Many Medicare Physician Fee Schedule times for surgical procedures are longer than the times typically observed in the real world. In this research, authors used two independent sources of data — operative times from the American College of Surgeons National Surgical Quality Improvement Program and operative times estimated from billed Medicare anesthesia times — to assess how times compare and whether there is agreement between the two data sources.

Surgical Procedure Time Comparisons

Comparing Physician Fee Schedule Intraservice Times with Real-World Times as Observed in National Surgical Quality Improvement Program Intraoperative Times and Anesthesia Claims

Rachel O. Reid, Anthony Yu, Peter S. Hussey, Joachim O. Hero, Cameron Klig, Daniel J. Crespin, Gretchen Swabe, Lane F. Burgette

ResearchPublished Sep 24, 2025

In the Medicare Physician Fee Schedule (PFS), the amount of time a physician service typically requires is a key input that the Centers for Medicare and Medicaid Services uses to set payment rates. In the past two decades, several studies have shown that many PFS times for surgical procedures are longer than the times typically observed in the real world. In this research, the authors used two independent sources of data — operative times from the American College of Surgeons National Surgical Quality Improvement Program and operative times estimated based on billed Medicare anesthesia times — to assess how PFS times compare and whether there is agreement between the two data sources.

Key Findings

  • Many PFS intraservice times differ substantially from typical surgical procedure times and can be measured in real-world data.
  • National Surgical Quality Improvement Program directly observed operative times generally agree with anesthesia-based claims analyses that estimate, rather than directly observe, procedure times.
  • Overall, the evidence points toward PFS times being too long on average.

Recommendations

  • Consider a transition toward time estimates based on real-world data rather than on responses to physician surveys.
  • Address the net effect on Medicare payments if real-world estimates of physician time were used in place of the current times used in the PFS, under scenarios that update work relative value units based on changes to time estimates and account for the impact that different intraservice times could have on practice expense relative value units.

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Document Details

Citation

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Reid, Rachel O., Anthony Yu, Peter S. Hussey, Joachim O. Hero, Cameron Klig, Daniel J. Crespin, Gretchen Swabe, and Lane F. Burgette, Surgical Procedure Time Comparisons: Comparing Physician Fee Schedule Intraservice Times with Real-World Times as Observed in National Surgical Quality Improvement Program Intraoperative Times and Anesthesia Claims. Santa Monica, CA: RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA3470-1.html.
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This research was funded by the Centers for Medicare and Medicaid Services and carried out within the Payment, Cost, and Coverage Program in RAND Health Care.

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