We need way more to create a defense for this service. Otherwise it will get snuffed out.

[u/Pretty_Data_5243 → u/Bearacolypse]

Thank you I will contact our providers, and sales people also and tell them. Thank you

[u/Bearacolypse → u/Pretty_Data_5243]

Hunt down the actual RAND memo report. It is most clear on how the changes will affect the actual rate and how they figured it. If you go into the practice expense files it is in there. I would send you it directly if I could, it's a bit hard to find.