Abstract
In January 2021, the Centers for Medicare and Medicaid Services (CMS) implemented changes that increased work relative-value units (wRVUs) for outpatient evaluation and management (E/M) services, potentially benefiting cognitive specialties such as pediatric dermatology. This cross-sectional study analyzed 230,524 dermatology outpatient encounters across pediatric, general adult, and micrographic surgery and dermatologic oncology (MSDO) providers at a large academic health system in 2019 and 2021 to assess the impact of these changes. We found that mean wRVUs per encounter increased in pediatric and adult dermatology and decreased for micrographic surgery after the CMS revision (pediatric: 1.3-1.9, p < 0.01; adult: 1.8-2.2, p < 0.01; MSDO: 12.9-12.6, p = 0.048). Both pediatric and adult dermatologists shifted toward billing higher-level E/M codes after the 2021 reforms. These findings suggest that the 2021 CMS reforms modestly narrowed, but did not eliminate-longstanding reimbursement disparities between cognitive and procedural dermatology practices.