Physician Fee Schedule Promises Significant Reimbursement Changes in the Coming Year

by Julie E. Kass and Mark A. Stanley, Ober Kaler, www.ober.com

CMS has released its Calendar Year (CY) 2010 Final Rule with Comment Period for practitioners who are paid under the Physician Fee Schedule (PFS). Some specialists can expect to see a substantial drop in Medicare payment rates under changes made in the final rule. The rule may be viewed here [PDF].

Among other changes, the rule:

• Eliminates billing codes for consultation services except for telehealth services;
• Ties reimbursement under the PFS to the Physician Practice Information Survey (PPIS);
• Establishes a system for accreditation with respect to suppliers of the technical component (TC) of advanced diagnostic imaging services;
• Clarifies the definition for "stand in the shoes" under the physician self-referral rules;
• Revises the utilization estimates for certain high cost, non-therapeutic equipment; and
• Solicits comments regarding whether CMS should define the meaning of "performed the DHS" in the context of the self-referral rules, and which factors to consider if it adopts such a definition.

Elimination of Consultation Codes

Consultation codes are used for evaluation and management services that are provided by physicians, based on a request by another physician or appropriate source. The final rule eliminates consultation codes in the context of everything but initial visits for telehealth services. Any other services that are currently billed using consultation codes must now be billed as new or established office visits, initial hospital visits, or initial nursing facility visits. CMS will increase the relative value units (RVUs) associated with new and established office visits, and with initial facility visits for hospitals and nursing homes in order to offset the reimbursement effect of eliminating consultation codes. Physicians may notice that, while the proposed rule anticipated a 2% increase in RVUs for hospital and nursing facility visits, the final rule provides for only a 0.3% increase. The final rule offers no explanation for this significant discrepancy, but a CMS representative responded to an inquiry on the subject by indicating that a correction notice will be forthcoming "that will look more like" the proposed rule. Click to continue...