Increasing Financial Performance of PHM Programs Through Appropriate Critical Care Billing

• DOI: 10.1542/hpeds.2024-008385
• Publication Date: 2025-04-23T01:00:20Z
• Authors: Paul Scalici; Erin E. Shaughnessy

INTRODUCTION Children meeting Centers for Medicare and Medicaid Services (CMS) criteria critical care billing are often cared by pediatric hospital medicine teams outside the intensive unit (ICU). Current CMS guidance allows of codes an ICU. These have substantially higher relative value units (RVU) attached to them reimburse at rates than usual evaluation management codes. Several efforts optimize use has been described in emergency literature, though few with hospitalists.