Gender bias alleged in CPT reimbursement codes. (Study of CPT-4 Codes for 2001).

SAN FRANCISCO -- An analysis of codes in the federal system used to calculate physician reimbursements revealed a persistent bias favoring higher payments for physicians who treat men, Dr. Geoffrey W. Cundiff said.

Like results from similar studies in 1993 and 1997, the current data suggest that the Medicare Resource-Based Relative Value Scale Fee Schedule is unfair to physicians who take care of women, he said at the annual meeting of the American Urogynecologic Society.

Implemented by Congress in 1992 to ensure that limited annual appropriations get shared equally among physicians who accept Medicare patients, the schedule has been adopted by many third-party payers in the intervening years, noted Dr. Cundiff of Johns Hopkins University in Baltimore.

The system is based on Current Procedural Terminology codes, which catalog all billable. interactions between physicians and patients. A Relative Value Unit (RVU) assigned to each CPT code quantifies a physician's expenses for that code in relation to all other CPT codes.

Each CPT code RVU is the sum of RVUs assigned to three components: the physician's work expense, including time, training, level of skills, and stress involved; practice expense, which differs by setting; and malpractice insurance premium expense.

The schedule calculates a CPT code's reimbursement rate for any given year by multiplying the sum of the three component RVUs, or total RVU, by a geographic index and the reimbursement rate for that year.

Dr. Cundiff and his associates stratified the CPT-4 codes for 2001 into three groups: female-specific surgical procedures, male-specific procedures, and non-gender-specific procedures.