Trends in Medicare Work Relative Value Unit Payment Rates Across Physician Specialties: 2018-2024

BACKGROUND: Recent Medicare Physician Fee Schedule revisions have sought to narrow perceived compensation differences between medical and surgical specialties, but their effects on work relative value unit (wRVU) payment rates are unknown. We estimated contemporary specialty-level wRVU payment rates and trends from 2018 through 2024. STUDY DESIGN: Repeated cross-sectional analysis of Medicare Part B fee-for-service claims linked CMS Physician Time File, Addendum B, and Physician/Supplier Procedure Summary Master File data at the CPT-specialty-year level across 42 specialties (27 medical, 15 surgical). The primary outcome was annual specialty-level wRVU payment rate (wRVUs/min). Linear regression quantified trajectories. A counterfactual holding service times at 2018 values estimated rates assuming constant service times. RESULTS: The medical-surgical payment-rate gap narrowed from 5.4% in 2018 (0.0405 vs 0.0426 wRVUs/min; P=.051) to 1.6% in 2024 (0.0428 vs 0.0435; P=.26), with convergence concentrated in 2021 and 2023, coinciding with evaluation and management revaluations. Primary care (+1.7%/year; P=.009) and nonsurgical nonprocedural specialties (+1.8%/year; P=.006) increased faster than surgical specialties (+0.4%/year). Under the counterfactual, 2024 rates exceeded actual values by 8.9% for primary care, 6.9% for nonsurgical nonprocedural, 5.0% for nonsurgical procedural, 4.5% for surgical, and 0.1% for facility-based specialties, narrowing the medical-surgical gap to 0.8%. CONCLUSIONS: From 2018 through 2024, the Medicare medical-surgical wRVU payment-rate gap narrowed from 5.4% to 1.6% under current CMS valuation assumptions. These findings suggest the Medicare Physician Fee Schedule may be a limited instrument for narrowing broader specialty compensation differences.