Tag Archives: 2011 Medicare Physician Fee Schedule
CMS Releases 2011 Conversion Factor Rate
Posted on 28. Dec, 2010 by jennifer.godreau.
Despite adjusted rate of 33.9764, overall change is zero.
The President locked in a zero percent adjustment to your Medicare Part B payments but that doesn’t mean you’ve got the same rate.
The Medicare and Medicaid Extenders Act of 2010, which was signed into law on Dec. 15, established a payment update for 2011 of zero percent. To cover the cost of the provision, Medicare had to modify a physical therapy provision that was in the proposed 2011 Medicare Physician Fee Schedule final rule. “In addition, the final rule made other changes to the conversion factor, including a re-weighting of the work, practice expense and liability expense components of the relative value scale that resulted in a reduction in the numerical value of the conversion factor, even though
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Congress Passes 1-Year Medicare Pay Fix
Posted on 09. Dec, 2010 by jennifer.godreau.
You won’t face the same nail-biting payment woes in 2011 as you did this year, thanks to a Senate Finance Committee bill that will freeze Medicare pay at current levels for another 12 months. The House of Representatives passed the Medicare and Medicaid Extenders Act of 2010 today and the Senate voted on it yesterday, so now it goes to President Obama’s desk for his signature. The bill will eliminate the 25 percent cut that medical practices were going to face effective January 1.
Physicians cheered the news that they won’t have to wait for the new Congress and Senate members to take their seats before determining whether a payment fix would take place. “The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year,” said AMA president Cecil B. Wilson, MD, in a statement today. “Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors’ access to physician care in 2011. Many physicians made clear that this year’s roller coaster ride, caused by five delays of this year’s cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat.”
Check out this week’s edition of Part B Insider for more on this story.
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Medicare Assigns G Codes for Medicare Wellness Visits
Posted on 07. Dec, 2010 by jennifer.godreau.
Medicare beneficiaries will be thrilled that Medicare will cover annual well checks.
The Center for Medicare introduces a new benefit of wellness visits for beneficiaries annually, except during the year of their Welcome to Medicare exam. You’ll use two HCPCS level II codes to represent the new annual wellness visits, as follows:
G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit
G0439 – Annual wellness visit; includes a personalized prevention plan of service (PPPS); subsequent visit
Medicare crosswalked the RVUs of 2.43 from new patient office visit code 99204 to G0438, and the RVUs of 1.50 from established patient office visit code 99214 to G0439.
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Congress Boosts Conversion Factor Through Dec. 31
Posted on 30. Nov, 2010 by jennifer.godreau.
Medicare Physician Fee Schedule rate won’t be cut 23 percent.
Although the government appeared poised to take a big bite out of your next Medicare Part B payments, you now have another month before you need to worry about losing pay. That’s because the 23 percent Medicare Physician Fee Schedule conversion factor cut that practices have feared since January was once again kicked to the curb by Congress.
On Nov. 18, the Senate voted to halt the Medicare physician pay cut for one month, and the House returned from Thanksgiving break on Nov. 29, at which point they also voted to freeze Medicare pay through the end of 2010.
Medicare pay is set to drop 25 percent effective Jan. 1, 2011, and the current legislation does not change that.
Stay informed on 2011 payments with weekly updates from Part B Insider by Torrey Kim, CPC, CGSC.
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Peds Win Per Component Vaccine Admin Codes, Lose Requested PE RVUs
Posted on 29. Nov, 2010 by jennifer.godreau.
Pediatricians who were thrilled with CPT 2011′s move to paying vaccines per component got a setback from Medicare’s rejection of the recommended RVUs for new vaccine administration codes 90460 and 90461.
The Relative Update Committe recommended that the 2011 Medicare Physician Fee Schedule and Resource Based Relative Value Scale assign 0.20 practice expense (PE) RVUs to 90460 and 0.16 PE RVUs to 90461. But CMS disagreed with the proposal. “We disagree with the recommendations and will
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Diabetic Foot Ulcer Skin Substitutes Require G Codes in 2011
Posted on 23. Nov, 2010 by jennifer.godreau.
When reporting diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity for a Medicare beneficiary in 2011, you’ll use two temporary G codes.
Providers were concerned about the different global periods for two tissue cultured skin substitutes codes causing financial incentive to use one product over another. “General surgeons, podiatrists, plastic surgeons, and wound care specialists were concerned that Apligraf had a 90 day global period versus Dermagraft, which had a 30 day global period,” explained Marc Hartstein, Deputy Director for the Hospital and Ambulatory Policy Group for the Center for Medicare in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT and RBRVS 2011 Annual Symposium in Chicago on Nov. 10, 2010.
Apligraf (which for 2010 is coded with 15430 or 15431) application involves up to 5 treatments over a 12-week period, where as Dermagraft (CPT 2010 codes 15360, 15361, 15365, and 15366) is applied weekly, up to 8 treatments over 1 12-week period.
During 2011, new codes will be worked on and valued. This will pave the way for
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CMS Slashes Conversion Factor for 2011, Establishes Preventive Visit Codes
Posted on 09. Nov, 2010 by jennifer.godreau.
Get ready for another year of nail-biting to find out if your Medicare payments will be slashed. “The calendar year 2011 Physician Fee Schedule conversion factor is $25.5217,” notes the 2011 Medicare Physician Fee Schedule Final Rule, printed in the Federal Register that will be published on Nov. 29. This amounts to a dismal 30 percent cut compared to the current rate of $36.8729.
Plus: If you perform a procedure that meets CMS’s description of an annual wellness visit, you should not report a code from CMS’s preventive medicine section to your Part B carrier, the Final Rule indicates. CMS does not pay for preventive medicine services billed under 99381-99397. Instead, report one of the following newly-established HCPCS codes:
- G0438 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit
- G0439 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit.
Get this: Some specialties will be facing cuts of up to 14 percent next year on top of the fee schedule cuts mentioned above. For the full story on the Fee Schedule changes and an analysis of how it affects the various specialites, check out Part B Insider.
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